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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J
uly 3
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The American Revolution and the Declaration of Independence, it has often
been argued
,
were fueled by the most radical of all American political ideas.
Carl Bernstein
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This Weekly's Hot Topic's
- FY 2019 ICD-10-CM code changes have been released. (National News)
- Send COA any & all PBM delayed & compromised patient care stories. (Affiliate News)
- BIO opposes any measure shifting greater drug costs to patients. (Industry News)
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California News
- The CMA reports that HealthNet will not proceed with implementation of its modifier -25 and emergency services payment policies in California. HealthNet will be sending out an official notice to physicians about the change. Additionally, HealthNet expressed a commitment to work with CMA and others to implement an educational program focused on providing data and feedback to physicians, as well as information on proper coding practices for emergency department services.
- The California Department of Managed Health Care (DMHC) has directed Anthem to include effective dates on all its guidelines and to ensure that its portal clearly notes whether particular guidelines apply in California. CMA reports that it does not appear that Anthem has fully complied with the DMHC order and has alerted DMHC to their concerns. DMHS is looking into the matter further.
- Please join CAPP/MICRA for an evening reception in honor of Assembly Member Marc Berman on Wednesday
, August 1st from 4:30 pm - 6:00 pm. The reception will be held at Los Altos Sub-acute and Rehabilitation Center (809 Fremont Ave, Los Altos, CA 94024).
- Last Friday was the last day for policy bills with a fiscal impact to pass the policy committee and make their way to the Appropriations Committee for consideration. A few of the key bills:
- AB 1860 (Limon): Health Care Coverage: cancer treatment. This bill would eliminate the sunset on a statute that caps out of pocket expenses for oral anti-cancer medication to $250 per prescription per month.
- AB 1998 (Rodriguez), would require health care providers to develop a policy related to the prescribing practices for opioids.
- AB 2863 (Nazarian) would prohibit a health plan from requiring an enrollee to pay the copayment amount for the prescription medication, if the retail price is less.
- AB 2965 (Arambula) would allow Medi-Cal access to undocumented immigrants between the ages of 19-25 years of age and SB 974 (Lara) would extend coverage to undocumented adults over age 65.
- SB 212 (Jackson), Solid waste: pharmaceutical and sharps waste stewardship, would develop a statewide drug and medical sharps take back program funding by the pharmaceutical industry. It would not pre-empt any of the current city/county take back programs. Many in the drug and sharps community, as well as the pharmacists and drug store associations, are opposed unless amended on the bill.
- SB 1021 (Weiner): This bill extends the January 1, 2020 sunset on law that caps cost sharing for a covered outpatient prescription drug at $250/$500 per 30-day supply and codifies a regulation that prohibits an enrollee or insured from beingcharged more than the retail price for a prescription drug when the applicable copayment or coinsurance is a higher amount.
The next deadline is for fiscal bills to move out of fiscal Committee on or before August 17th. With the legislature out on break the month of July, there will not be a lot of time between when they get back on August 6th and that deadline.
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- Noridian/JEMAC has the following updates on their website
- MLN Connects Provider eNews:
Announcements: New Medicare Card Mailing Update-Wave 3 Begins, Wave 1 Ends; New Medicare Card: Use MBI Like HICN; CMS Data Element Library Supports Interoperability; Physician Self-referral Law RFI: Submit Comments by August 24; Qualified Medicare Beneficiary Information on RAs and MSNs; Laboratory Date of Service Exception-Reminder; Administrative Simplification Compliance Resources
Claims, Pricers & Codes:
New Part B Edit for Duplication of Diagnosis Codes on Hard Copy Claims
Publications
:
MBI: Get It, Use It MLN Matters Article-Revised; Hospital OPPS: July 2018 Update MLN Matters Article-Revised; Telehealth Billing Requirements for Distant Site Services MLN Matters Article-Revised
* Non-Covered Services LCD-R23
* Additional Information Required for Coverage and Pricing for Category III CPT Codes-R4
* MBI-Get It, Use It-Revised SE18006
* HCPCS Drug/Biological Code Changes-July 2018 Update-Second Revision CR10624
* Qualified Medicare Beneficiary Information on RAs and MSNs
* Interactive Voice Response (IVR) Authentication
- Upcoming Noridian/JEMAC webinars include:
* What's New in the Third Quarter 2018 Webinar (July 10)
* Critical Care Webinar (July 11 and 12)
* Noridian Part B Web Tour (July 12)
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In recognition of Independence Day, MOASC Office will be closed Wednesday (7/4).
MOASC will resume normal hours on Thursday 7/5. Enjoy the holiday!
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SAVE THE DATE! Saturday, August 11, 2018, 1:00pm - 7:00pm for MOASC's Spotlight on Oncology, at the Waterfront Beach Resort Huntington Beach.
Southern California Oncologists, who attended ASCO in June, will present topics that include updates on:
Breast cancer; Genitourinary GU cancer; Melanoma; Targeted Agents in Non-Small Cell Lung Cancer; GI Non-Colorectal Malignancies; GI Colorectal Malignancies; Precision Medicine in Oncology. For more information and to register, e-mail moasc@moasc.org or call 800-310-3553 x1.
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A MOASC Member is having trouble finding and purchasing IV Magnesium
. Please contact
moasc@moasc.org
if any of your suppliers have it in stock. Thank you!
- MOASC and ANCO are jointly conducting a 2018 staff salary survey. The survey will be USPS mailed, e-mailed/FAXed to all MOASC members in mid-May and is available online at
www.anco-online.org/salary.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.
JOB BOARD:
The Medical Oncology Care Associates in Orange, California has 3 available positions:
Physician:
Full-time, board certification and/or board eligible in oncology &/or hematology.
Register Nurse:
Immediate position available 3 days/week. Must have a minimum of 2-3 years of experience. Duties include: Injections, start IV's, PAC/PICC access, flushes, chemo admin, computer-EMR, vitals, venipuncture and admin duties as required.
Medical Assistant:
Back Office/Full-time Monday-Friday. Taking vitals, venipuncture, phlebotomy, multitask, Injections, assists MD. Requirements: H.S. graduate or GED equiv., Medical Assistant diploma and Phlebotomist Certification. At least 1 year of working experience. Spanish speaking preferred, but not necessary. Please email your CV or resume to
Julie@medicaloncologycare.com or fax (714) 547-7326.
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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.
- 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 members may register at a discounted rate for the
19th Annual International Lung Cancer Congress
(Hyatt Regency Huntington Beach, July 26-29) at
http://gotoper.com/go/ILC18ANCO
.
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SAVE THE DATE: ANCO'S
ASCO Highlights 2018
will take place on August 25 at The Claremont Resort in Oakland. Download the announcement and registration form at www.anco-online.org/ASCOHL2018.pdf.
- ANCO is organizing a series of Hematologic Malignancies Updates in 2018. The first Update took place on June 16 at the Sacramento Hyatt Regency with Gabriel Mannis, M.D., University of California, San Francisco, 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--leukemias, lymphomas and myeloma--along with case studies for these diagnoses were presented. 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; watch for an announcement and registration form in August.
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- The National Center for Health Statistics has released the FY 2019 ICD-10-CM code changes. The FY 2019 ICD-10-CM codes are to be used from Oct. 1, 2018 through Sept. 30, 2019. Click here for more information, to access the changed codes, and to download the complete code set.
- The UnitedHealthcare Network Bulletin (July 2018) is now available online at www.unitedhealthcareonline.com> Tools & Resources > News & Network Bulletin and features articles entitled: Network National Laboratory Services Care Providers 2019; Enhanced Prescription Functionality Now Available with Athena Health; Updates to Notification/Prior Authorization Requirements for Specialty Medications for UnitedHealthcare Commercial and Community Plan Members; Process Change: Colony-Stimulating Factors.
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CMS News
- As the new Medicare cards are replacing the beneficiaries' Social Security (SSI) numbers with Medicare Beneficiary Identifier (MBI) numbers, some Medicare Administrative Contractors (MACs) are adding QR codes to the new Medicare cards, which replace older cards. The QR codes have been added to assure the correct cards are being sent to the right beneficiaries. Neither your practice, facility, nor the patient need to do anything with the code on the card. The new cards started being mailed April 2018 and are being mailed to Medicare beneficiaries through next year. Federal agencies hope the new numbers will cut identity theft and fraud of the SSI numbers and protect personal health information.
More information is available on the CMS website.
- Physicians who bill Medicare for telehealth services are reminded that they must use the place of service code 02 to indicate services were furnished via telemedicine. Previously, the modifier -GT was used on telehealth claims, but use of this modifier was eliminated except in limited circumstances for certain Critical Access Hospitals billing under Method II. If the -GT modifier is used in any other circumstances, the claim line will be rejected. To learn more about billing and payment for telehealth services in 2018, download CMS' guidance.
- On July 24 and 26, CMS will host two 60-minute Physician Compare webinars about public reporting on Physician Compare and information in the pipeline for potential inclusion on Physician Compare in late 2018, including Year 1 Quality Payment Program performance information. Specifically, the webinars will cover: Overview of public reporting on Physician Compare; Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) on Physician Compare; Upcoming 30-day Preview Period.
Two different times are offered. Both webinars will present the same information. During each webinar, you will have an opportunity to ask questions. Registration information coming soon.
To learn more about public reporting on Physician Compare, visit CMS' Initiative page where you can find resources and documents, including information about the 2016 performance information currently available on Physician Compare.
- The public comment period ends this Thursday, July 5, 2018 until 2:00 p.m. Pacific time, for CMS' published draft, 2019 CMS Quality Reporting Document Architecture (QRDA) Category III Schematron for Eligible Clinicians and Eligible Professionals. This is a draft document and the contents are subject to change. The 2019 CMS QRDA III Schematron is a companion to the 2019 CMS QRDA III Implementation Guide (IG) and allows for computerized validation of QRDA documents against the IG requirements. The Schematron helps eligible clinician and eligible professional submitters check QRDA III files for the calendar year 2019 reporting period in the Merit-based Incentive Payment System (MIPS), Comprehensive Primary Care Plus (CPC+) Program, and the Medicaid Promoting Interoperability (PI) Program. To Submit Comments on the draft Schematron, use JIRA ticket number QRDA-700. A JIRA account is required to comment. The final 2019 CMS QRDA III Schematron and sample file will be published in late July 2018 on the
Electronic Clinical Quality Improvement (eCQI) Resource Center QRDA page
. Additional QRDA-Related Resources, as well as current and past implementation guides, are found on the eCQI Resource Center QRDA page. For questions related to this guidance, the QRDA Implementation Guides or Schematrons, visit the
ONC QRDA JIRA Issue Tracker
.
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Affiliate Association News
- COA and their Pharmacist group, COPA, are needing your help to send to them ANY & ALL PBM delay stories, as well as any other stories where patient care is compromised.
Several fronts, including legislative (federal and state levels) and legal are being tapped into! The message MUST go out far and wide. Below are some quick links to a couple of projects that COPA board members have been working on. There are links to two articles and one podcast below that are very well done regarding the challenges that we all face surrounding PBMs and them restricting our ability to care for our patients.
- ASH has submitted comments on the CMS National Coverage Analysis for CAR T-cell therapy for cancer. ASH recommended that CMS not proceed with a National Coverage Determination (NCD) at this time because CAR T-cell therapy is an evolving area of medicine and with over 400 clinical trials in process, it is impossible to know what the ultimate applications of this therapy will be. Read ASH's letter at
- On July 10, ASH, along with the Lymphoma Research Foundation and the National Comprehensive Cancer Network, is co-hosting a briefing on Capitol Hill to educate Members of Congress and staff on chimeric antigen receptor (CAR) T-cell therapy. This innovative treatment, currently approved for certain patients with leukemia and lymphoma, is used to treat the sickest of the sick, typically individuals who have exhausted all other treatment options, including chemotherapy, radiation, or stem cell transplant. The briefing will provide an opportunity for attendees to learn about the development of CAR T-cell therapy, the way in which CAR T-cell therapy treats blood cancer, and to hear directly from a patient about her own treatment experience. Confirmed speakers include MOASC member, Dr. Joseph Alvarnas, City of Hope, Duarte, CA, Chair, ASH Committee on Practice. Please reach out to Leslie Brady
lbrady@hematology.org
for more information.
- ASCO's Best of ASCO San Diego takes place on July 13-14. Registration and housing is now available at
https://west-boa.asco.org.
- ASH is accepting nominations for the Honorific and Mentor Awards through July 16, 2018. The ASH Honorific and Mentor Awards are the highest level of recognition that the Society bestows for contributions to the field of hematology. Information about the awards is available on the ASH website: Honorific and Mentor. Nominations can be filled out at: https://awards.hematology.org.
- ASCO is requesting you to
submit an abstract
no later than July 24 by 8:59 PM (PDT) for the Palliative and Supportive Care in Oncology Symposium, on November 16-17, 2018 in San Diego.
Innovative and cutting-edge research is growing across the field of palliative and supportive care, underpinned by continuing advances in symptom science. This symposium is the ideal venue to present your research to colleagues interested in the integration of palliative and supportive care across various cancer care settings.
- The Medicare PROPOSED Regulations for 2018 should be out this week. onPoint Oncology and Bobbi Buell are scheduling the following Lunch and Learn Webinars: Proposed 2018 Medicare Regulations: Offices and Hospital Outpatient on 7/20/2018 and 7/27/2018 at 9am PDT (12pm EDT, 11am CDT, 10am MDT).
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All hematology researchers are encouraged to submit an abstract by
August 1 at 11:59 p.m. Pacific time, for the best new scientific research in all areas of hematology. More than 1,000 abstracts will be presented orally, at the 60th ASH Annual Meeting and Exposition in San Diego, with thousands more accepted for poster presentations. All accepted abstracts will be published in Blood. Don't miss this great chance to showcase your research in front of the brightest minds and influencers in the field of hematology! Visit the
ASH website for a full list of abstract review categories, policies, and eligibility requirements.
- ASCO has launched a new ACT Network that makes it easier than ever to advocate on behalf of the oncology community. The new portal is tailored specifically to each user, and automatically provides detailed profiles of the user's state and federal lawmakers. Access the new ACT Network at http://www.asco.org/ACTNetwork.
- Purchase an all-access pass to watch ASCO Annual Meeting videos and download the high-resolution slides in any of five main tracks--breast cancer, lung cancer, genitourinary cancer (prostate), genitourinary cancer (non-prostate), and gastrointestinal cancer. Purchase these materials at
- NCCN has published the following updates at www.nccn.org: B-cell lymphomas (V4.2018), bladder cancer (V4.2018), cervical cancer (V2.2018), chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL; V5.2018), non-small cell lung cancer (V5.2018), penile cancer (V2.2018), prostate cancer (V3.2018), rectal cancer (V2.2018), systemic light chain amyloidosis (V1.2018).
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- Array BioPharma
informs ANCO and MOASC that the US FDA has approved Braftovi capsule and Mektovi tables as an oral combination therapy for patients with unresectable or metastatic melanoma with BRAF V600E/K mutation as detected by an FDA-approved test. Braftovi is not indicated for the treatment patients with wild-type BRAF melanoma.
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Biotechnology Innovation Organization (BIO) and its members believe that insurance coverage policies should provide all patients access to appropriate treatments in a timely manner.
Even seemingly small changes to cost-sharing requirements can have detrimental impacts on patient adherence and can lead to higher health care costs when a disease is not managed appropriately. Whether or not a patient can access treatments recommended by their health care provider should not depend on the structure of that patient's health benefit plan.
BIO opposes any measure that would shift greater drug costs to patients - including the adoption of rules or requirements by health plans that restrict or limit the ability of individuals to utilize the full benefit of manufacturer patient assistance programs. Read More
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MOASC CALENDAR
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SAVE THE DATE
ANCO Hematologic Malignancies Updates (Palo Alto,
September 15)
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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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