California Oncology Weekly
"Where California Oncologists Go For Answers!"
A publication of the
Medical Oncology Association of Southern California, Inc.
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This
Weekly
's Hot Topics
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- TOMORROW, April 29, webinar on Protecting Patients with NERLYNXIndustry News
- State issued guidelines for, "Resuming California's Deferred and Preventive Health Care." California News
- CMS will be suspending new APP applications & reevaluating APP amounts CMS News
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The State just issued guidelines for "Resuming California's Deferred and Preventive Health Care." The link to the full memo is below. It looks like the focus is on the following:
- COVID-19 indicators (e.g., infection rates, hospitalizations, ED admissions, ICU beds, and SNF outbreaks);
- Ensuring adequate PPE is available;
- Availability of testing when knowing the COVID-19 status of staff or patients is important for clinical care and infection control;
- Consultation with local public health officers;
- Availability of qualified staff;
- Having patient flow systems and infection control precautions in place.
It does appear that we will have a great deal of variability in how this gets implemented from region to region and among-st provider and facility types.
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Recent Announcements Published to "Latest Updates" of Medicare Jurisdiction E Part B.
- A publication from Noridian provided billing and coding guidelines for Truxima
https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/761088s001s002lbl.pdf). The coverage article summary states that, effective July 1, 2019, Noridian covers Truxima (rituximab-abbs) only for the FDA approved labeled indications of: * Relapsed or refractory, low grade or follicular, CD20-positive B-cell NHL as a single agent. *Previously untreated follicular, CD-20 Positive, B-cell NHL in combination with the first line chemotherapy and in patients achieving a complete or partial response to a rituximab product in combination with chemotherapy, as a single-agent maintenance therapy. And, * Non-progressing (including stable disease), low-grade, C20-positive, B-cell NHL as a single agent after first-line cyclophosphamide, vincristine and prednisone (CVP) chemotherapy.
Billing instructions for C9399 with dates of service between 11/28/2018 and 06/30/2019. Effective 07/01/2020, Q5115 is to be used by all facilities when billing this drug.
Our colleague, Bobbi Buell noticed that under this policy, TRUXIMA does not show an indication for CLL, yet is a covered indication according to the FDA. Per Bobbi, "...It is not the largest indication for TRUXIMA. The drug manufacturer claims they have spoken to Dr. Lurvey several times about this. The drug was approved a long time ago. But, it wasn't launched until the end of last year, so there aren't a huge number of claims. Yet, there are denials in your area (southern California), claims are going thru fine for other indications..."
The MOASC Office moasc@moasc.org or 909-985-9061 x1, is interested to know of any member having Noridian payment issues with this drug and the FDA labeled indications.
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Upcoming Education: Please see Noridian's schedule of events webpage for upcoming trainings on Telehealth and COVID-19. JEA, JEB, JAF, and JFB
- Tomorrow -Telehealth Services: A Review of Common Questions Related to COVID-19 on Wednesday, April 29, 2020 10:00 AM - 11:30 AM PDT, due to the increased number of inquiries that Medicare received regarding telehealth service benefits related to this public health emergency, on this webinar, we will review common questions and provide you with answers. We will also share available resources to assist you. To register got to: https://register.gotowebinar.com/register/250751729582895627
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MolDX: Decipher Biopsy Prostate Cancer Classifier Assay for Men with Intermediate Risk Disease Final LCD - Effective May 04, 2020. This Local Coverage Determination (LCD) has completed the Open Public Meeting and Contractor Advisory Committee (CAC) comment period and is now finalized under contractor numbers: 01112 (NCA), 01182 (SCA), 01212 (AS, GU, HI, NMI), and 01312 (NV). Responses to comments received may be found as a link at the bottom of the final LCD. Read the complete update.
- Noridian Medicare Portal (NMP) Self Service Reopenings Webinar - May 5, 2020. This event includes: How to complete a reopening through the NMP, Resources and Reminders Read the complete update.
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Top Denial Code Inquiries and Solutions Webinar - May 13, 2020. This event includes: Duplicate Claim Denials, Medical Unlikely Edit Denials, Medicare Secondary Payor Denials, Overlapping Claim Denials, MBI Denials, Resources Read the complete update.
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Small physician practices and independent medical groups might have to close or sell their business as they manage the severe financial problems resulting from the coronavirus pandemic.
Some are seeing revenue drop by 50% to 90%, and a recent survey revealed 20% of primary care practices expect to close temporarily within the coming month Axios
.
MOASC is a source to assist member practices through this time. You are encouraged to contact the MOASC Office at 909-985-9061 x1 or moasc@moasc.org to work with you.
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MOASC continues to solicit questions and provides the answers for members. Following are some of this week's Q & A for your review.
Q: May all Medicare-enrolled providers bill for telehealth services?
A: These providers may perform approved telehealth services that are within their approved scope of practice and within CMS coverage guidelines. Medicare-enrolled providers who may bill telehealth services are: Physicians; NPs; Pas; Nurse-midwives; CNSs; Certified Registered Nurse; Anesthetists. For more information, refer to the MLN® Booklet: Telehealth Services.
Q: What modifiers are needed for telehealth claims?
A: Services provided via telehealth require a modifier -95. Telehealth claims submitted by Critical Access Hospitals still require modifier -GT. Rules for other previously used modifiers remain the same (e.g., modifier -25) and these may be used as applicable.
Q:
When is Modifier -CS used on a claim for a telehealth service?
A: Physician and practitioner services that lead to either an order for, OR administration of, a COVID-19 lab test, are not subject to copay or deductible charges. Modifier -CS is added to the physician/practitioner service to define this circumstance and allow the claim to process without co-pay or deductible application. During either a telehealth or face-to-face service, the provider may order a COVID-19 test or perform a COVID-19 test. Modifier -CS is added to the claim for either of these visits. This applies to all pertinent claims with date of service 3/18/2020 and thereafter.
- MOASC wants to assure their members and colleagues that if the need arises, MOASC Board, Officers & Staff are available to answer any questions you may have. Through this publication and e-mail notices, MOASC has provided COVID-19 related advice regarding telehealth, Cares Act funding, pension plan funding and the nuance of these programs in your practice. PLEASE SHARE YOUR CONCERNS AND ISSUES WITH US at moasc@moasc.org. We wish to help you in any way to get through these challenging times, as we surely will. After all, we are in this together. Here are links to some useful COVID-19 resources:
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- The Association of Northern California Oncologists (ANCO) is conducting a survey for Hematologists and Oncologists to learn how COVID-19 is impacting their practice. Please take a moment to complete our brief survey:
https://forms.gle/5jPTGrGtVeSEujVf9
- The Association of Northern California Oncologists (ANCO) continues to monitor the novel coronavirus (COVID-19) pandemic and is committed to providing the membership the best possible information with which to make clinical and personal well-being decisions.
We encourage member practices to let ANCO know of COVID-19 resources they are depending upon and found useful and how they are responding to COVID-19 and serving their patients and staff at director@anco.org (Use Subject: COVID-19: RESPONSE). Thanks!
- Applications period has been extended for ANCO's Travel Awards to Fellows and Young Clinicians to support attendance at the ASCO Annual Meeting, ASH Annual Meeting, or other national oncology meeting in 2020. The deadline for submission is the end of the shelter in place. Awards will be announced by 30 days after the shelter in place ends. Learn more at
https://anco.org/membership/fellow-benefits/
.
- 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
.
- Use ANCO's
job board
to post or search for employment opportunities at ANCO member practices.
- Follow ANCO on Twitter at @ANCO News.
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National News
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The number of confirmed COVID-19 cases in the US has reached at least 842,624, while deaths climbed to 46,785, according to data from Johns Hopkins University.
A state-by-state comparison of novel coronavirus mortality showed the Northeast accounted for almost two-thirds of total deaths, while New York, New Jersey and Connecticut had the most fatalities per 100,000 people. The CDC has added six symptoms to its list of possible signs of COVID-19 patients: chills, repeated shaking with chills, muscle pain, headache, sore throat and sensory changes such as new loss of smell or taste. Other symptoms not included in the CDC list but that have been observed in some hospitalized COVID-19 patients include diarrhea, nausea or vomiting; skin rash or lesions; delirium, dizziness and weakness; and possibly cardiovascular complications such as unusual blood clotting in the extremities.
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The FDA is temporarily relaxing regulatory requirements for certain Class II digital pathology devices to increase the availability of remote reviewing and reporting of pathology slides during the pandemic. "Increased availability of these devices may help to facilitate continuity of patient care by preventing disruptions to critical pathology services rendered by clinical laboratories, hospitals, and other healthcare facilities, and by reducing healthcare personnel contact and risk of exposure to SARS-CoV-2," the FDA noted.
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Problems with IT systems and clinical burnout are more apparent in the COVID-19 pandemic, and health care leaders are turning to technology that will likely be used even after the pandemic ends to mitigate the issues,
according to several health leaders and experts. Improved data sharing, more collaboration and speedier data analysis are likely to remain, and Brian Dixon, director of public health informatics at the Regenstrief Institute, says the pandemic "makes us ask, why weren't we doing this before? And after this pandemic, how can we continue to do this?"
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An analysis by Harvard University and Phreesia that included 50,000 providers found a 60% decrease in patient visits to ambulatory practices in mid-March, with volume continuing to be low in April.
The Journal of American Health Information Management Association has published an FAQ about COVID-19 financing for small and medium-sized businesses. The FAQ covers many questions, including:
- How does the CARES Act support small business?
- What is the Paycheck Protection Program?
- What is the maximum loan a small business can receive?
Read the FAQ today
and consider bookmarking it, as it will be updated as more information becomes available.
-The FDA has intensified seizures of prescription drugs sent to US consumers from pharmacies in Canada and other countries, according to customers and the Florida store operators who facilitate such transactions. The trend comes as the federal government works with Florida, Colorado and other states to develop a framework for drug importation from Canada to give Americans access to cheaper medications.
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CMS News
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On April 26, the Centers for Medicare & Medicaid Services (CMS) announced that
beginning Monday, April 27, 2020, CMS will not be accepting any new applications for the Advance Payment Program, it is reevaluating the amounts that will be paid under its Accelerated Payment Program and suspending its Advance Payment Program to Part B suppliers effective immediately. CMS had expanded these temporary loan programs to ensure providers and suppliers had the resources needed to combat the beginning stages of the 2019 Novel Coronavirus (COVID-19). Funding will continue to be available to hospitals and other health care providers on the front lines of the coronavirus response primarily from the Provider Relief Fund. The Accelerated and Advance Payment (AAP) Programs are typically used to give providers emergency funding and address cash flow issues for providers and suppliers when there is disruption in claims submission or claims processing, including during a public health emergency or Presidentially-declared disaster. Congress appropriated $100 billion in the Coronavirus Aid, Relief, and Economic Security (CARES) Act (PL 116-136) and $75 billion through the Paycheck Protection Program and Health Care Enhancement Act (PL 116-139) for health care providers. HHS is distributing this money through the Provider Relief Fund, and these payments do not need to be repaid. The CARES Act Provider Relief Fund is being administered through HHS and has already released $30 billion to providers and is in the process of releasing an additional $20 billion, with more funding anticipated to be released soon. This funding will be used to support health care-related expenses or lost revenue attributable to the COVID-19 pandemic and to ensure uninsured Americans can get treatment for COVID-19.
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The CMS urged all Medicare Advantage plans and Part D sponsors to temporarily waive or relax prior authorization requirements that health care providers check insurance coverage before providing certain services. The move would "facilitate access to services with less burden on beneficiaries, plans and providers" during the COVID-19 pandemic, according to the CMS.
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The CMS has suspended reporting and data collection associated with several health insurance quality programs, including the Quality Improvement Strategy, the Qualified Health Plan Enrollee Survey and Quality Rating System. "Given the challenges healthcare providers are facing responding to the COVID-19 virus, we are not continuing with this year's data collection and reporting efforts as that may divert physician offices from caring for patients," the agency noted.
- COVID-19 EMERGENCY DECLARATION BLANKET WAIVERS FOR HEALTH CARE PROVIDERS. The Trump Administration is taking aggressive actions and exercising regulatory flexibilities to help healthcare providers contain the spread of 2019 Novel Coronavirus Disease (COVID-19). CMS is empowered to take proactive steps through 1135 waivers as well as, where applicable, authority granted under section 1812(f) of the Social Security Act (The Act) and rapidly expand the Administration's aggressive efforts against COVID-19. As a result, the following blanket waivers are in effect, with a retroactive effective date of 3/1/2020 through the end of the emergency declaration. These waivers DO NOT require a request to be sent to the 1135 waiver@cms.hhs.gov mailbox or that notification be made to any of CMS' regional offices.
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CMS has recently published the following MLN Matters articles:
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Affiliate Association News
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The ASCO Survey on COVID-19 in Oncology Registry (ASCO Registry) aims to help the cancer community learn more about the patterns of symptoms and severity of COVID-19 among patients with cancer,
as well as how COVID-19 is impacting the delivery of cancer care and patient outcomes. The ASCO Registry is designed to collect both baseline and follow-up data on how the virus impacts cancer care and cancer patient outcomes during the COVID-19 pandemic and into 2021. Learn more and enroll your practice.
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The
ASH Registry for Hematologic Malignancy helps inform care for people with blood cancers.
Health care providers: submit your case today to help other providers on the frontline.
Learn more and enter a case
.
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ACCC's SURVEY ON THE MANAGEMENT OF OLDER ADULT PATIENTS WITH CANCER
, offers a comparison to younger patients, in this era of COVID-19 infections. Please Take the survey.
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In partnership with
CancerCare, COA is providing free transportation for your patients during this difficult time. The COA/Cancer Care Patient Assistance Transportation Program ensures your patients can continue to receive needed treatment where care delivery is safest: your practice. COA is proud to work with CancerCare, a trusted non-profit organization that offers free, professional support services for people affected by cancer. COA CancerCare Travel Program
- On April 13, ASH hosted a webinar on Telehealth during COVID-19. The webinar covered best practices for using telehealth during the COVID-19 public health crisis, including specific examples from speakers' institutions. It also featured information on COVID-19-related changes to Medicare telehealth policy - including coverage, reimbursement, coding, and billing. The webinar was moderated by Chair of ASH's Committee on Practice, Dr. Chancellor Donald (Tulane University School of Medicine), and speakers included Dr. Jean Connors (Brigham and Women's Hospital/Dana-Farber Cancer Institute), Dr. Colleen Morton (Vanderbilt University Medical Center), Dr. Michelle Griffith (Vanderbilt University Medical Center), and Ellen Riker, policy consultant for ASH. To watch the recorded webinar, click here. For additional COVID-19 resources, please visit the ASH Website.
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Please share with your patients!
The National Coalition for Cancer Survivorship is conducting a survey among individuals with a history of cancer and would value your participation. NCCS is conducting this survey with their research partner, Edge Research, and your responses will help understand how NCCS and its partners can better address the survivorship needs of patients and survivors.
Your participation is important. The first 100 people to qualify and complete this survey will receive a $10 Amazon gift card.
Please be assured that this is for research purposes only, and your opinions will help inform NCCS's future work. The survey will take approximately 15 minutes to complete. Responses will remain strictly confidential. The information you provide will only be viewed together with the responses of others, and your information will never be sold to a third party.
This survey will only be online for a short period of time.
Please click on the link below or copy and paste the address to your Internet browser to begin:
https://survey.us.confirmit.com/wix/p546481822727.aspx?S=C
.
If you need assistance completing the survey, please contact Liana Gainsboro at
gainsboro@edgeresearch.com
. If you would like more information about NCCS and the survey, please contact Elena Jeannotte at
ejeannotte@canceradvocacy.org
. Thank you for participating in this very important survey; your feedback truly helps make a difference!
- Conquer Cancer, the ASCO Foundation, is pleased to announce the recipients of its 2020 ASCO Annual Meeting Merit Awards. These distinguished awards support oncology trainees who are first authors on abstracts selected for presentation at the ASCO Annual Meeting. This year, Conquer Cancer will recognize 104 recipients with Merit Awards.
Read More
- Join Physicians' Education Resource
®, LLC
, to their 11th Annual International Symposium on Ovarian Cancer and Other Gynecologic Malignancies® a 1-day, educational and scientific LIVE-WEBCAST on May 2, 2020 the meeting will focus on key clinical topics in the management of ovarian cancer, as well as endometrial, uterine, and cervical malignancies. For more information and to register go to gotoper.com/go/IOG20A
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Industry News
- Attention Clinical Staff! PUMA Biotechnology cordially invites you to their webinar TOMORROW, Wednesday, April 29, 2020 at 5:30pm PDT, Anne O'Dea, M.D. will present, "Protecting Patients with NERLYNX, the only HER2-directed small molecule approved by the FDA in both eBC & mBC." This is not an independent educational program. No CME credits will be provided. Please RSVP to www.moasc@moasc.org or call 909-985-9061 x1.
- Pfizer Oncology
is pleased to announce that IBRANCE® (palbociclib) is transitioning from capsules to tablets. The new film-coated tablets may be taken with or without food and will be dispensed in blister packs (rather than bottles). The blister packs are designed to enable patients to track where they are in their treatment cycle. The tablet formulation is bioequivalent to the capsule formulation. There is no change to the active ingredient, available dosage strengths or dosing schedule. Read the
FULLPRESCRIBING INFORMATION FOR CAPSULES and IMPORTANT SAFETY INFORMATION.
- As part of Project Orbis, the FDA approved IMBRUVICA® (ibrutinib) in combination with rituximab for the initial treatment of adult patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL).
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The FDA has approved Immunomedics' Trodelvy for treating women with triple-negative metastatic breast cancer.
The drug will be on the market as soon as possible, company officials said.
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MOASC CALENDAR
(Davis, New Dates:
March 11-12, 2021)
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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 material contained in the
California Oncology Weekly
is intended as general information for 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 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
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