California Oncology Weekly
"Where California Oncologists Go For Answers!"
A collaborative publication of the
Medical Oncology Association of Southern California, Inc.
and the
Association of Northern California Oncologists, Inc.
February 20, 2018
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- DMHC proposed regulations for payors' average contracted rate.(California News)
- Harnessing the Power of Immunotherapy, March 3, Huntington Beach (MOASC News)
- What's New with Physician Compare webinar TOMORROW & Thursday(CMS News)
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California News
- The California Department of Managed Health Care (DMHC) has issued proposed regulations for calculating payors' "average contracted rate" under California's new out-of-network billing and payment law. The law (AB 72), which took effect July 1, 2017, requires fully insured commercial payors to make "interim payments" to non-contracted physicians for covered, non-emergent services performed at in-network health facilities. The interim rate is the greater of 125 percent of Medicare or the plan/insurer's average contracted rate (ACR).
Under the new law, the Department of Managed Health Care (DMHC) and the California Department of Insurance (CDI) are each required to specify a methodology to determine the ACR by January 1, 2019. CDI is also expected to issue its proposed ACR methodology very soon. If your practice has received incorrect payments or denied claims related to the new law, CMA wants to hear from you. Practices can contact CMA at (888) 401-5911 or economicservices@cmanet.org. To learn more about this law, find out if payors are reimbursing you correctly and learn how to dispute the interim rate, visit CMA's AB 72 Resource Center.
- California Public Protection & Physician Health Inc. (CPPPH) is offering a series of free informational workshops about the Medical Board of California's new Physician Health and Wellness Program. The workshops will discuss: how the new program will work, when it will be available to physicians, and what role medical group and medical staff well-being committees will play. CPPPH, together with the California Society of Addiction Medicine and California Medical Association (CMA), are encouraging all wellbeing committees and medical staff leaders to attend one of these workshop sessions so they can consider how they may use this new resource when it becomes available.
Southern California sessions will be March 3, 2018, at the San Diego County Medical Society and March 24, 2018, at LAC-USC Medical Center. Northern California dates will be added soon. These special sessions are FREE, but advance registration is required.
- The California Nurses Association and the Service Employees International Union endorsed Senate President Pro tem, Kevin de Leon for US Senate over incumbent Sen. Diane Feinstein. In their endorsements, CAN praised de Leon's advocacy on SB 562 regarding Single Payer, while the SEIU focused on his work championing the state's $15 minimum wage legislation and his work on immigration. These endorsements proceed the California Democratic Convention, which is set for next weekend in San Diego.
- The CMA is seeking nominations for physicians to serve as at-large delegates and alternates to the American Medical Association (AMA) House of Delegates. Current delegates who are eligible for reappointment must submit an application for the 2018 term. They will not be reappointed if a form is not submitted. The CMA is seeking physicians who are active CMA members and able to serve as delegates or alternates twice a year during the annual (June) and interim (November) meetings of the AMA House of Delegates for a two-year term beginning January 1, 2018. Service on the delegation entails both a commitment of time and a commitment to advocate for CMA's interests, as well as a willingness to meet the basic responsibilities of the role set forth by AMA in its "Delegate Role and Responsibilities."
Please submit nominations to nominations@cmanet.org. Please indicate that the nomination is for the California Delegation to the AMA in the subject line. Every nomination must include a Completed nomination form and a brief CV (less than five pages).
Nominations must be submitted no later than 11:59 p.m. on Friday, February 23, 2018.
The CMA Committee on Nominations will present its recommendations to the CMA Board of Trustees at its meeting on April 27, 2018, and appointments will be announced shortly thereafter. Contact: Brandon Marchy, (916) 551-2062 or bmarchy@cmanet.org.
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* MLN Connects
Announcements--MIPS Reporting Deadlines Fast Approaching: 10 Things to Do and Know; Quality Payment Program: Performance Scores for 2017 Claims Data; EHR Incentive Program: Accepting Proposals for New Measures by June 29
Claims, Prices & Codes--
January 2018 OPPS Pricer File
Events
--2018 QCDR Measures Workgroup Webinar-February 27; MIPS Quality Data Submission Webinar-February 28; Open Payments: The Program and Your Role Call-March 14; MIPS Attestation for Advancing Care Information and Improvement Activities Webinar-March 14
Publications
--PECOS FAQ Booklet-Revised; PECOS Technical Assistance Contact Information Fact sheet-Revised; Medicare Secondary Payer Booklet-Reminder.
* Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment-Quarterly Update CR10445
* HCPCS Drug/Biological Code Changes-April 2018 Update CR10454
* Additional Information Required for Coverage and Pricing for Category III CPT Codes Article-R2
* Non-Covered Services LCD-R20
* Mammography HCPCS Codes, Waiver of Coinsurance and Deductible for Preventive and Other Services, and Addition of Anesthesia and Prolonged Preventive Services-Revised CR10181
* Therapy Claims with KX Modifier-Update
* HCPCS Codes Subject to and Excluded from CLIA Edits-Revised-CR10446
- Upcoming Noridian/JEMAC webinars include:
* Reopenings Webinar (February 21)
* Understanding National and Local Coverage Determinations Webinar (February 22)
* Basic Non-Covered Services Webinar (February 28)
* Preventive Services and Screenings Webinar (March 7)
* Modifier 59, NCCI and MUE Webinar (March 22)
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- You are cordially invited to MOASC's 3rd Annual Oncology Summit®, Harnessing the Power of Immunotherapy. March 3, 2018 at the Waterfront Hilton, Huntington Beach. Topics & speakers: *Head and Neck Ezra Cohen, MD, UCSD *Colon Cancer Marvan Fakih, MD, COH *Lung Cancer Karen Reckamp, MD, COH *Breast Cancer Sara Hurvitz, MD, UCLA *Melanoma Omid Hamid, MD, The Angeles Clinic & Research Institute. Register at
moasc@moasc.org.
- Once you are registered for the MOASC Oncology Summit®, you are invited to participate in the Biocept Advisory Board Meeting, Saturday, March 3, 2018, 2pm - 5pm, immediately following the MOASC Oncology Summit®. Topic: Liquid Biopsies: The Future is Now. Register early as there is limited seating for the advisory board. Honorarium is provided. The purpose of the ad board is to:
1. Compare the relative strengths and limitations of liquid biopsy against those of conventional tissue biopsies;
2. Discuss current and emerging testing technologies with respect to sensitivity, specificity, and clinical applications for patients with cancer;
3. Evaluate clinical evidence pertaining to specific testing modalities that may help to individualize treatment protocols for patients with cancer;
4. Discuss which cancer types are best suited for liquid biopsy testing;
5. Discuss the clinical value of plasma testing be used be used in conjunction with tissue testing;
6. Discuss the value of doing targeted marker liquid biopsy testing vs. large panels for liquid biopsies.
- City of Hope presents a dual track of "How the Experts Treat Hematologic Malignancies,"
March 14-17,
2018 in Las Vegas.
OBJECTIVES:
Provide an update of new molecular & immunological treatments being developed for these diseases.
Discuss the rationale for new targeted diagnostic therapeutic strategies for lymphoma, myeloma and leukemia
Summarize the evolving therapeutic strategies in the treatment of hematologic malignancies
Review the role and timing of hematologic cell transplant in the management of younger and older patients
Integrate best practices for prevention, detection and management of side effects related to current therapies.
- MOASC Member, UC Irvine, presents their 3rd Annual UCI Hematology Symposium on Saturday, April 21, 2018. The program will feature regional and national experts bringing you state-of-the-art updates on sickle cell disease, modern anticoagulants, CAR-T Cell therapy, and others. New this year, we will feature a Case Conference segment with individual case presentations and interactive discussions. We hope to see you at the 3rd Annual UCI Health Hematology Symposium.
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- The 18th Multidisciplinary Management of Cancers: A Case-based Approach returns to the Silverado Resort and Spa in Napa on March 16-18, 2018. The meeting is sponsored by the Association of Northern California Oncologists, Stanford Cancer Institute, UC Davis Comprehensive Cancer Center, and UCSF Helen Diller Family Comprehensive Cancer Center. Go to www.multicancers.org for more information, to register, and arrange for housing.
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- The deadline is now March 2, 2018 for reporting offers of health coverage made during the 2017 calendar year. The Internal Revenue Service (IRS) issued an extension of the due date. Previously, insurers and employers had until January 31, 2018, to provide individuals with either Form 1095-B, Health Coverage, or Form 1095-C, Employer-Provided Health Insurance Offer and Coverage. Click to continue »
- As anticipated, the President's 2019 budget includes changes to the 340B program. Specifically, the budget notes that it will propose to modify payments for Part B drugs purchased through the 340B program to reward "hospitals that provide charity care and reducing payments to hospitals that provide little to no charity care." We anticipate to see more details of the proposal when the HHS budget in brief is released, but we have heard that this will be implemented through an additional HOPPS change later this year. A high level discussion of the proposal is on page 22 of the budget. Trump 2019 Budget Proposal
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CMS News
- You still have time to register for the "What's New with Physician Compare" webinars.
The Centers for Medicare & Medicaid Services (CMS) will be hosting two 90-minute
Physician Comparewebinars to talk about the recent Physician Quality Reporting System (PQRS) and non-PQRS PY 2016 measures release on Physician Compare. Learn about star ratings and what Quality Payment Program information is in the pipeline for potential inclusion on Physician Compare in late 2018.
Specifically, the webinars will cover:
PY 2016 Performance information added in December 2017 measures release
Physician Compare star ratings
Upcoming additions to Physician Compare
Two different times are offered to accommodate your busy schedule. Both webinars will present the same information. During each webinar, you will have an opportunity to ask questions.
Webinars will be conducted via WebEx at the following times:
- The Center for Connected Health Policy (CCHP) recently released two updated resource fact sheets:
Telehealth Policy Barriers
and
Telehealth Reimbursement
.
The fact sheets provide comprehensive summaries of telehealth policy barriers and an examination of the reimbursement policies of Medicare, Medicaid, and private payers. The new fact sheets include updates regarding the Center for Medicare and Medicaid Service's (CMS) chronic care management (CCM) code. CMS has released instructional documents, added reimbursement for complex CCM, and unveiled new codes. Also briefly discussed is the practice of health plans incorporating telehealth to meet network adequacy standards. The updated reimbursement factsheet features recent changes as a result of the passage of the
Bipartisan Budget Act of 2018
,
which brings changes to Medicare reimbursement and coverage for telehealth services. To read the updated fact sheets and learn more about current telehealth reimbursement policy and policy barriers, visit the
CCHP's fact sheets page
.
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Affiliate Association News
- ASCO is inviting all practices to participate in the annual Survey of Oncology Practice Operations, which looks at the current state of business and operational issues in oncology. Take the survey by February 23 by clicking
HERE.
- "The theme of the
2018 Community Oncology Conference
-Keeping Patients at the Center, April 12 -13, 2018
at the Gaylord National Harbor Hotel -reflects the critical mission that justifies our existence in the field of community oncology. All of our advancements in technology, in science, and even policy, are for the patients we serve." Lucio N. Gordan, MD. The 2018 Community Oncology Conference agenda and faculty list are online. Check them out to see all the great speakers and sessions! Check out the full Conference agenda at conference.communityoncology.org/2018-conference-agenda/
The discounted Community Oncology Conference room block is selling out fast. Be sure to register and reserve your room today. Join more than 1,300 oncologists/hematologists, pharmacists, practice administrators, nurses, advocates, payers, and industry partners for two days of learning and networking. Visit
www.COAConference.org
for details.
- Registration for ASCO's QOPI Round 1 opens on February 20 and will close on June 1.
- ASCO has published statement on Biosimilars in Oncology in the Journal of Clinical Oncology. The statement examines a range of issues to help ASCO members better understand the impact of biosimilars on oncology care. Read the statement at
http://ascopubs.org/doi/full/10.1200/JCO.2017.77.4893
.
- NCCN has published updates to the below. For the complete updated versions, please visit
NCCN.org
. Recent updates include: acute lymphoblastic leukemia (V5.2017), B-cell lymphomas (V1.2018), bladder cancer (V2.2018), breast cancer (V4.2017),
cervical cancer version 1.2018,
chronic lymphocytic leukemia/small lymphocytic lymphoma (V3.2018), head and neck cancers (V1.2018), hepatobiliary cancers (V1.2018), kidney cancer (V3.2018), malignant pleural mesothelioma (V1.2018), melanoma (V2.2018), multiple myeloma (V4.2018),
uterine neoplasms version 1.2018
,
vulvar Cancer version 1.2018.
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- AstraZeneca informs ANCO and MOASC that the United States Food and Drug Administration has approved Imfinzi for the treatment of patients with stage III non-small cell lung cancer (NSCLC) whose tumors are not able to be surgically removed (unresectable) and whose cancer has not progressed after treatment with chemotherapy and radiation (chemoradiation). Imfinzi FDA Approval.
- AstraZeneca will host a dinner program entitled Head to Head Progression-Free Survival Data for Patients who have progressed after EGFR TKI Therapy with Hatim Husain, M.D., Moores Cancer Center, University of California, San Diego, on March 17 at Morimoto Restaurant in Napa. RSVP to Jason Yonehiro, (415) 205-3699 or jason.yonehiro@astrazeneca.com.
- Janssen Oncology informs ANCO and MOASC that the United States Food and Drug Administration has approved Erleada for patients with non-metastatic castration-resistant prostate cancer (NM-CRPC). Read the Press Release HERE.
- Oncology data company Flatiron Health has agreed to be acquired by drugmaker Roche for $1.9 billion. The landmark deal
is part of a push to expedite its development and delivery of treatments for cancer patients.
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MOASC CALENDAR
Oncology Summit
March 3, 2018
Huntington Beach, CA
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(Napa, March 16-18)
(San Francisco,
April 27-28)
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The
Medical Oncology Association of Southern California
(MOASC) is a leading oncology society that advances and protects the ability of cancer patients to obtain, and the ability of the oncology physicians to provide, optimal cancer care. The
Association of Northern California Oncologists
(ANCO) is an association of hematologists/oncologists dedicated to promoting high professional standards of cancer care by providing a forum for the exchange of ideas, data, and knowledge.
The material contained in the
California Oncology Weekly
is intended as general information for ANCO and MOASC members. Because diagnostic, treatment, contracting, coding, and billing decisions should be made on a case-by-case basis, any such information contained in the
California Oncology Weekly
may not apply in any given situation. Members are encouraged to contact their own consultants or advisors to obtain specific advice on matters relating to contracting, coding, and billing. The information contained in
California Oncology Weekly
should not be used as a substitute for such advice.
This publication provides a summary of regulations affecting oncology and its business practices. Reading this newsletter does not substitute for understanding regulations and verifying the validity of every claim. This information is time-sensitive and is subject to change. MOASC or ANCO accepts no liability for any statements or articles herein.
CPT codes are owned and trademarked by the American Medical Association. All Rights Reserved.
MOASC: P.O. Box 161, Upland, CA 91785 | P (909) 985-9061 | F (909) 804-5006| www.moasc.org
ANCO: P.O. Box 151109, San Rafael, CA 94915 | P (415) 472-3960 | F (415) 472-3961 | www.anco-online.org
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