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
.
September 4,
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This Weekly's Hot Topics
- BY SEPTEMBER 10th!!! YOUR VOICE MUST BE IN THIS FIGHT!(CMS News)
- Urge Governor to sign AB 1860 - access to oral anti-cancer drugs(California News)
- Revenue for physicians through Medi-Cal program(DHCS/Medi-Cal News)
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California News
- The 2017-2018 California Legislative session came to a close midnight last Friday, August 31, 2018. A great deal of health policy work was finalized by the Legislature.
Last week's California Oncology Weekly urged California physicians to make multiple copies and share
this letter
with your patients who are on oral chemotherapy and ask that they send the letter to Gov. Brown for his signature. AB 1860 (Limon): Health care coverage: cancer treatment bill is sitting on Gov. Brown's desk for signature or veto. This bill ensures that patients continue to have access to affordable anti-cancer oral medications. Here is MOASC and ANCO's joint letter to the governor for your perusal. AB 1860 Co-sponsor Letter. We encourage all practices and their patients to urge Gov. Brown to sign this bill. Also on the Governor's desk is AB 315 (Wood): Pharmacy benefit management. The bill will require registry of PBMs, some disclosure for PBMs to health plans; pilot projects regarding mail-only drug dispensing programs; and a Task Force to report to the legislature on recommendations on more data discloser for PBMs. Pharmacists actively supported the bill, and health plans strongly oppose the measure.
SB 212 (Jackson)
, Solid waste: pharmaceutical and sharps waste stewardship, would develop a statewide drug and medical sharps take back program funded by the pharmaceutical industry.
- On October 2nd, the California Department of Justice (CDoJ) will begin enforcing mandatory use of the Controlled Substance Utilization and Review System (CURES) Database
. In general, mandatory use will require prescribers to consult with CURES the first time that a patient is prescribed a controlled substance. For more information on mandatory use, see this publication from the California Medical Board.
- The Medical Board of California recently released its first mobile app, currently available on Apple iOS devices. The technology notifies patients about changes to their physician's license status, rather than patients having to actively seek out that information. READ MORE
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- NHS will no longer support modem functionality after October 1st, 2018.
Any provider or vendor who utilizes modems for connectivity and data exchange with Noridian will need to find alternative methods for their connectivity. Many submitters who still utilize modems may not be aware of the alternative connectivity options available to them. Network Service Vendors (NSVs) offer many affordable, user-friendly connectivity options which allow submitters to utilize a secure SFTP internet connection for file transfers. A listing of Network Service Vendors conducting business with NHS can be found by going to
www.edissweb.com
, selecting your state, and clicking the link at the end of the EDISS to End Support of Modem Technology article under the "What's New" section.
- Noridian/JEMAC has the following updates on their website
- MLN Connects Provider eNews:
Announcements
: ACOs Taking Risk in Innovative Payment Model Generate Savings for Patients and Taxpayers; Physician Fee Schedule Year 3 Proposed Rule: Comments due September 10; Call for Panel on 2018 MIPS IA Performance Category-Nominations due September 21; MIPS Targeted Review Request: Deadline October 1; Hospice Public Reporting: Key Dates; Provider Minute: Laboratory and Diagnostic Services Billing Video
Claims, Pricers & Codes
: Claims for Biosimilars Drug Code Q5108
Events
: New Medicare Card Open Door Forum-September 13
Publications
: Next Generation ACO Model 2019 Benefit Enhancement MLN Matters Article-New; HPTCs Code Set Update: October 2018 MLB Matters Article-New; Claim Status Category and Codes Update MLN Matters Article-New; Diagnosis Coding: Using the ICD-10-CM Web-Based Training Course-Revised; Medicare Enrollment for Physicians, NPPs, and Other Part B Suppliers Booklet-Reminder
* MRI and CT Scans of the Head and Neck Final LCD-Effective October 8, 2018
* Non-Covered Services LCD-R24
* In Vitro Chemosensitivity & Chemoresistance Assays Final LCD-Revised Effective October 8, 2018
* Claim Status Category and Claim Status Codes Update CR10925
* HPTCs Code Set-October 2018 Update CR10857
* Act Now: EDI Dial-Up Model Support Ending October 1, 2018
* Liability Modifier Appeal Rights Webpage Now Available
* ACT Questions and Answers-July 18, 2018
- Upcoming Noridian/JEMAC webinars include:
* Recovery Audit (RAC) Program Webinar (September 19)
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DHCS/Medi-Cal News
- DON'T MISS THIS REVENUE OPPORTUNITY! The California Health Care, Research and Prevention Tobacco Tax Act of 2016 (Prop 56) created new revenues dedicated to the Medi-Cal program.
Physicians receive supplemental payments in both fee-for-service and Medi-Cal managed care when providing Medi-Cal services under certain CPT codes. A total of $325 million was allocated for physician payments in the budget for 2017-18, with $488 million proposed for 2018-19. The California Department of Health Care Services (DHCS) began disbursing supplemental fee-for-service payments in January 2018. Federal approval of the supplemental Medi-Cal managed care payments was delayed, which resulted in delayed payment for Medi-Cal managed care services. DHCS issued an All Plan Letter that contained instructions for managed care plan distribution of the funds on May 1, 2018, and began dispersing the funds to the plans as part of its capitated payments in May. DHCS is requiring managed care plans to ensure that Prop 56 supplemental payments are issued to providers within 90 calendar days of the date the plan receives the funds from DHCS.
DHCS also included language, requiring plans to have a formal process to resolve provider grievances related to the payments, as well as a designated point of contact for provider questions, which will be published on the DHCS website. Medi-Cal managed care plans are also required to have a process to communicate with providers about the payment process that must, at a minimum, include how payments will be processed, how to file a grievance and how to determine who the payer will be. Since capitated payments to plans are disbursed throughout the month, physicians may not start seeing the supplemental payments until late August (i.e., 90 days after the plans received the money). Physicians with questions can contact MOASC moasc@moasc.org or CMA's Reimbursement Helpline at (888) 401-5911 or
economicservices@cmadocs.org
.
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- SAVE THE DATE! Don't miss MOASC's Educational Series Program Thursday, September 20, 8:00am to 12:30pm at the Waterfront Beach Resort, Huntington Beach. For practice administrators & managers, topics include: utility and value of COA Analyzer Tool, Pharmacy Standards Update and Value Based Care and bundled payment negotiation. Billers' topics will address: Navigating Denials; Billing Updates; Telemedicine in Oncology, Care Management reimbursement opportunities; proposed changes for 2019 Medicare physician fee schedule and much more. Contact moasc@moasc.org for meeting information.
- Immediately following the MOASC Educational Series Program on September 20th, MOASC Corporate Sponsor, AMGEN, is interested in scheduling lunch with attendees to discuss and get your input on:
· Amgen's Comprehensive Product Support for KYPROLIS
· Current oncology landscape
· Practice Resources and Patient Resources
· Q&A
If you are interested in participating, please answer the following questions and respond to moasc@moasc.org.
1. Name, Title and Name of Practice
2. Contact phone number
- Return your completed survey no later than September 30! MOASC and ANCO are jointly conducting a 2018 Staff Salary Survey. The survey was USPS mailed, e-mailed/Faxed to all MOASC members in mid-May and is available online at www.anco-online.org/salsrvy.html. A $50 Visa gift card for respondents is included in this year's survey. Results will be analyzed and reported in 4Q2018.
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- The Conquer Cancer Foundation is now accepting applications for the 2019 Young Investigator Award (YIA), including the YIA dedicated to a northern California Fellow. Learn more about the YIA at https://www.conquer.org/young-investigator-award and submit your application no later than September 25. In addition, ASCO is accepting applications for Career Development Awards (CDAs) that provide research funding to clinical investigators who have received their initial faculty appointment as they work to establish an independent clinical cancer research program. Applications for CDAs are also due by September 25 at www.conquer.org/career-development-award.
- ANCO and MOASC are jointly conducting a 2018 staff salary survey. The survey will be USPS mailed, e-mailed/FAXed to all ANCO members in mid-May and is available online at www.anco-online.org/salsrvy.html. A $50 Visa gift card for respondents is included in this year's survey. Return your completed survey no later than September 30; results will be analyzed and reported in 4Q2018.
- ANCO is organizing a series of Hematologic Malignancies Updates in 2018. These updates are supported by AMGEN, Janssen Oncology, Jazz Pharmaceuticals, Novartis Oncology, and Seattle Genetics. Download the presentations www.anco-online.org/education.html. The next
Update
takes place on September 15 in Palo Alto; download the meeting announcement/registration form at www.anco-online.org/3Q2018HemeMaligUpdate.pdf
- ANCO'S 2018 Professional Education Meeting will take place on September 19 at The Claremont Resort in Oakland. The agenda will focus on the oncology care model. Download the meeting announcement/registration form at www.anco-online.org/2018ProfEducMeeting.pdf.
- ANCO members may take advantage of complimentary registration at the Best of World Conference on Lung Cancer organized by the International Association for the Study of Lung Cancer and taking place in San Francisco on November 17. Register for an "Early Bird ANCO Member" ticket at https://bestofwclc2018.eventbrite.com.
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CMS News
- BY SEPTEMBER 10th!!! YOUR VOICE MUST BE IN THIS FIGHT! Community oncology practices and professionals need to do their part and submit comment letters! Specifically, more comment letters must be sent to CMS on the 2019 Medicare Physician Fee Schedule Proposed Rule, informing them of how your patients and practice will be adversely impacted. Run your numbers and report the severe impact that this will have on the care you deliver. Comments must be submitted to CMS no later than 2:00 PM Pacific, on September 10, 2018. In commenting, refer to file code CMS-1693-P. Comments can easily be submitted electronically at http://www.regulations.gov. Follow the "Submit a comment" instructions on the website. You can attach a document, if you choose. COA has made available, a tool to estimate the impact. If you would like to access the tool and submit data, please email info@coacancer.org and COA will help.
If you want to fix these cuts, you need to weigh in with CMS. Your voice and comments can help make a difference. The squeaky wheel gets the grease.
- CMS is seeking comment on various QPP provisions in the Notice of Proposed Rule Making (NPRM). Comments are due by 2:00 pm PT on September 10.
MOASC, ANCO and more than 150 health care associations sent a letter to CMS Administrator Seema Verma applauding the reduction of documentation requirements for evaluation and management procedures in the proposed Medicare Physician Fee Schedule for 2019. However, the groups opposed proposed policies collapsing payment rates for office visits for new and established patients and reducing multiple service payments, saying the former could be detrimental to health care providers and adversely affect patients' access to care.
On July 12, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that includes proposals to update payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2019.
Click Here to review the CMS Newsroom Proposed Policy Fact Sheet for more details.
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QPP & Non-QPP comments are due by September 10, 2018.
Johnson & Johnson has put together the following for your review:
Of note:
Hospital Outpatient (OPPS) comments are due by September 24, 2018
CMS Targeted Review Requests are due by October 1, 2018
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The Centers for Medicare and Medicaid Services (CMS) has published a FREE 5 page Fact Sheet for health care providers addressing Medical Privacy.
These topics are addressed in the Fact Sheet: Consent Forms; Incidental Disclosures; Electronic Communications; Sharing Patient Health Status and Location; Mental Health Guidance; Clergy and Family Guidance;
HIPAA - Child Abuse Reporting; List of Resource Hyperlinks to Government websites and documents. Click Here for the CMS Provider Compliance Medical Privacy of PHI Fact Sheet.
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Affiliate Association News
- As has been extensively reported, ASCO has serious concerns about the CY2019 Medicare Physician Fee Schedule, and is outlining concerns for CMS in comments that will be submitted before the open comment period ends on September 10. Estimates show a 4% reduction in reimbursement for the hematology/oncology specialty and a 2% reimbursement reduction for radiation oncology (the actual impact on individual physician practices will depend on the mix of services the practice provides). ASCO's own analysis from PracticeNet shows potential for a 7% cut for cancer care. ASCO has created a practice template letter to allow practices to submit comments through the ACT Network. ASCO strongly encourages practices to personalize the template and add information specific to your practice. Download the practice template letter at https://asco.quorum.us/action_center/.
- NCCN has published the following updates at
www.nccn.org: cancer-associated venous thromboembolic disease (V2.2018), hepatobiliary cancers (V3.2018), Hodgkin lymphoma (V3.2018), lung cancer screening (V2.2019), and vulvar cancer (V1.2019)
NCCN Framework for Resource Stratification of NCCN Guidelines (NCCN Framework™):
B-Cell Lymphomas v4.2018 (updated - preliminary version)
Esophageal and Esophagogastric Junction Cancers v2.2018 (updated - preliminary version)
Gastric Cancer v2.2018 (updated - preliminary version)
Pancreatic Adenocarcinoma v2.2018 (updated - final version)
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- AbbVie and Janssen Oncology inform ANCO and MOASC that the United States Food and Drug Administration has approved Imbruvica for use in combination with Rituxan as a treatment option across all lines of therapy for patients with Waldenstrom's macroglobulinemia.
- In response to California's wildfires, Pfizer Oncology informs ANCO and MOASC that it has implemented emergency relief protocols to ensure that patients have continued access to their Pfizer medicines. If a medicine provided through a Pfizer patient assistance program has been destroyed or lost, or patients who are enrolled are unable to reach their doctors' offices and need their medicine shipped to an alternate location, Pfizer can arrange for early refills and/or new shipping addresses. If new patients urgently need a Pfizer medicine but have been displaced and are unable to access income documentation and other paperwork needed for enrollment into the program, Pfizer is able to waive these requirements so that patients can receive their medication as quickly as possible. Facilities that participate in Pfizer's Institutional Patient Assistance Program can request early replenishment of the Pfizer medicines covered or request additional inventory to meet increased demand. For help with Pfizer's oncology medicines, call Pfizer Oncology Together directly at (877) 744-5675, Monday through Friday, 5am-5pm Pacific. For help with other Pfizer medicines, call Pfizer RxPathways at (844) 989-PATH (7284), Monday through Friday, 6am-3pm Pacific.
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MOASC CALENDAR
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SAVE THE DATE
19th Multidisciplinary Management of Cancers: A Case-based Approach
(Napa, March 15-17)
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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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