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.
November 26, 2019
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- Tweet Medi-Cal reimbursement rates & clawbacks expose. California News
- MBIs must be submitted on all claims by January 1, 2020. Noridian News
- President Trump planning to allow states to purchase prescription drugs from other countries. National News
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NBC Los Angeles
aired and published a story on the issues pharmacists and patients are facing due to Medi-Cal NADAC reimbursement rates and clawbacks.
Please share this video and tag your local representatives to spread the word and engage them about the draconian cuts and clawbacks implemented by the Department of Health Care Services. Click hereto tweet this video now.
- California lawmakers urge US House of Representatives leadership not to jeopardize care by cutting off supplemental Medi-Cal payments. The supplemental payments, known as disproportionate share allotments, provide "an essential funding source helping safety-net hospitals serve the uninsured and underinsured residents of their communities," a group of 47 legislators stated in a letter to House Speaker Nancy Pelosi and House Minority Leader Kevin McCarthy. "They help offset the cost of uncompensated care these hospitals provide." California hospitals stand to lose as much as $500 million in the current fiscal year and as much as $950 million from fiscal 2021-25, the representatives said. Read more from Cathie Anderson of the Sacramento Bee.
- Proposition 65 requires California businesses to label products and buildings with warnings about substances the state deems as toxic, ranging from aloe vera to chemotherapeutics to asbestos. A state panel plans to debate whether to add acetaminophen, the active ingredient of common over-the-counter medications such as Tylenol, to the toxics list, raising questions about the value of these ubiquitous warnings.
- California's Health Insurance Marketplace, Covered California, 2020 open enrollment period will continue through January 31. More generous subsidies are available for Californians this year, overall premiums are only increasing by 0.9%, and three insurers are expanding into new markets. However, it is not entirely clear that Covered California enrollees are enjoying the full benefits of a competitive health insurance market.
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The Department of Managed Health Care (DMHC) invites you to the Pharmacy Benefit Management (PBM) Reporting Task Force meeting being held in Sacramento on December 4, 2019, from 10 a.m. to 1 p.m., as required by Assembly Bill (AB) 315 (Wood, Chapter 905, Statutes of 2018). Please view the agenda for the public meeting. The purpose of the Task Force is to recommend what information, if any, related to pharmaceutical costs health care service plans or their contracted pharmacy benefit managers should report to the DMHC as required by AB 315. The Department will submit a report with the Task Force's recommendations to the Legislature by February 1, 2020. If you have questions about this e-mail, please submit your questions to stakeholder@dmhc.ca.gov.
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If you have complaints about billing patterns from your PBM or a health plan, you need to submit a complaint through the California Dept. of Managed Health Care.
The DMHC will only act on "patterns" of complaints,
so multiple providers need to submit complaints to establish a record of problems in order for DMHC to act. This is standard procedure for claims filed by providers and consumers alike. The link to submit a provider complaint to the Department is here. Towards the bottom of the page you will see "Submit a Provider Complaint." If you click on that link it will take you to an online portal where providers can register and submit complaints to DMHC online. If you need assistance, you can contact the DMHC Provider Complaint phone line at 1-877-525-1295. DMHC encourages you to read the information on this page about eligible and ineligible claims and the requirement to first go through the Provider Dispute Resolution (PDR) process. The California Department of Managed Health Care will be holding another PBM stakeholder meeting on Wednesday, December 4 from 10 AM to 1 PM. You can view the agenda here.
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- MBIs must be submitted on all claims by January 1, 2020 or the claim will be rejected and not processed by Medicare. Noridian's MedicarePart A/B Provider Outreach and Education Departmentis providing you with the latest news and updates on the Medicare Beneficiary Identifier (MBI). Medicare providers need to use the recently issued MBI's on their claims submissions. New insurance cards were issued to beneficiaries with a new MBI number to replace the Health Insurance Claim Number (HICN). The Centers for Medicare & Medicaid Services (CMS) has MBI resources available on their website. Their September Open Door Forum event included the MBI adoption rate information.
If you do not use MBIs on claims (with a few exceptions) after January 1, you will get:
Electronic claims reject codes: Claims Status Category Code of A7 (acknowledgment rejected for invalid information), a Claims Status Code of 164 (entity's contract/member number), and an Entity Code of IL (subscriber)
Paper claims notices: Claim Adjustment Reason Code (CARC) 16 "Claim/service lacks information or has submission/billing error(s)" and Remittance Advice Remark Code (RARC) N382 "Missing/incomplete/invalid patient identifier"
We encourage people with Medicare to carry their cards with them since we removed the Social Security Number-based numbers; if your patients do not bring their Medicare cards with them:
Use your Medicare Administrative Contractor's look-up tool.
Sign up
for the Portal to use the tool. Check the remittance advice. Until the end of December, we return the MBI on the remittance advice for every claim with a valid and active Health Insurance Claim Number.
- Noridian/JEMAC has the following updates on their website
Announcements:
MIPS: Virtual Group Election Period Open Through December 31; Promoting Interoperability Programs: Updated List of eCQMSs; MIPS Improvement Activities Technical Expert Panel: Nominations due November 29; Modernizing CMS: Organizational Changes Announced; Improper Payment for Intensity-Modulated Radiation Therapy Planning Services
Publications:
2020 Annual Update to the Therapy Code List; 2020 Annual Update to the Per-Beneficiary Threshold Amounts; Medicare Physician Fee Schedule Database (MPFSDB) Update to Status Indicators; Positron Emission Tomography (PET) Scan-Allow Tracer Codes Q9982 and Q9983 in the Fiscal Intermediary Shared System (FISS); Medical Privacy of Protected Health Information-Revised; Remittance Advice Resources and FAQs-Revised
* New Medicare Card: Get Paid January 1, 2020-Use MBIs Now
* MBI Displays in Remittance Advance--Update Your Files Before December 31, 2019
* Medicare Beneficiary Identifiers (MBIs) For Ordering and Referring Providers
* MolDX: TruGraf Blood Gene Expression Test Final LCD and Billing and Coding: MolDX TruGraf Blood Gene Expression Test Article-Effective January 5, 2020
Forthcoming Noridian JEMAC meetings/webinars/workshops
* Noridian Medicare Portal Registration for Part A, B, and
* Using the Medicare Beneficiary Identifier (MBI) Webinar (December 3)
* New Provider Enrollment Rebuttal Process Webinar (December 4)
* Drug Units in Excess of MUE: Comparative Billing Report Webinar (December 4)
* Using the Medicare Beneficiary Identifier (MBI) Webinar (December 19)
For more information and to register visit:
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- MOASC members can register for the 61st ASH Annual Meeting and Exposition in Orlando, December 7-10, 2019, using your ASH username
moasc@moasc.org and password. If someone else is registering for you, please provide your credentials to avoid delays. If you have forgotten your credentials, you may reset them on the ASH website using the "Forgot your Username or Password" links.
- 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
- President Trump planning to allow states to purchase prescription drugs from other countries as part of efforts to improve access to cheaper medicines. Speaking at a White House event, Trump said he is working with governors, including Florida's Ron DeSantis, to create a plan.
Reuters
- An explosion of biological data will lead to the first drug candidates discovered by an artificial intelligence system within the next few years, a feat that promises to change the way pharmaceutical companies conduct research. That was a consensus opinion that emerged among experts in machine learning who spoke at the STAT Summit last week about the use of AI in the pharmaceutical industry. Stat: Machine Learning Will Yield New Drug Candidates Within Three Years
- Dr. Stephen Hahn, who has been nominated to lead the FDA, assured lawmakers he will work with them to tackle drug shortages and high prescription drug prices. Read More
- Recent research indicates most patients want to talk about costs during medical visits. To facilitate this conversation, physicians and care teams need enriched data and insights, including a clear line of sight into final costs, alternatives, social needs and past patient adherence. Learn more.
- Caregiving is an incredibly important role. But you don't need to do it all on your own. Caregivers can turn to their health insurance providers for help, questions, and support.
Read on for some of the resources available
from health insurance providers around the country.
- The holidays are a great opportunity to enjoy time with family and friends, to celebrate life, to be grateful, and to reflect on what's important. They are also a time to appreciate - and safeguard - the gift of health. Here are some holiday tips to support your efforts for health and safety during the season: Eat Healthy and Be Active;
Get Your Flu Vaccination; Food Safety; Handwashing; Cold Weather Safety and Home Heating; Cope with Stress; Travel Safety; Prevent Injuries.
8 CDC Health Tips for a Safe and Healthy Holiday. Learn More
about safe handling of your holiday turkey.
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CMS News
- Physicians have until December 31, 2019 to review and dispute their 2018 open payments data reported by CMS earlier this year. To learn more and review your data go to https://openpaymentsdata.cms.gov.
- The 2019 MIPS performance year is coming upon its final month and there are important steps participants can take to ensure successful data reporting. For participants utilizing EHR vendors to submit MIPS data, make time to check-in with those vendors to ensure they are on track to submit data during the submission period early next year. Dec. 31 is the last day MIPS participants can apply for a Promoting Interoperability hardship exception and an extreme and uncontrollable circumstances application . Those that qualify will receive re-weighting of one or more MIPS performance categories.
- The final 2020 Physician Fee Schedule (PFS), includes payment updates for Medicare services, changes to billing guidance for certain codes, and modifications to reporting requirements under the Merit-based Incentive Payment System (MIPS).
MGMA Government Affairs reviewed, analyzed, and distilled this nearly 2,500-page final rule in a member-benefit analysis. The resource breaks down significant payment and quality reporting changes for 2020 and offers practical takeaways for busy medical group practice executives. Key regulatory provisions include: *The CY 2020 PFS conversion factor remains relatively flat at $36.0896. *In 2021, CMS will maintain separate payment rates for E/M office visits, delete level 1 office visits for new patients, and increase the payment rate for E/M services. *The MIPS score to avoid a negative payment adjustment in 2022 will increase to 45 points based on performance in 2020.
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Medicare's revamped prescription plan finder can steer unwitting seniors to coverage that costs much more than they need to pay
, according to people who help with sign-ups as well as program experts. Serving some 60 million Medicare recipients, the plan finder is the most commonly used tool on Medicare.gov and just got its first major update in a decade.
- The Center for Medicare and Medicaid Innovation (Innovation Center) is excited to announce that the Request for Applications (RFA) for the Direct Contracting Professional and Global options is available at https://innovation.cms.gov/initiatives/direct-contracting-model-options/. The Letter of Intent (LOI) for the Professional and Global options of Direct Contracting is open until December 10, for those organizations who did not submit a LOI previously. The LOI is available at https://app1.innovation.cms.gov/dc. CMMI encourages you to monitor the Direct Contracting website for future updates. Please contact the help desk with any questions or comments at DPC@cms.hhs.gov.
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Affiliate Association News
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- Below, please find a link to the latest COA Government Affairs and Policy committee update. This new publication is part of COA's renewed effort to give the COA community more regular updates on the policy issues COA is working on or following. P
lease feel free to share this with your partners and colleagues.
COA GAP Update Q4 2019
- Starting November 15, ASH opened applications for the ASH Congressional Fellowship Program, a yearlong opportunity available for one ASH member starting in September 2020 to work in a Congressional office and help shape health care and hematology policy. Learn more at
https://www.hematology.org/Advocacy/6872.aspx
.
- MOASC members can register for the 61st ASH Annual Meeting and Exposition in Orlando, December 7-10, 2019, using your ASH username moasc@moasc.org and password. If someone else is registering for you, please provide your credentials to avoid delays. If you have forgotten your credentials, you may reset them on the ASH website using the "Forgot your Username or Password" links.
- Voting closes on December 2 for the ASCO Board Election. The Committee has selected 14 distinguished ASCO members as candidates for open leadership positions within the Society, including President-Elect, four seats on the Board, and two seats on the Nominating Committee. Eligible ASCO members can vote for their chosen leader beginning November 1. ANCO member Beverly S. Mitchell, MD, Stanford Cancer Center, is among the candidates for the Nominating Committee. Review the online candidate information at
- Round 2 data submission runs through December 3 for ASCO Quality Oncology Practice Initiative (QOPI). The oncologist-led, practice-based, quality assessment program for outpatient oncology clinics, is free for practices with at least one active ASCO member. Practices can benchmark their quality of care against more than 150 quality measures. Register at
https://myqopi.asco.org/registration/login.aspx
.
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The Institute for Clinical and Economic Review (ICER) has issued a call for public input to help identify and prioritize non-drug topics for ICER assessments in 2020. While ICER is most known for reviews of emerging pharmaceuticals, ICER also conducts many assessments of devices, procedures, and other health systems innovations. These assessments have spanned a wide range of areas, including breast cancer screening. For 2020, ICER is considering selecting two or more non-drug topics. Topic selections criteria are available here. Importantly, for 2020 ICER hopes to identify topics that fit within one of two broad categories: 1) common interventions that may be priced far higher than their clinical value; and 2) new, promising interventions for vulnerable populations that may currently be underappreciated by clinicians and/or insurers. The Public Comments will be accepted from all interested stakeholders until December 13, 2019 at 2 p.m. PT. There are no page limits for these submissions, and all comments are to be e-mailed to publiccomments@icer-review.org. The final decision on the topic for each ICER review will be announced at the outset of the review process. The review process begins approximately eight months prior to a corresponding public meeting held under the auspices of one of ICER's three public programs -- the California Technology Assessment Forum (CTAF), the Midwest Comparative Effectiveness Public Advisory Council (Midwest CEPAC), and the New England Comparative Effectiveness Public Advisory Council (New England CEPAC). Apart from this formal Public Comment process on non-drug topics, other topic suggestions are always welcome. Submissions can be made at any time via this online form.
- In a new
ASCO Connection article
,
ASCO shares their plans to launch the Association for Clinical Oncology early next year
- NCCN has published updated guidelines at
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Industry News
- AstraZeneca Pharmaceuticals announces that the FDA has approved CALQUENCE® (acalabrutinib) capsules for the treatment of adult patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL). CALQUENCE for CLL was granted Breakthrough Therapy Designation by the FDA, and the approval was granted under the FDA's Real Time Oncology Review (RTOR) and newly established Project Orbis programs. View the full
press release here. Please see full Prescribing Information, including patient information.
- A
s of November 22, 2019 Celgene and Bristol-Myers Squibb have officially joined.
Together, they are creating a leading biopharma company focused on transforming the lives of patients through science. Their teams have worked collaboratively to ensure that the combined company leverages the strengths of both Bristol-Myers Squibb and Celgene to build on their promise to deliver innovations that help patients prevail over serious diseases.
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MOASC CALENDAR
California PBMs
December 2
December 5
December 9
City of Hope CME presents: Immunotherapy of Cancer: CAR T Cell to Checkpoint Inhibitors
March 18-21, 2020
Oncology Summit
March 14, 2020
Spotlight On Hematology
February 1, 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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