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.
December 10, 2019
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- Six days left to enroll in 2020 health coverage. National News
- Effective December 1, new safety standards were set under USP General Chapter <800> National News
- Republicans present a new proposal to lower the cost of prescription medicines. National News
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- The California state Department of Managed Health Care (DMHC) has fined Anthem Blue Cross with $9.6 million from January 2014 through early November 2019, according to a California Healthline analysis of agency data. This represents about 44% of the $21.7 million in total penalties that the department issued against full-service health plans during that period. Of the 10 largest healthplans regulated by the California DMHC, Anthem Blue Cross has received a disproportionate share of violations, penalties, fines and enforcement actions since January 2014, mostly related to its mishandling of patient grievances. By comparison, its largest competitors, Kaiser Permanente and Blue Shield of California, faced far fewer sanctions.
- A California law, which took effect in July 2017, protects consumers who use an in-network hospital or other facility from surprise bills when cared for by an out-of-network doctor. However, physicians say the law has allowed insurers to shrink networks, limiting access to those doctors who have contracted with the patients' insurance plans. More than half of states now provide some level of consumer protection against surprise bills, and the efforts vary. State surprise-billing laws protect only people insured by state-regulated plans. In California, that means 5.5 million consumers whose employers self-fund workers' health claims directly, rather than through an insurance plan, are not covered by the law.
California Surprise-Billing Law Protects Patients But Aggravates Many Doctors
.
Reps. Joe Morelle, (D-N.Y.), Donna Shalala (D-Fla.), Phil Roe (R-Tenn.) and Van Taylor (R-Texas) are circulating a letter asking their House colleagues to support surprise billing legislation including an independent dispute resolution process, an approach supported by providers. The Education & Labor Committee shares jurisdiction over surprise billing.
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- Starting January 1, if you do not use the MBI (regardless of the date of service) for Medicare transactions Noridian
will reject your claims with a few
exceptions
and Noridian will reject all eligibility transactions.
- Noridian/JEMAC has the following updates on their website
Announcements:
MBI Transition Ends This Month: Will You Be Paid on January 1?; Quality Payment Program: MIPS Exception Applications due December 31; Clinical Laboratory Fee Schedule: CY2020 Final Payment Determinations; Quality Payment Program: 2019 APM Inventive Payment Details; Average Sales Price Files: January 2020
Events:
Medicare Promoting Interoperability Program 2020 Webinar-January 16
Publications:
* Jurisdiction E Part B LCDs and LCAs-Effective December 1, 2019
* Medicare Secondary Payer (MSP) Education on Demands
* Summary of Policies in the Calendar Year (CY) 2020 Medicare Physician Fee Schedule (MPFS) Final Rule, Telehealth Originating Site Facility Fee Payment Amount and Telehealth Services List, CT Modifier Reduction List, and Preventive Services List CR11560
* MRI and CT Scans of the Head and Neck LCD-R7
* ACT Questions and Answers-November 14, 2019
* Educational Events-December 2019
Forthcoming Noridian JEMAC meetings/webinars/workshops
* Using the Medicare Beneficiary Identifier (MBI) Webinar (December 19)
* What's New in the First Quarter 2020-After Hours Webinar-(January 7)
* What's New in the First Quarter 2020-After Hours Webinar-(January 14)
For more information and to register visit:
http://med.noridianmedicarecom/web/jeb/education/training-events
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- The MOASC Oncology Summit, Saturday, March 14, 2020 at the Hyatt Regency Huntington Beach. The MOASC Oncology Summit continues to highlight cutting-edge topics presented by world-renowned physicians. You will not want to miss our 2020 program!
- MOASC Member, City of Hope CME presents: Immunotherapy of Cancer: CAR T Cell to Checkpoint Inhibitors March 18, 2020 to March 21, 2020 @ Waldorf Astoria, Las Vegas, Nevada. For more information click
here
and to register go to
https://cme.cityofhope.org/eventinfo_11295.html
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- REGISTER for
Best of SABCS Northern California
taking place in Berkeley on January 11.
Best of SABCS
is cosponsored by ANCO and
Encore Medical Education
.
- REGISTER for the
20th Multidisciplinary Management of Cancers: A Case-based Approach
taking place in Napa on March 13-15.
- ANCO physician members should have received an e-mail instructing them on how to vote in the 2019 Annual Election that is being conducted online from now through the end of December. If you have not received an e-mail, then please contact ANCO at courtney@anco.org.
- ANCO physician members, their practice staff, and representatives from ANCO's corporate members must register to access password-protected content (e.g., The ANCO Directory, ANCO meeting materials) on the ANCO website (
www.anco.org
) at
https://anco.org/membership/already-a-member/
.
- Follow ANCO on Twitter at
@ANCO News
.
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National News
- There are six days left to enroll in 2020 health coverage.
Visit HealthCare.gov today to enroll in a plan that meets your needs. The last day to enroll in a 2020 health plan is Sunday, December 15. Create Account Here
- Effective as of December 1, new safety standards were set under USP General Chapter <800> regarding the handling and administering of hazardous drugs. These new standards will impact the eight million healthcare professionals nationwide that come into contact with these drugs. As such, implementing new compliance procedures can be a huge undertaking for practices.
Read here for more information from RxVantage or contact the MOASC office moasc@moasc.org about the updates and strategies to ensure compliance in your practice.
- Yesterday, Republicans were set to accelerate Capitol Hill's drug pricing chaos with a new proposal to lower the cost of prescription medicines. The proposal intends to compete with a Democratic package from House Speaker Nancy Pelosi that is expected to come up for a vote this week. The Republican lawmakers' new proposal includes a collection of bipartisan proposals collectively rebranded as the "Lower Costs, More Cures Act." The House bill, according to Republican aides, is a "good-faith effort" to overcome partisan drug pricing squabbles, and includes a number of provisions that could conceivably become law before the end of 2019.
- A wave of Facebook ads that ran this fall appeared to suggest that House Speaker Nancy Pelosi's bill to lower drug prices does not have the backing of many of the nation's biggest labor groups. The ads, featuring a dejected-looking man in a hard hat, warned that the bill "threatens thousands of good-paying jobs and restricts access to lifesaving medication." It appears that labor unions are teaming up with drug makers.
A low-profile group, financed by the pharmaceutical industry, has hired former union officials to oppose drug-price proposals around the country.
- Last year, Congress passed the SUPPORT for Patients and Communities Act as part of an effort to combat the opioid epidemic. The act required the Drug Enforcement Administration (DEA) to issue regulations on a special registration process that would allow providers to prescribe controlled substances through telemedicine under certain circumstances. The DEA officially missed its deadline, set at one year from the passing of the Act on October 24th. A recent regulatory posting suggests the DEA plans to publish a proposal for the special registration in December, although there is no definitive timeline outlined for the rule's publication. The directive originated from the Special Registration for Telemedicine Clarification Act of 2018, which was adopted into the final opioid package, and was intended to ensure compliance with the Ryan Haight Act while expanding access to controlled substances, especially medications used in medication assisted therapy and psychiatric care.
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CMS News
- A new CMS rule will require Medicare, Medicaid and Children's Health Insurance Program to disclose relationships with other providers and suppliers who may have been sanctioned by the CMS or had other negative interactions with the agency. Practices will need to determine which entities would be considered an "affiliated relationship," and "bad actors" may need to be avoided in order to protect the practice. Modern Medicine/Physicians Practice
- Earlier, CMS had published updated open payments data reported in 2018 and physicians have until December 31 to review and dispute the 2018 data reported in their name. Learn more and review your data at
https://openpaymentsdata.cms.gov.
- Group practices or individual eligible clinicians interested in applying for a hardship exception to the promoting interoperability category or an extreme and uncontrollable circumstances exception to other MIPS categories for the 2019 performance year must submit an application by Dec. 31. For more information, visit the Quality Payment Program
resource library
, which outlines eligibility, where to submit applications, and information on how approval will be noted.
- With the release of the final 2020 Fee Schedule, the American College of Physicians agrees with CMS for their updated E/M payment proposals and recommends the Agency finalize acceptance of the E/M codes, Current Procedural Terminology (CPT) guidelines, and Specialty Society Relative Value Scale Update Committee (RUC) recommended values exactly as implemented by the CPT Editorial Panel and submitted by the RUC. ACP fully supports CMS' proposal to align the previously finalized E/M office visit coding changes with the framework adopted by the CPT Editorial Panel. Despite its support, ACP is calling for further guidance from CMS: ACP recommends CMS provide additional clarity on what will be accepted for time-based and MDM-based documentation, either in the final rule or through sub-regulatory guidance. Further, CMS should work to ensure that the auditing guidelines and procedures are updated and aligned to focus on both time-based and MDM-based notes, as well as applied consistently by all auditing organizations.
- Updating codes is essential in a medical practice. The repercussions of failing to do so can be detrimental, including slower-processed claims or cause denials, or a loss of eligibility of participation in programs like Medicare and Medicaid, among others. Proper preparation is crucial to avoiding such fallout, which bodes well for the 69% of healthcare leaders who responded to the latest MGMA Stat poll saying their practices provide training to staff for yearly code updates.
Holidazed and confused: Making sure your coders are ready for Jan. 1 updates
- Total national healthcare spending in 2018 grew 4.6 percent, which was slower than the 5.4 percent overall economic growth as measured by Gross Domestic Product (GDP), according to a study conducted by the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS). Health care spending growth was mixed in 2018 for the three largest goods and service categories - hospital care (
33 percent of total healthcare spending an increase of 4.7 percent)
; physician and clinical services
(20 percent of total healthcare spending an increase of 4.1 percent);
and retail prescription drugs
(9 percent of total healthcare spending an increase of 2.5 percent)
.
- Primary care is not sufficient for residents in rural communities with complex chronic conditions, according to new research that revealed a lack of access to specialists has driven up mortality rates and preventable hospitalizations. Medicare beneficiaries who lived in rural areas had a 40% higher preventable hospitalization rate and a 23% higher mortality rate compared with their urban peers, according to a new study published in Health Affairs. But attending one or more specialist visits during the previous year dropped mortality rates for people with complex chronic conditions by 16.6% and preventable hospitalization rates by 15.9%, the researchers' analysis of nearly 12,000 Medicare beneficiaries from 2006 to 2013 found.
Telemedicine can fill rural specialist shortages in areas like stroke neurology, diabetes and infectious disease consultation. But reimbursement remains an issue.
The CMS aims to bridge primary-care gaps by paying for virtual check-ins by telephone, remote evaluations of imaging and remote wellness visits. The agency also expanded the scope of practice of lower-level non-physician providers to offer primary care and increased the wage index of rural hospitals to allow them to recruit more clinicians.
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Affiliate Association News
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- Please support the Community Oncology Alliance (COA) for 2020.
With COA serving as your voice in the legislative deliberations, decision-making, and negotiations in Washington, community oncologists have been able to markedly influence public policies like never before for the better of patients and practices. This year COA faced down major reforms to the ASP reimbursement system, including proposals for ASP + 3 percent and even a flat-fee add-on; provided guidance to CMS on the Oncology Care Model (OCM) and just-announced successor, the Oncology Care First (OCF) model; advocated for changes to site parity with hospital payments and the 340B program; and so much more. Importantly, COA spent an incredible amount of resources, time, and money fighting a variety of PBM and insurer issues, launching a major media campaign, undertaking legal action, and advancing legislation, all aimed at exposing and stopping PBM abuses that hurt patients and practices. COA 2020 Member Renewal Letter
- Read COA's government affairs update. This new, exclusive publication is part of COA's renewed effort to give you more regular updates on the issues COA is working on. COA GAP Update Q4 2019
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The Oncology Nursing Society (ONS) and ASCO will co-host a free
webinar, Offering Clinical Trials Can Make a Difference: Patient and Care Team Perspectives, on December 11 from 12:00pm-1:00pm Pacific. A cancer survivor, community oncologist and research nurse will share their perspectives on the benefits and challenges of being involved in clinical trials, especially in the community setting. They will offer practical strategies and resources to increase clinical trial access and participation, including how to effectively discuss clinical trials with patients and colleagues.
Register Now
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ASCO urges all members to tell Congress to pass a full FY2020 funding bill that invests in cancer research.
Congress
passed another continuing resolution (CR) on November 21--the second CR since the start of the fiscal year (FY), which was October 1. Short-term spending bills make it difficult for the National Institutes of Health (NIH)--as well as the institutions and scientists it supports--to effectively plan for research projects. Stay up to date on Federal funding and other oncology policy issues at
ASCO's ACT Network
.
- ASCO has launched a new payment reform model to transform cancer care delivery and enhance the quality of patient care. The Patient-Centered Oncology Payment (PCOP) model is uniquely positioned to confront care delivery challenges in an increasingly complex medical specialty. Learn more here.
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ASCO Education Essentials for Oncology Fellows include access to over 100 up-to-date clinical care eLearning courses and ASCO's Meeting Library, where you can view presentation videos and slides from ASCO Annual Meetings and Symposia.
- NCCN has published updated guidelines at
https://www.nccn.org/professionals/physician_gls/default.aspx
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Industry News
- Foundation Medicine announced that the FDA has approved FoundationOne CDx
(F1CDx) to be used as a companion diagnostic (CDx) for alpelisib in combination with fulvestrant for the treatment of men and postmenopausal women with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative, PIK3CA-mutated, advanced, or metastatic breast cancer following progression on or after an endocrine-based regimen.
- Genentech BioOncology announces that the FDA has approved Tecentriq in combination with paclitaxel protein-bound and carboplatin for the first-line treatment of adult patients with metastatic non-squamous non-small cell lung caner (NSCLC) with no EGFR or ALK genomic tumor aberrations.
- Teva Oncology will reintroduce Vincristine, a cancer drug used in adult cancers and of special importance to pediatric oncology, to the market.
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MOASC CALENDAR
Spotlight On Hematology
February 1, 2020
City of Hope CME presents: Immunotherapy of Cancer: CAR T Cell to Checkpoint Inhibitors
March 18-21, 2020
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(Stanford, April 2-3, 2020)
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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 MOASC and ANCO 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 2954, Alameda, CA 94501 | P (415) 472-3960 | www.anco.org
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