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"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.
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- MolDX: ResponseDX Tissue of Origin - R2, coverage article has been revised. (Noridian News)
- ANCO President, Daniel P. Mirda, M.D., chosen as one of ASCO's Advocacy Champions (ANCO News)
- Last week to submit comments to CMS regarding the 340B Drug Pricing Program (CMS News)
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California News
- In response to some health insurers leaving the individual market, state lawmakers are considering a bill that would ensure continuity of care for people with complex health conditions. SB 133 would require a new insurance firm to cover the providers of qualifying patients, even if the provider isn't in the insurer's network. The insurance industry says the bill would provide a blank check for out-of-network care in some instances. Sen. Ed Hernandez (D-West Covina), the author, recognizes the bill would obligate insurers to cover costly care provided by doctors who are not in their networks, but he says it would only be needed on rare occasions.
- One of the bills in the California legislature designed to address high prescription drug costs takes aim at the middlemen who negotiate pharmaceutical prices by bringing them under the state's regulatory purview. Pharmacy benefit managers represented by the trade group The Pharmaceutical Care Management Association, are the go-betweens who negotiate drug prices with manufacturers on behalf of health insurers. They also write the formularies that list which drugs are covered by a particular health plan. AB 315, authored by Assemblyman Jim Wood (D-Healdsburg), would require pharmacy benefit managers to register and submit information about drug costs, rebates and fees to the state Department of Managed Health Care. It has passed the Senate and is now in the Assembly. AB315 is one of four moving through the legislature aimed at high drug prices. For Wood, SB 17, the Hernandez bill, that will require pharmaceutical manufacturer to notify purchasers in advance of a price increase for an existing product when the increase exceeds a specified threshold, goes hand-in-hand with his legislation.
- The FDA announced last week it had sent members of the U.S. Marshals Service to a biotechnology company in San Diego to seize samples of a vaccine which are used as part of a "potentially dangerous and unproven treatment" administered to cancer patients at a Rancho Mirage clinic. The vaccine, which the federal agency said is used only on people who have a high risk of smallpox, was combined with stem cells and was then injected directly into cancerous tumors.
- Forthcoming CMA webinars include:
* MACRA: Guidance on the Merit-Based Incentive Payment System (MIPS; September 20)
* Assembly Bill 72: How to Challenge the Interim Payment for Out-of-Network Services at In-Network Facilities (September 27). Learn more and register at
www.cmanet.org/events
.
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* MLN Connects
Announcements--Participate in Quality Payment Program Website Testing; Billing for Stem Cell Transplants
Claims, Pricers & Codes
--
Events--Qualified Medicare Beneficiary Program Billing Requirements Call-September 19; Reporting Hospice Quality Data: Tips for Compliance Cell-September 20; PQRS: Feedback Reports and Informal Review Process for PY2016 Results Call-September 26; Physician Compare Call-September 28
Publications--
A Physician's Guide to Medicare Part D Medication Therapy Management Programs MLN Matters Article-Revised; Medicare Costs at a Glance: 2017 Educational Tool-Reminder; Physician Fee Schedule Fact Sheet-Reminder; Telehealth Services Fact Sheet-Reminder;
* September Webinars-Register Now
* MolDX: NSD1 Gene Tests; MolDX: Myriad BRCAnalysis CDx; PIK3CA Gene; RPS19 Gene Tests; TERC Gene Tests; IKBKAP-- Billing and Coding Guidelines
* MIPS and APM Webpage Available To Help with the October 1, 2017 Deadline
* Screening for Lung Cancer with LDCT-Second Revision-Republished CR9246
* CMS-1500 Claim Form Must Be the 02/12 Version
- September Webinars - Register Now
Noridian is hosting free, web-based workshops (webinars). This article includes a listing of this month's webinar topics.
Read the complete update
webinars include:
* Duplicate Claims (September 13)
* Critical Care (September 14)
* Basic E and M Common Errors (September 20)
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- AB 205 (Wood): Medi-Cal: Medi-Cal managed care plans. This bill would require the Department of Health Care Services to make several changes to the operation of the Medi-Cal managed care program, to conform to new federal requirements. Patient advocacy groups strongly support the access to care standards included in the bill. Health plans continue to express concerns about a couple of issues, including how they will be regulated and how the medical loss ratio will be calculated. The bill was approved by the Senate Appropriations Committee and will head to the Floor for a vote.
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- Limited drug access, power outages and floodwater injuries are challenges the residents of Houston will have to face right away. Are you ready for the natural disasters facing your community through earthquake, fire and flood? Not only do we have emergency disasters in California, but every community across the United States have such emergencies! Find out how you can protect your practice and your patients from these disruptions through MOASC's Oncology Patient Emergency Network (OPEN). Contact the MOASC Office moasc@moasc.org for more information on the OPEN program.
- With 51 other organizations, MOASC, ANCO & NOSN have signed onto a letter to Secretary of HHS, Honorable Thomas E. Price, MD, to ensure the continued protection of the categories and classes of drugs identified for unique patient access under the Social Security Act (the "protected classes"), these medications are vital to the treatment of: (1) epilepsy; (2) mental illness; (3) cancer; (4) HIV-AIDS; and (5) organ transplants. Attached, please find the letter. Partnership Letter for Part D Access.
- SAVE THE DATE! Join us for the 2017 Clinical Staff, Oncology Billing & Administrator Programs. November 8, 2017- Clinical Staff Program (Nurses, pharmacists, NPP's) and November 9, 2017- Administrators Program and Billers Program, at the DoubleTree Suites by Hilton Anaheim Resort, from 8:30am to 12:30pm. Topics to be presented and discussed are: Pharmacy Standards/USP Regulations; Immunotherapy and Targeted Therapy; MACRA/MIPS; Pain Management; A/R & Billing Updates, and more. For more information contact the MOASC office at
moasc@moasc.org
or 909-985-9061 x1.
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- The Conquer Cancer Foundation of the American Society of Clinical Oncology is now accepting applications for the 2018 Young Investigator Award (YIA). The Association of Northern California Oncologists (ANCO) is funding one 2018 YIA for a qualified northern California applicant, and urges all eligible northern California physicians to apply. The YIA is a one-year, $50,000 grant that provides research funding to promising physicians to support their transition from final years of training to faculty appointment and to encourage and promote quality research in clinical oncology. Applications in all areas of cancer research are accepted from U.S. and international applicants. For 2018, CCF has dedicated funding for the following areas: breast cancer, northern California researchers, global oncology, kidney cancer, lung cancer, pediatric cancer, sarcoma, and supportive care. Other areas of interest include cholangiocarcinoma, chronic lymphocytic leukemia, gynecological caners, and melanoma. YIA applications opened on July 1 and are due by 11:50PM ET on September 21. Eligibility criteria, award details, and the request for proposals are available on the CCF website (www.conquer.org/YIA). For questions about the YIA or assistance with your application, please e-mail grants@concquer.org.
- ANCO's 2017 Professional Education Meeting will take place on September 6 at the San Jose Fairmont and feature talks on QPP/MACRA, ASCO's COME HOME Project, USP 797/800, and California Legislative/Regulatory Updates. Download the meeting announcement and registration form at www.anco-online.org/ProfEduc2017.pdf.
- ANCO's 3Q2017 Hematologic Malignancies Update will take place on September 9 at the Stanford Park Hotel in Menlo Park. Watch for a meeting announcement in late July. Bruno Medeiros, M.D., Stanford University, Charalambos Andreadis, M.D., University of California, San Francisco, and Brian Sworder, M.D., Ph.D., Stanford University, will review the latest research on novel treatment modalities for leukemia and lymphoma, along with case studies for these diagnoses. These Updates are supported by Janssen Biotech, Merck, Pfizer Oncology, and Pharmacyclics. Download the meeting announcement and registration form at www.anco-online.org/3Q2017HemeMalig.pdf.
- Stanford Cancer Center's MDS Center is co-sponsoring the MDS Foundation's Educational Patient-Caregiver Forum on Saturday, October 28. The Forum takes place at 875 Blake Wilbur Drive, Room 2103, Stanford CA 94305 from 9:30AM through 2PM.
- 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 to register your interest in receiving registration and housing information when it becomes available in the Fall.
- ANCO is proud to announce that Daniel P. Mirda, M.D., ANCO President, has been chosen as one of ASCO's Advocacy Champions based on his advocacy efforts in 2016.
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The Senate's parliamentarian ruled that Republicans have until the end of the month to use the legislative process known as reconciliation to pass their current repeal-and-replace effort for the Affordable Care Act.
The Senate's Health Committee will hold two hearings in the coming week on a bipartisan healthcare bill, with testimony from governors and state insurance officials on Wednesday and Thursday, in addition to two more hearings the following week. The goal is to pass a bill by the end of the month to stabilize the insurance markets for 2018.
- An Institute for Clinical and Economic Review (ICER) report finds inadequate evidence to compare PARP inhibitors across key ovarian cancer indications. The report will be the subject of an upcoming public meeting on September 14. Evidence Report.
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- Read COA, ASCO & ASH comments
on the 2018 QPP proposed rule below.
COA Comments;
The legal team at
Johnson & Johnson created "2018 MACRA QPP Proposed Rule Update" highlights and Q&A documents. These provide a concise summary of the 2018 MACRA QPP Proposed Rule. CRA QPP CY2018 MACRA QPP
- The Medicare appeals backlog is significant and has been increasing in recent years. In an effort to reduce the backlog, HHS has issued a final rule, which includes an assortment of initiatives. There are steps providers can take to reduce the risk and/or negative outcomes of an SMRC review, including using trigger language and ensuring timestamps. Once a denial is fully reviewed, there are proven strategies a provider can employ to appeal the denial, such as distinguishing IRF level of care. Download the white paper, Addressing Medicare's Appeals Backlog to learn more.
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Affiliate Association News
- Applications for ASCO's Leadership Development Program will be accepted through September 24. Through the Program, participants will gain extensive exposure to the roles and mission of ASCO, its Leadership, and the Society's powerful place in developing the future of cancer care. Applicants must have completed their final subspecialty training between 2008 and 2013. Learn more and apply at
http://www.asco.org/training-education/professional-development/leadership-development-program
.
- NCCN has published updates to the following Guidelines: acute lymphoblastic leukemia (V2.2017); bladder cancer (V5.2017); bone cancer (V1.2018); myelodysplastic syndromes (V1.2018); ovarian cancer (V3.2017); uterine cancer (V2.2017).
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- AstraZeneca informs ANCO and MOASC that the United States Food and Drug Administration has approved Faslodex for initial mono therapy for postmenopausal women with hormone receptor-positive (HR+), human epidermal growth factor receptor 2 negative (HER2-) advanced breast cancer not previously treated with endocrine therapy.
- Genentech BioOncology informs ANCO and MOASC that the United States Food and Drug Administration has approved Actemra for the treatment of chimeric antigen receptor (CAR) T cell-induced severe or life-threatening cytokine release syndrome (CRS) in people two years of age or older.
- Jazz Pharmaceuticals informs ANCO and MOASC that it has reimbursement assistance available for patients being treated with Vyxeos, a new treatment for AML. The Jumpstart Reimbursement hotline number is 1-855-5VYXEOS (1-855-589-9367; M-F, 9AM-8PM ET).
- Pfizer Oncology informs ANCO and MOASC that the United States Food and Drug Administration has approved Mylotarg for the treatment of newly-diagnosed CD33-positive acute myeloid leukemia (AML) in adults and for the treatment of relapsed or refractory CD33-positive AML in adults and in pediatric patients 2 years and older. Mylotarg may be used in combination with daunorubicin and cytarabine for adults with newly-diagnosed AML, or as a stand-alone treatment for certain adult and pediatric patients.
- Novartis Oncology informs ANCO and MOASC that the United States Food and Drug Administration has approved Kymriah for children and young adults with B-cell acute lymphoblastic leukemia. The Centers for Medicare & Medicaid Services, "...CMS congratulates all of the scientists and researchers involved in the development of Kymriah (tisagenlecleucel)," said CMS Administrator Seema Verma. "Innovations like this reinforce our belief that current healthcare payment systems need to be modernized in order to ensure access to new high-cost therapies, including therapies that have the potential to cure the sickest patients. Improving payment arrangements is a critical step towards fulfilling President Trump's promise to lower the cost of drugs."
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MOASC CALENDAR
Professional Educational Series
November 8-9
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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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