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 13, 2018
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- MBC requesting medical records for patients who died in 2012 & 2013.(California News)
- Independent Payment Advisory Board is officially repealed! (National News)
- CMS proposes increase to Medicare Advantage for 2019. (CMS News)
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California News
- Both of California's health insurance regulators said they will investigate how Aetna Inc. makes coverage decisions, as the lawsuit of a California man, who is suing the nation's third-largest insurer for improper denial of care, heads for opening arguments tomorrow
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The Department of Managed Health Care, which regulates the vast majority of health plans in California, said it will investigate Hartford, Ct.-based Aetna after CNN first reported that one of the company's medical directors had testified in a deposition related to the lawsuit that he did not examine patients' records before deciding whether to deny or approve care. Rather, he relied on information provided by nurses who reviewed the records, which, he said, was how he was trained by the company. California Insurance Commissioner Dave Jones has said his office will investigate Aetna. "If a health insurer is making decisions to deny coverage without a physician ever reviewing medical records that is a significant concern and could be a violation of the law" Jones said. Jones' investigation of Aetna will review denials of coverage or pre-authorizations during the tenure of the medical director who testified in the California lawsuit, Jay Ken Iinuma, who has since left the company. Insurance department investigators will also look into Aetna's procedures for managing medical coverage decisions.
- CMA has received several inquiries regarding physicians who recently received letters from the Medical Board of California (MBC) requesting medical records for patients who died in 2012 and 2013
. The physicians were informed that the records were being requested based on investigation of prescribers connected to opioid-related deaths during this time period.
At the July 2017 meeting of the MBC Enforcement Committee, MBC staff reported that in 2015, pursuant to an interagency agreement with the California Department of Public Health (CDPH), it had received information on deaths in 2012 and 2013 related to opioid prescription drugs.
California law requires the MBC to file an accusation within seven years after the act or omission alleged as the ground for disciplinary action occurred. The MBC cited the statute of limitations as the reason for requesting data back to 2012. The CDPH dataset received by the MBC in 2015, which is based on death certificate information, used a set of codes that CDPH used to identify the underlying cause of death and the contributing cause of death to identify opioid pharmaceutical-related deaths. The data identified 2,692 deaths that met the criteria.
CMA has concerns with the Medical Board's activity in this area and we are monitoring the issue and reaching out to the Medical Board staff to obtain additional information on this issue.
If you receive a letter requesting medical records pursuant to this issue, please contact CMA to track the extent to which these letters are impacting physicians. Please note that the letters from the Medical Board contain personal health information and as such should not be circulated without redaction. It is enough to provide the physician who has been contacted. If members require additional information about how to respond to inquiries from the Medical Board, please see the CMA website: http://www.cmanet.org/resources/medical-board-assistance/
- Implementation of California's first-of-its-kind drug pricing legislation (SB17) began on January 1 and the complete roll-out of the legislation will occur over the next 12-18 months. RunawayRx's new infographic helps explain what SB17's roll-out will look like, who will receive notice of price hikes, and when the public can expect to see data on Rx price changes. The infographic is at http://runawayrx.org/wp-content/uploads/2018/01/CAHP-SB-17-Implementation-Infographic-FINAL.pdf.
- CMA's Practice Resources (CPR) for February is now available online at www.cmanet.org/cpr and features articles entitled: Physicians report loss of patients due to Anthem error; Noridian implements temporary ICD-10 code fix for mammography and bread biopsy policies; Anthem dials back modifier 25 payment reduction policy and delays implementation; Having trouble getting paid correctly under California's out-of-network billing and payment law?--CMA can help; The Coding Corner: The top three E/M documentation problems.
- 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 Clinicians: 2017 Extreme and Uncontrollable Circumstances Policy; Quality Payment Program: Patient-facing Encounters Resources; Find Medicare FFS Payment Regulations; MIPS: Call for Advancing Care Information Measures and Improvement Activities; Quality Payment Program: Advanced APM Table; Hospice Quality Reporting Program Resources
Events
--What's New With Physician Compare Webinar-February 21 or 22
Publications
--Looking for Educational Materials?; Medicare Enrollment Resources Educational Tool-Revised
* Enrollment Application Status Tool
* MolDX: Molecular Test Registration and Claims Submission
* QMB Indicator Reinstate in Medicare FFS Claims Processing System from CR9911 CR10433
* NMP and/or IVR Enrollment Application Status Search Use Now Required
* HCPCS Drug/Biological Code Changes-April 2018 Update CR10454
* NCCI PTP Edits-Version 24.1, Effective April 1, 2018 Update CR10472
- Upcoming Noridian/JEMAC webinars include:
* Chronic Care Management (CCM) Webinar (February 14)
* Reopenings Webinar (February 21)
* 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 continuing resolution passed by Congress and signed by the President on February 9 includes an important correction to the Merit-based Incentive Payment System (MIPS) that ensures that quality payment adjustments under the program are applied only to fee schedule services and not to Part B drug reimbursement.
- 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 »
-Thank you to all who supported our efforts over the years to repeal the Independent Payment Advisory Board (IPAB), which is officially repealed! IPAB repeal language was included in the two-year budget agreement that the U.S. Senate and House both successfully passed and was signed by the President last Friday morning. Thanks for your hard work and support in making IPAB repeal possible. Congratulations!
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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 Compare webinars 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:
- CMS has proposed increasing baseline Medicare Advantage payment rates for 2019 by an average of 1.84 percent. According to CMS, the proposed payment increase is based on better use of encounter data and changes to the risk adjustment model used to pay for aged and disabled beneficiaries. Medicare Advantage is at an all-time high, with approximately one-third of all Medicare beneficiaries enrolled in a Medicare managed care plan. Enrollment has more than doubled over the past decade. CMS is accepting comments on the proposal until March 5, with the final rates posted on April 2. For more information, see the CMS fact sheet.
- To help you prepare for the transition to the Medicare Beneficiary Identifier (MBI) on Medicare cards beginning April 1, 2018, review the new information about remittance advices. Beginning in October 2018, through the transition period, when providers submit a claim using a patient's valid and active Health Insurance Claim Number (HICN), CMS will return both the HICN and the MBI on every remittance advice. Here are examples of different remittance advices:
Find more new information on the New Medicare Card provider webpage.
- Applications for the Model Performance for BPCI Advanced must be submitted via the
Application Portal, which will close on March 12, 2018, at 8:59 pm PT. The Model Performance Period for BPCI Advanced starts on October 1, 2018, and runs through December 31, 2023. For more information about the model and its requirements or to download a Request for Applications document, the application template, and attachments, visit the BPCI Advanced webpage. See the full text of this excerpted CMS Press Release.
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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.
- ASCO has released its review of leading oncology pathway vendors. Oncology Clinical Pathways: Charting the Landscape of Pathway Providers, published in the Journal of Oncology Practice (JOP), examines the clinical pathways offered by six commercial vendors using the Society's criteria for high-quality clinical pathways. The report found that--with a few exceptions--overall, prominent commercial pathway programs are largely aligned with ASCO's criteria. ASCO's Criteria for High-Quality Clinical Pathways in Oncology (www.asco.org/practice-guidelines/cancer-care-initiatives/clinical-pathways), a set of 15 inter-related criteria that provide an overarching framework for assessing pathway programs in the United States, focus on three key areas--development, implementation and use, and analytics. Read the JOP article at http://ascopubs.org/doi/10.1200/JOP.17.00033.
- ASCO has provided comments on the latest draft statement on the compounding of medications by physicians by the Federation of State Medical Boards (FSMB), largely reiterating concerns had with the first draft. In the comments, ASCO asks FSMB to reference the FDA definition of compounding, which excludes the missing and diluting typically done in medical oncology practices. ASCO also disagrees with FSMB's recommendation of compliance with USP Chapters 797 and 800. Read ASCO's comments at
- NCCN has published updates to the below. For the complete updated versions, please visit
NCCN.org. Recent updates include: acute myeloid leukemia (V1.2018), anal carcinoma (V1.2018), bladder cancer (V1.2018), chronic myeloid leukemia (V4.2018), ovarian cancer (V5.2017), and penile cancer (V1.2018).
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- 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 Zytiga in combination with prednisone for the treatment of patients with metastatic high-risk castration-sensitive prostate cancer (CSPC).
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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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