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
.
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- DHCS releases two draft telehealth proposals for Medi-Cal patients(California News)
- Oncology Health Care Trends webinar TOMORROW!(MOASC News)
- Bipartisan group of U.S. House of Representatives signs letter to CMS to review and improve prior authorization practices under Medicare Advantage (National News)
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California News
- The California Department of Health Care Services (DHCS) released two draft proposals impacting telehealth policy for Medi-Cal patients. The Department is soliciting feedback from interested stakeholders on both proposals.
The first proposal is California's State Plan Amendment (SPA) intended for submission to the Centers for Medicare and Medicaid Services (CMS), that provides clarification as to when services provided outside of the "Four Walls" of a federally qualified health center (FQHC) or rural health center (RHC) is eligible for the prospective payment system (PPS). It is proposed that all such services be paid the PPS when rendered to homebound, migratory, seasonal workers and homeless patients, patients in the hospital, dental services rendered to established patients by a contracted dental provider, and telehealth services provided to its established patients when certain requirements are met.
The telehealth specific requirements include the following:
"The telehealth communication system must allow the provider at the distant site to view the patient's condition directly without the interposition of a third person's judgement;
The originating site must have a current written agreement with the distant site to furnish the telehealth services. If the originating site compensates the distant site for the provision of telehealth services, the distant site cannot bill for the services outside the PPS rate.
The originating site must provide its established patient with specific information, such as the risks, benefits and consequences of telehealth, confidentiality protections, etc. ... (See SPA text for complete details).
The originating site must document in the established patient's health record the patient's consent to telehealth services.
All health information transmitted during the delivery of telehealth services must be maintained by both the originating and distant sites. Additionally, both originating and distant sites must document that the telehealth services were medically necessary with the same specificity required to obtain approved treatment authorization request (TAR); and
The telehealth services at the distant site must be provided by a licensed health care provider in California."
DHCS has requested that any comments be submitted via e-mail to PublicInput@dhcs.ca.gov and indicate SPA 18-0055 in the subject line by Nov. 2, 2018 no later than 5 pm.
Additionally, DHCS is also proposing to update and clarify its telehealth policy manuals within the Medi-Cal program for: Fee-for-service - Managed Care - Indian Health Services - Family Plan, Access, Care and Treatment (Family PACT) - Teledentistry - FQHCs/RHCs.
Despite points that need clarification, the proposed draft Medi-Cal telehealth policy represents a remarkable step forward. Since the passage of and enactment of AB 415, the Telehealth Development Act, Center for Connected Health Policy has long noted that DHCS had the ability in law to create a more expansive telehealth policy, and is pleased to see such innovative and forward movement by the State.
- On November 15, experts from California and the nation will gather in Sacramento to discuss California's all-payer claims database (APCD). Speakers from Arkansas, Colorado, and Massachusetts will offer lessons learned about designing and implementing databases in their own states. Register now.
- California's low rate of lung cancer deaths saved nearly 5,000 lives in 2014 - and saved Californians at least $500 million just in that year, according to a CALmatters analysis in consultation with public health researchers. Those savings will likely grow into the billions of dollars in the decades ahead, experts say. Earlier this month, a study from the UC San Diego School of Medicine found California's rate of lung cancer mortality was 28 percent lower than the rest of the country in 2014, the most recent year of available data. The study's authors attributed California's low number of lung cancer deaths to the state's early and aggressive anti-smoking initiatives.
- In California, liver cancer incidence and death rates have also declined among Asian Pacific Islanders (APIs) since 2000. Yet rates among Latinos and African-Americans have increased over that same period, according to data from the California Cancer Registry. Just over half of liver cancer cases arise from well-established risk factors, like viral hepatitis, cirrhosis, and non-alcoholic fatty liver disease, according to Salma Shariff-Marco, a UCSF professor who works on the Greater Bay Area Cancer Registry. Researchers, health care professionals and advocates are doing their best to screen, prevent and treat for those risk factors.
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- Noridian/JEMAC has the following updates on their website
- MLN Connects Provider eNews:
Announcements
: New Medicare Card: Handouts and Videos for Patients;
Publications
: Quality Payment Program 2018 MIPS Cost Performance Category Web-Based Training Course-New; Quality Payment Program 2018 MIPS Improvement Activities Performance Category Web-Based Training Course-Revised; Quality Payment Program 2018 MIPS APMs Web-Based Training Course-Revised; Quality Payment Program 2018 Advanced APMs Web-based Training Course-Revised; Items and Services Not Covered under Medicare Booklet-Revised
* Chemotherapy Administration-R14
* Magnetic Resonance Imaging (MRI)
* What's New in the Fourth Quarter Webinar (November 1)
* Recovery Auditor (RAC) Program Webinar (November 2)
* Provider-Based Billing Webinar (November 6)
* Recoupment Webinar (November 27)
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- TOMORROW! Genentech cordially invites MOASC and ANCO members to the LunchTimes Series presentation, Oncology Health Care Trends, Wednesday, October 31, 2018 at 12:00pm Pacific time. Dawn Holcombe, President DGH Consulting, will present perspectives from managed care organizations, specialty pharmacies, oncologists, practice managers and employers. To RSVP, go to: www.geniersvp.com/SGEN19453 or contact Jennifer Fraga at fraga.jennifer@gene.com or (415)740-5445.
No Industry Representatives Allowed.
- MOASC Member, presents City of Hope CME: Current Trends in Urologic Oncology CME Conference. We hope you will support this program and invite a colleague to join you. Below, please find a breakdown of the conference information:
-Meeting name: Current Trends in Urologic Oncology CME Conference
-Meeting dates and location: February 8 to February 10, 2019 The Pines Lodge, Beaver Creek Resort, CO.
- SAVE THE DATE! Saturday, February 23, 2019 for MOASC's Oncology Summit, Advancing Cancer Care in the Elderly, at the Hyatt Regency Huntington Beach Resort & Spa. Mark your calendar and keep watch for further information on speakers and topics.
- The MOASC Office receives questions from members that we believe are worth sharing:
Question:
A Medicare patient presents at the practice for an office visit, a B-12 injection and Advance Care Planning (ACP). All services performed on that day (E&M, drug, drug administration and ACP) are billed to Medicare. Medicare subsequently denies the ACP.
Answer:
If ACP is done on a day other than the Annual Wellness Visit (AWV), the ACP charge is subject to the patient's coinsurance and deductible. No modifier is to be used on ANY of the services billed for this day. The claim is processed to pay the E&M, drug and drug administration, but the ACP cost is applied to the patient's deductible/coinsurance, NOT waived, and is the patient's responsibility to pay.
It is recommended that the practice discuss these costs with the patient prior to providing ACP services outside an AWV.
JOB BOARD:
Cancer and Blood Care Specialists in Santa Ana is looking for a full time Oncology Nurse.
Minimum qualifications:
2 years experience as a Registered Nurse (RN) in a Medical Oncology setting.
Current CA Registered Nurse (RN) License in good standing.
Current CPR/BCLS certification.
Excellent oral and written communication skills. Excellent customer relationship skills
Compassionate Oncology Medical Group
, a Solo physician medical practice with IV Treatment Suite, located in Laguna Niguel, is looking for an Oncology Register Nurse. Minimum qualifications:
Chemotherapy mixing/administration experience with strong IV skills required.
OTN Nucleus drug management system/Allscripts EHR are a plus.
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- Four seats on the ANCO Board of Directors are up for election in 2018. ANCO seeks nominations for candidates for these seats. This year's election will be conducted via mail ballot in December. Candidates with the top four vote totals will serve for three years (i.e., from 2019-2021, inclusive). Nominate an ANCO member (including yourself) to stand for election to the Board
via e-mail/FAX to the ANCO office at
execdir@anco-online.org/(415)472-3961.
- 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. The next Update takes place on November 17 in San Francisco; download the meeting announcement/registration form at
www.anco-online.org/4Q2018HemeMaligUpdate.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
- HHS Secretary Alex Azar vowed to push forward with the administration's plan to align prices paid by Medicare for most physician-administered drugs with prices paid in other countries, despite opposition from the pharmaceutical industry. The plan also would change how doctors are paid for drugs under Part B. The International Pricing Index Model would create a system in which physicians and hospital outpatient departments would no longer buy and bill for drugs under Part B. Instead, the CMS would contract with private-sector vendors to procure drugs and then distribute them to providers.
- CMS posted three new CME modules on the Medicare Learning Network Learning Management System for the 2018 MIPS:
* Improvement Activities Performance Category: Basics, including reporting requirements, scoring, and flexibilities for small and rural practices
* Cost Performance Category: Overview and how CMS calculates scores
- CMS has published a new MLN Matters
Article MM10984
on Order Requirements when Prescribing Practitioner is also the Supplier and is Permitted to furnish specific DMEPOS
. Effective November 13, 2018, MACs will look at the entire medical record to fulfill the elements of the written order.
The Official Instructions - Transmittal 834 Change Request 10984 -
Click Here
Certification in Clinical Documentation Improvement for the Medical Office WBT - Click Here for more information.
Certification in Forensic Auditing WBT - Click Here for more information.
- The CMS has unveiled a proposed rule that would permit Medicare Advantage plans to provide telehealth services to urban and rural enrollees and allow plan recipients to receive telehealth at home. The proposal would also streamline the appeals processes across Medicare and Medicaid for enrollees in certain dual-eligible special needs plans, require health plans to enhance benefits integration across the two programs to improve coordinated care and upgrade the method used to calculate MA plan star ratings.
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Affiliate Association News
- Register by November 1 for the 60th ASH Annual Meeting on Hematologic Malignancies in San Diego, December 1 - 4, 2018. As Partners with ASH, MOASC & ANCO invite you to register for this highly informative program in southern California. Read more about the meeting and register by November 1 at www.hematology.org/Annual-Meeting.
- ASCO's QOPI Certification Program (QCP) team will host a Standards Webinar on November 9 and an Application Webinar on November 14. These programs allow practices to evaluate performance and demonstrate excellence in quality care. Interested in learning more? Take a closer look at the Program's standards, documentation, and other requirements, and review the application process. Register for a webinar at
https://www.surveymonkey.com/r/qcpwebinarsregistration?
- You are cordially invited to the Research To Practice (RTP) "Year in Review," moderated by Dr. Neil Love, Saturday, November 17, 2018 at Fairmont Miramar Hotel & Bungalows; 101 Wilshire Blvd., Santa Monica, CA 90401. Physicians, nurses and other healthcare providers are welcome. This activity is accredited for CME-ABIM MOC and CNE - ILNA/ONCC. To view the invitation, click HERE. To register or to learn more, please visit:
http://www.researchtopractice.com/Meetings/YIR2018/CA
- In the latest ASCO in Action Podcast, ASCO highlights key studies from this year's ASCO Quality Care Symposium. Specifically, Dr. Hudis highlights new studies on patient financial toxicity and opioid use risks. Listen to the Podcast at
- ASCO's Policy Issue Brief: Federal Funding for Cancer Research--Strengthening the Nation's Commitment to Curing Cancer was published on October 22. Read it at
- The ASCO Nominating Committee has selected fifteen distinguished ASCO members as candidates for open leadership positions with the Society. This year's ballots will also include proposed amendments to the ASCO Bylaws to create a new, affiliated association that will enable ASCO to increase the impact of its policy and advocacy efforts. Eligible ASCO members will be able to vote from November 1 to December 3, 2018. Learn more at
https://www.asco.org/about-asco/asco-overview/asco-election
.
- You have until January 4, 2019 to sign-up with the Web Interface Tool to manually enter quality data. The QOPI Reporting Registry, a QCDR brought to you by ASCO and ASTRO, is your one-stop shop for 2018 MIPS reporting. In one easy-to-use dashboard, report on 25 CMS-approved quality measures as well as attest to participation in Improvement Activities and Promoting Interoperability (formerly Advancing Care Information). Learn more and sign up at https://practice.asco.org/quality-improvement/quality-programs/qopi-reporting-registry?
- SAVE THE DATE for the 2019 Community Oncology Conference! The conference is on April 4-5, 2019 at the Wald Disney World Dolphin Hotel, Orlando, Florida.
- NCCN has published the following updates at www.nccn.org: hepatobilliary cancers (V4.2018), testicular cancer (V1.2019),
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- Amgen announces KYPROLIS® (carfilzomib) is indicated in combination with dexamethasone or with lenalidomide plus dexamethasone for the treatment of patients with relapsed or refractory multiple myeloma who have received one to three lines of therapy.
Here is a link to the new phase 3 study fact sheet.
KYPROLIS®(carfilzomib) for Injection Prescribing Information
.
- AstraZeneca
invites you to participate in a CAP TODAY Webinar focusing on Resectability in Stage III NSCLC: Case-Based Considerations for Clinical Decision Making,
Wednesday, November 14, 2018, 1:00 pm-2:00 pm ET.
Register FREE of charge at
http://www.captodayonline.com/111418webinar
- Genentech informed
MOASC and
ANCO about some changes to their Genentech Access to Care Foundation (GATCF). Effective October 29, 2018, GATCF is officially the
Genentech Patient Foundation. Along with a new name, below are some updates on other changes. Genentech Patient Foundation condensed 5 individual forms to a single Enrollment Form that includes one page for the patient to complete and one page for your office to complete. The Enrollment Form as well as additional helpful information is available
at www.GenentechPatientFoundation.com. If you have any questions, please do not hesitate to call the Foundation phone number at 888-941-3331.
- Seattle Genetics will host an educational program entitled Overview of Adcetris + AVD vs ABVD Clinical Data with Caroline Behler, M.D., California Pacific Medical Center on November 8 at Brix in Napa. RSVP to Renee Belder at (510) 501-6164 or
rbelder@seagen.com
.
- Spectrum Pharmaceuticals' folate analog Khapzory, or levoleucovorin, injection was approved by the FDA for three indications: to rescue after high-dose methotrexate therapy in osteosarcoma patients, to treat patients with metastatic colorectal cancer in combination with fluorouracil, and to lessen the toxicity associated with overdosage of folic acid antagonists or impaired methotrexate elimination. The company intends to introduce the product in January.
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Verastem Oncology informs ANCO and MOASC that the
United States Food and Drug Administration
has approved Copiktra capsules, for oral use, for the treatment of adult patients with relapsed ro refractory chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) after at least two therapies and the treatment of adult patients with relapsed ro refractory follicular lymphoma (FL) after at least two prior sytemic therapies.
-
Verastem Oncology will host a live broadcast and Q&A session on November 1 entitled
Introducing Copiktra capsules: Now Approved for the Treatment of CLL/SLL. Two sessions are being offered at 4PM PST and 6:30PST. Register at
https://verastembroadcast.com.
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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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