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.
April 10, 2018
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- California physicians are encouraged to contact their state legislators NOW (California News)
- Noridian answers denial of 96402 when billed with J9395 and J9217 (MOASC News)
- UCSF study exploring cancer survivorship care plans. (MOASC News)
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California News
- Assemblymember Ash Kalra (San Jose) amended last year's AB 3087 to create a government commission to set the prices a physician, physician group, hospital, or health plan can charge. California's government would set prices for hospital stays, doctor visits and other healthcare services under legislation introduced yesterday, vastly remaking the industry in a bid to lower healthcare costs.
The bill labels physicians as major drivers to the ever-increasing cost of health care, devastates the state's ability to attract physicians, and significantly depresses the economic viability of practicing physicians.
The bill establishes a commission to set the prices a physician can charge for their services.
The commission will consist of nine members. Practicing physicians are prohibited from serving on the commission. The funding to support the administration of the commission includes physician licensing fees.
The commission has the authority to only set price in the commercial market; both Medi-Cal and Medicare are excluded. The commission will annually base prices on Medicare rates.
The bill also allows for intervenor fees to support so-called consumer advocates to lobby the commission.
- The
California Medical Association's
(CMA)
Practice Resources
(CPR)
for April is now available online at www.cmanet.org/cpr and features articles entitled HealthNet announces significant policy changes to Medicare Advantage and Medi-Cal managed care product lines, CMA advocacy results in DHCS revaluing two CPT codes, CMA asks DMHC to require Anthem to publish effective dates for clinical policies, Payors report system changes to comply with AB72, Free on-demand webinar: MACRA and the Quality Payment Program, The Coding Corner: Modifier 25: Getting it Right!
- AltaMed Health Services, a Federally Qualified Community Health Center providing care to 300,000 Southern California residents, uses AHRQ's Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey to learn about patient experiences in receiving health care. The results not only help AltaMed improve patient care, but also influence the financial incentives its medical providers can earn. Access the impact case study.
- CAPP is hosting a reception in honor of Senator Anthony Portantino this Thursday, April 12th. The event is being held from 5:30 - 7:00 p.m. at Autumn Hills Health Care Center, 430 N. Glendale Ave., Glendale, CA. There is no cost to attend and nor soliciting contributions at the event. RSVPs can be given to Tina de Vere White at 916.448.7992 x 3 or
- The CMA thanks all participants in their survey on health plan payment abuses. 741 different practices responded. The survey confirms that health plans regularly engage in unfair payment practices, despite a California law passed in 2000 to address these widespread abuses. To address this issue, CMA is sponsoring AB 2674 (Aguiar-Curry), which would require DMHC to investigate provider complaints that a health care service plan has underpaid or failed to pay the provider in violation of the Knox-Keene Act. If DMHC finds that a health plan has unlawfully underpaid a provider, AB 2674 would require the penalty amount to, at a minimum, equal the amount of the underpayment plus interest. Furthermore, AB 2674 would protect the health care delivery system by ensuring providers are made whole when health care service plans violate the law. The bill would also deter future violations of the law, thereby saving providers and the state vital resources that should be invested in patient care. CMA published an article summarizing the results and linking to the full survey summary and responses. Link to article: http://www.cmanet.org/news/detail/?article=cma-survey-finds-rampant-health-plan-payment.
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- Noridian/JEMAC has posted more updates to its website:
* MLN Connects Provider eNews--
Announcements--Qualified Medicare Beneficiary Claims: Replacement RAs; Advanced Diagnostic Laboratory Tests: Applications and Guidance; Hospice Quality Reporting Program Video Series: Navigating HQRP Websites; Hospice Item Set Coding Video Series; Physician Compare Quality Measure TEP Summary Report; New Medicare Card Project-Important Updates; Bipartisan Budget Act: CMS Reprocessing Impacted Claims; MIPS APM: Resources for Performance Year 2018
Claims, Prices & Codes--
HCPCS Code Set Modifications
Publications--Adjustments to QMB Claims Processed under CR9911 MLN Matters Article-New; Open Payments Call: Audio Recording and Transcript-New; Prohibition on Billing Dually Eligible Individuals Enrolled in the QMB Program MLN Matters Article-Revised; April 2018 Update of the Hospital OPPS MLN Matters Article-Revised; Medicare FFS Response to the 2017 California Wildfires MLN Matters Article-Updated; Medicare Parts A & B Appeals Process Booklet-Reminder
* Using NMP vs the IVR
* Medicare FFS Response to the 2017 Southern California Wildfires-Revised SE17037
* Medicare FFS Response to the 2017 California Wildfires-Second Revision SE17035
* Skilled Nursing Facility Advance Beneficiary Notice of Non-Coverage CR10567
- Upcoming Noridian/JEMAC webinars include:
* Preventive Services and Screenings (April 18)
* What's New in the Second Quarter 2018 Webinar (April 18)
* New Medicare Card Project Webinar (April 25)
* Evaluation and Management Modifiers Webinar (April 25)
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- The MOASC Office has been in receipt of calls from members regarding denials on 96402 when billed with J9395 and J9217 with denial codes COB15 and M51.
Following is Noridian's response:
"...We've detected a system issue a couple weeks ago and are researching this. The Provider Contact Center is asking providers to give us time to determine the issue and resolve. They can always check our website periodically as we will post an issue, resolution and timeframe of resolution - if it affects many providers it's posted. Here's where we would post that:
https://med.noridianmedicare.com/web/jeb/fees-news/alerts. I'm assuming, as with most detected mass adjustments are made to reprocess the claim for payment. But that determination is made based off several things."
- Dear MOASC members, m
y name is Dr. Niharika Dixit and I'm a physician and associate professor at University of California, San Francisco.
I'm contacting you because I'm currently involved in a study exploring the content and use of cancer survivorship care plans in the U.S., and I'd like to ask you-
1) Whether cancer survivorship care plans are used for patients with breast or colorectal cancers in your institution, and
2) if so, whether I can obtain a copy of the plan(s) that your institution has in use to analyze for our study.
I want to assure you that any information you share with us about survivorship care plans in use at your institution will be kept confidential and will not be linked to your specific institution in our analysis.
Thank you in advance for your consideration and please don't hesitate to reach out to me if you have any questions about this request or would like to learn more about our study.
Niharika Dixit, M.D.
Associate Clinical Professor,
Divison of Hematology/Oncology
UCSF/SFGH
995 Potrero Avennue
San Francisco, CA
94110
415-476-4082 x 134
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In the next 5 years,
technology will improve health care through better diagnoses, cures and prediction of diseases and conditions, per
80%
of more than 1,000 adults ages 55 and older surveyed by Alignment Healthcare.
MOASC's LunchTime Series webinar, "
Patient Management Technology,"
on Wednesday, April 25 at 12:00pm Pacific, will
prepare you for this evolution.
Older adults said they wanted to be able to see a physician on demand using web-enabled devices and have electronic record keeping, monitoring technology to track vitals, and the ability to send emails and images to their physician. P
roactive care and remote monitoring is integral to preventing unnecessary emergency visits and reducing hospitalizations. These have been identified as key opportunities to lowering the cost of cancer care. Do you have the technology in place to do this? Speakers, Phil Beck, RPh, Director, Navigating Cancer and Barry Russo, CEO, Center for Cancer and Blood Disorders, will show you how to successfully implement patient relationship management technology and provide proactive patient care throughout treatment. Register for this invaluable webinar at
moasc@moasc.org
.
Sponsored by
Navigating Cancer.
- 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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- NOTE DATE CHANGE--ANCO is organizing a series of Hematologic Malignancies Updates in 2018. The first Update takes place on June 16 at the Sacramento Hyatt Regency with Joseph Tuscano, M.D., University of California, Davis, Jeffrey Wolf, M.D., University of California, San Francisco, and Naseem Esteghamat, M.D., University of California, Davis. The latest research on novel treatment modalities for hematologic malignancies--lymphomas and myeloma--along with case studies for these diagnoses will be presented. These updates are supported by AMGEN, Janssen Oncology, Jazz Pharmaceuticals, Novartis Oncology, and Seattle Genetics. Download the meeting announcement and registration form at www.anco-online.org/2Q2018HemeMaligUpdate.pdf.
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- National Cancer Control Month
is an annual campaign to promote cancer prevention, screening, resources for survivors, investment into research and progress toward effective cancer control. Take advantage of this awareness month. Download the
toolkit.
- The federal government and 31 states are suing wholesale drug distributor McKesson for allegedly repackaging leftover cancer drugs from single-use vials, leading to fraudulent payments and serious infections.
Read More
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The Anthem Blue Cross Network eUpdate
(April 2018) is now available online at
https://www11.anthem.com/ca/provider/f5/s3/t3/pw_g334024.pdf?refer=provider
and features articles entitled Important: Reimbursement policy update: Evaluation and Management Services and Related Modifiers 25 and 27, Update regarding specialty pharmacy and oncology claim processing; Clinical practice and preventive healthy guidelines available online.
- UnitedHealthcare's Network Bulletin (April 2018) is now available online at www.unitedhealthcareonline.com > Tools & Resources > News & Network Bulletin and features articles entitled Update to Notification/Prior Authorization Requirements for Specialty Medications for UnitedHealthcare Commercial and Community Plan Members, Review at Launch Drug Program for UnitedHealthcare Commercial and Community Plan Members, Changes in Advance Notification and Prior Authorization Requirements, Introducing ACE Smart Edits-Enhanced Messages for Pre-Adjudication Claim Returns.
Results could advance treatments for head and neck and other cancers.
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CMS News
- Medicare is simplifying claims documentation requirements so that you spend less time on paperwork, allowing you to focus more on your patients. Visit the Provider Compliance Group's Simplifying Documentation Requirements and Reducing Provider Burden webpages to learn about CMS' recent initiatives, including:
Documentation Requirements Simplification Initiative; Simplifying medical review with Targeted Probe and Educate; Where should CMS focus next?
- CMS started mailing newly-designed Medicare cards with the new Medicare Beneficiary Identifier (MBI), or Medicare Number. People enrolling in Medicare for the first time will be among the first to get the new cards, no matter where they live. Current Medicare beneficiaries will get their new cards on a rolling basis over the
coming months. CMS will continue to accept the Health Insurance Claim Number (HICN) through the transition period.
For more information, visit the New Medicare Card
landing and provider webpages.
- A revised
Medicare Parts A & B Appeals Process Booklet is available. Learn about:
Five levels of claim appeals; New option for a level three on-the-record review; Forms and helpful tips for filing an appeal.
If you submitted data through the Quality Payment Program website, you are now able to review your preliminary performance feedback data. However, please keep in mind, this is not your final score or feedback. Between now and June 30, 2018, your score could change based on several criteria. Your final score and feedback will be available on July 1, 2018 through the Quality Payment Program website. You will be able to access preliminary and final feedback with the same EIDM credentials that allowed you to submit and view your data during the submission period.
Don't have an EIDM account?
Start the process now! Refer to the Enterprise Identity Management (EIDM) User Guide for instructions. If you have questions about your MIPS performance feedback preliminary data, please contact the Quality Payment Program by:
Phone: 1-866-288-8292/TTY: 1-877-715-6222 or Email:
QPP@cms.hhs.gov
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The Philadelphia Regional Office of the Centers for Medicare & Medicaid Services will host a national webinar on Year 2 (2018) of the Quality Payment Program (QPP) on Tuesday, May 1, 2018, from 9:00am until 10:30 am Pacific.
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Affiliate Association News
- ASCO invites interested stakeholders to submit comments on draft recommendations in the Evaluating Susceptibility to Pancreatic Cancer Provisional Clinical Opinion and draft standards for Safe Handling of Hazardous Drugs between March 30 - April 13, 2018. This open comment process provides greater transparency in the guideline and standard development process and the opportunity for key stakeholders to provide feedback before the documents' finalization and publication. To participate, visit http://www.asco.org/open-comment-guidelines. Please contact guidelines@asco.org with any questions.
- ASCO invites all members to submit comments on draft standards for Safe Handling of Hazardous Drugs between March 30 and April 13. The open comment process provides greater transparency in the standard development process and the opportunity for key stakeholders to provide feedback before the documents finalization and publication. To participate, visit www.asco.org/open-comment-guidelines.
- The Presidential theme for the 2018 ASCO Annual Meeting,June 1-5 in Chicago, developed by Dr. Bruce Johnson, is Delivering Discoveries: Expanding the Reach of Precision Medicine. Arrive early, May 31 & June 1, and expand your educational opportunities ASCO offers two types of innovative educational programs. Space for these sessions is limited - register today by clicking 2018 ASCO Annual Meeting.
- The sixth edition of the ASH-SAP contains 23 pertinent peer-reviewed chapters, covering the full spectrum of adult and pediatric hematology including:
Laboratory hematology and cellular therapy
Consultative hematology
Thrombosis and hemostasis
Anemia, iron physiology, and iron disorders
Myeloid diseases
Lymphoid disorders
In addition, this latest edition will feature 3D animation and audio, 285 new questions in the Q&A book, and six separate tests that can be taken individually or together and are worth up to 70 CME/MOC credits.
To order your copy or for more information, visi
Hematology.org/BuyASHSAP6
.
- ASCO's Practice Engagement Program helps administrators, physicians, and other members of the care team navigate ASCO tools, programs, and resources available to help oncology practices respond to the changes occurring in the cancer care delivery system. Learn more at
http://practice.asco.org
.
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The cancer survivors attending your Celebration of Life on Sunday, June 3, will feel extra special when they leave your NCSD event with carefully selected keepsakes to remind them of special moments shared on National Cancer Survivors Day®.
Create cool swag bags for your guests with special keepsakes and souvenirs from our online Merchandise Catalog. The catalog features a variety of items that cancer survivors (and supporters) will love.
- NCCN has published updates to the below. For the complete updated versions, please visit
NCCN.org
. Recent updates include: acute lymphoblastic leukemia (V1.2018),
anal carcinoma (V1.2018),
bone cancer (V2.2018), breast cancer (V1.2018), cancer-associated venous thromboembolic disease (V1.2018), central nervous system cancers (V1.2018),
Immunotherapy-Related Toxicities (v1.2018), Burkitt Lymphoma for B-Cell Lymphomas (v2.2018),
chronic lymphocytic leukemia/small lymphocytic lymphoma (V5.2018), colorectal cancer screening (V1.2018), esophageal and esophagogastric junction cancers (V1.2018), head and neck cancers (V1.2018), neuroendocrine and adrenal tumors (V1.2018), non-small cell cancer (V3.2018), penile cancer (V2.2018),
prostate (v2.2018),
rectal cancer (V1.2018), soft-tissue sarcoma (V2.2018), uveal melanoma (V1.2018).
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- AMGEN
informs ANCO and MOASC that the United States Food and Drug Administration has approved Blincyto for the treatment of adult and pediatric patients with B-cell precursor acute lymphoblastic leukemia (ALL) in first or second complete remission with minimal residual disease (MRD) greater than or equal to 0.1%.
- Foundation Medicine
will host an educational dinner meeting entitled Comprehensive Genomic Profiling:
What is new and exciting in the world of genomics
with Jeffrey Gregg, M.D., University of California, Davis, on April 25 at Long Meadow Ranch, St. Helena. RSVP to Krista Gallucci at
kgallucci@foundationmedicine.com
or (415) 830-0365.
- Kite Pharmaceuticals informs ANCO and MOASC that CMS has assigned HCPCS code Q2041 to Yescarta, up to 200 million autologous Anti-CD19 CAR T Cells, including leukapheresis and dose preparation procedures, per infusion. The code is effective as of April 1.
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MOASC CALENDAR
LunchTime Series
April 25, 2018
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(San Francisco,
April 27-28)
(
Sacramento, June 16--NOTE DATE CHANGE)
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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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