California Oncology Weekly
"Where California Oncologists Go For Answers!"
A collaborative publication of the
Medical Oncology Association of Southern California, Inc.
Association of Northern California Oncologists, Inc.
December 19, 2017
This is the last edition of the California Oncology Weekly for 2017.
We wish you and yours a wonderful holiday season.
Our next publication will resume Tuesday, January 9, 2018.
's Hot Topics
- CMS supporting California residents impacted by wildfires(California News)
- It's a new year! Obtain updated patient insurance and eligibility(National News)
- ANCO's Medicare Reimbursement for Oncology 2018 on Jan. 3rd. (ANCO News)
- Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma announced that the agency has taken immediate steps and is monitoring conditions in support of California residents displaced and recovering from the wildfires ravaging southern portions of the state. On Dec. 11, 2017, Acting Health and Human Services Secretary Eric D. Hargan declared a public health emergency (PHE) in the state of California retroactive to Dec. 4, 2017. The agency has taken the following steps to support the state of California and those residents impacted by wildfires:
Healthcare Provider Hotline
CMS established a toll-free hotline servicing Medicare's Part B providers and suppliers in California. The hotline is intended to assist non-certified Part B suppliers, physicians and non-physician practitioners helping with recovery efforts enroll in federal health programs and receive temporary Medicare billing privileges. CMS is temporarily waiving the application fee, finger print-based criminal background checks, site visits, and in-state licensure requirements usually required for providers to access Medicare billing privileges. The toll-free hotline telephone number is (855) 259-2396.
Special Enrollment Opportunities and Medicare Flexibilities
CMS is providing beneficiaries affected by the California wildfires a Special Enrollment Period (SEP) that gives them an additional opportunity through March 31, 2018 to add, drop or change their Medicare health and prescription drug plan in the event they are eligible for an SEP and were unable to make an election during the fall open enrollment period or another election period for which they were eligible. For more information on these special enrollment periods, visit:
When a public health emergency is in effect, Medicare Advantage Organizations
in affected areas are required to waive prior authorization and other gatekeeper requirements and to allow care to be provided by non-contracted providers and facilities. In addition, Part D plan sponsors are expected to lift certain limit for drug benefits.
Waivers for Skilled Nursing Facilities and Assistance for Hospitals and other Healthcare Facilities:
CMS issued a blanket Skilled Nursing Facility waiver, described on the website below; and the Regional Office has provided numerous technical assistance responses to the state, California Hospital Association and providers on specific types of CMS and other HHS program flexibilities that were available with and without waivers. These program flexibilities and waivers work to provide continued access to care for beneficiaries.
- As it will disproportionately harm California physicians, the California Medical Association (CMA) is
urging the California Congressional Delegation to oppose the proposed cuts
recommended by the U.S. House of Representatives' Ways and Means Committee who is working to extend the "rural" work Geographic Practice Cost Index (GPCI) payment adjustment. The rural GPCI floor does not help California's rural areas, while California physicians treat the bulk of Medicare patients in this country. Physicians cannot remain in practice and maintain patients' access to care under these flawed policies. This proposal harms all California physicians, particularly those in the Central Valley, where there are already significant physician shortages and margins to operate a practice are slim because the main payers are the low-paying Medicare and Medicaid programs.
CMA is urging Congress
to find other funding sources to fund the rural payment floor. Read more under
in this publication.
- The California Medical Association's (CMA) Practice Resources (CPR; December) is now available online at www.cmanet.org/cpr and features articles entitled: Anthem still not complying with AB27 interim payment rules, physicians report; Physicians fight back against Anthem modifier 25 payment reduction policy; Do you see TRICARE patients? Check out CMA's new toolkit to assist physicians; Are your prescriptions pads compliant with the law?; Time to verify your patients' eligibility and benefits for 2018; Reminder: There's still time to avoid a MIPS penalty for 2017; Medicare 2018 fee schedule finalized; Reminder: Be prepared for Covered California changes in 2018; Blue Shield corrects two problems affecting "interim rate" payments; The Coding Corner: What's new in CPT2018.
* MLN Connects
Announcements--New Medicare Card: Less Than Four Months until Transition Begins; Hospice Compare Quarterly Refresh; MACRA Measure Development Plan Technical Expert Panel: Submit Nominations by December 20;2018 Annual Update CLFS and Laboratory Services Subject to Reasonable Charge Payment, CR10409 provides instructions for the Calendar Year (CY) 2018 clinical laboratory fee schedule (CLFS), mapping for new codes for clinical laboratory tests and updates for laboratory costs subject to the reasonable charge payment. Read the complete update; Medicare Advisory Panel on Clinical Laboratory Tests: Request for Nominations; Provider Enrollment Application Fee Amount for CY2018
Claims, Pricers & Codes--January 2018 Average Sales Price Files Available; If You Submit Paper Claims: Avoid Crossover Issues.
Publications--How to Use the Searchable Medicare Physician Fee Schedule Booklet-Revised; Long-Term Care Hospital Prospective Payment System Booklet-Revised; Quality Payment Program Call: Audio Recording and Transcript-New; Evaluation and Management Services Web-Based Training Course-Reminder
* Obinutuzumab (Gazyva): Wastage Billing Instructions Article Retirement-Effective December 4, 2017
* Medicare Deductible, Coinsurance and Premium Rates-2018 Update CR10405
* MolDX: EndoPredict Breast Cancer Gene Expression Test Final LCD-Effective January 30, 2018
* MolDX: Prometheus IBD sgi Diagnostic Policy Final LCD-Effective January 30, 2018
* Medicare After Hours-Evening Webinars Available for Your Professional Growth
* Modifier 59/NCCI Education on Demand Tutorial Available
* Enrollment Application Status Search Tool Available Soon
* Open Enrollment Participation Program for 2018
- Upcoming Noridian/JEMAC webinars include:
* Modifier 59, NCCI and MUE Webinar (January 10)
* Mammography, PapTest, Pelvic Exam, and Cervical Cancer with HPV Tests Webinar (January 17)
* Evaluation and Management Modifiers Webinar (January 24)
Providers can also view the Evaluation and Management (E/M) Modifiers Education on Demand tutorial. Read the complete update
- MARK YOUR CALENDAR, for MOASC's Spotlight On® Hematology, Saturday, January 27, 2018 in Huntington Beach. MOASC's Spotlight On series presentation brings highlights of the 2017 ASH annual meeting. MOASC awarded educational grants to 3 UCI Fellows who attended the ASH Annual in Atlanta, GA on December 9 - 12, 2017. They & UCI faculty will present their discoveries through interactive discussions on ASH highlights. For more information and to register please contact the MOASC office at email@example.com.
- You are cordially invited to MOASC's 3rd Annual Oncology Summit®, Harnessing the Power of Immunotherapy. March 3, 2018 at the Waterfront Hilton, Huntington Beach. Topics & speakers: *Head and Neck Ezra Cohen, MD, UCSD *Colon Cancer Marvan Fakih, MD, COH *Lung Cancer Karen Reckamp, MD, COH *Breast Cancer Sara Hurvitz, MD, UCLA *Melanoma Omid Hamid, MD, The Angeles Clinic & Research Institute.
- Once you are registered for the MOASC Oncology Summit®, you are invited to participate in the Biocept Advisory Board Meeting, Saturday, March 3, 2018, 2pm - 5pm, immediately following the MOASC Oncology Summit®. Topic: Liquid Biopsies: The Future is Now. Register early as there is limited seating for the advisory board. Honorarium is provided. The purpose of the ad board is to:
1. Compare the relative strengths and limitations of liquid biopsy against those of conventional tissue biopsies;
2. Discuss current and emerging testing technologies with respect to sensitivity, specificity, and clinical applications for patients with cancer;
3. Evaluate clinical evidence pertaining to specific testing modalities that may help to individualize treatment protocols for patients with cancer;
4. Discuss which cancer types are best suited for liquid biopsy testing;
5. Discuss the clinical value of plasma testing be used be used in conjunction with tissue testing;
6. Discuss the value of doing targeted marker liquid biopsy testing vs. large panels for liquid biopsies.
- Receive a $10 gift card! MOASC is conducting a quick Communications Survey, and we need you help to better serve you and to know how we are doing. We are simply looking for your opinions. The survey should take less than 5 minutes to complete for you to receive your $10 gift card. Take the Survey NOW!
- ANCO's 2017 Annual Report is now available online at www.ancoonline.orgAR2017.pdf. A copy was also mailed to ANCO physician members and Corporate Member representatives the last week of November.
- ANCO's Medicare Reimbursement for Oncology 2018 & Revenue Cycle State of the State with Bobbi Buell takes place in San Jose on January 3 and Sacramento on January 4. Learn the latest information impacting Medicare's reimbursement for oncology in 2018 and what to do about your denial rate, days to pay, and days to file using data specific to northern California. This will be a unique opportunity to get benchmarks that you can use for billing and appeals at your facility. Download the meeting announcement and registration form at www.anco-online.org/MedicareUpdate2018.pdf.
- In the meantime, you may now register for Bobbi Buell's 2018 Reimbursement Webinars on January 5, 12 PM PST.
- ANCO, in association with the Organizing Committee of the San Antonio Breast Cancer Symposium and Encore Medical Education, is hosting the Best of San Antonio Breast Cancer Symposium San Francisco (Best of SABCS San Francisco) at The Claremont Hotel on Saturday morning, January 27, 2018. Hope S. Rugo, M.D., is the Regional Director for the Best of SABCS San Francisco. For more information and to register, visit
- The 18th Multidisciplinary Management of Cancers: A Case-based Approach returns to the Silverado Resort and Spa in Napa on March 16-18, 2018. The meeting is sponsored by the Association of Northern California Oncologists, Stanford Cancer Institute, UC Davis Comprehensive Cancer Center, and UCSF Helen Diller Family Comprehensive Cancer Center. Go to www.multicancers.org for more information, to register, and arrange for housing.
- It is more important than ever for Congress to hear from all of us that IPAB still needs to be repealed. As the end of the year approaches, much of Congress' work remains in flux. Please contact your Senators and House members who voted in favor of repeal, to have them urge Leadership to incorporate IPAB repeal in any legislative vehicle that must move.
- The U.S. House of Representatives' Ways and Means Committee is working to extend the "rural" work Geographic Practice Cost Index (GPCI) payment adjustment, which is set to expire December 31, 2017. In order to pay for the extension, the committee has proposed an overall cut to Medicare physician payments by identifying and lowering payments for "misvalued" services. In 2014, Congress included a physician-opposed provision in the Protecting Access to Medicare Act (PAMA), designed to hold down Medicare spending by requiring the Centers for Medicare and Medicaid Services (CMS) to identify "misvalued" codes.
The misvalued code legislation has eroded the modest MACRA payment increases at the same time that physicians were required to make significant investments in their practices to meet MACRA reporting requirements. Physicians are also facing a payment freeze from 2019-2024.
If this new proposal takes effect, total physician payment updates for the entire 10-year period of 2015-2024 will be approximately 1 percent. From 2005-2015, physicians' fees were essentially frozen under the Medicare Sustainable Growth Rate formula, while the costs to operate a medical practice rose more than 20 percent. These Congressional actions will represent more than two decades of nearly frozen payment rates, while all other Medicare provider groups have received updates. If CMS is unable to meet the savings target in the PAMA legislation, the remaining amount was to be obtained by an across-the-board payment cut to all services. The Ways and Means Committee is now proposing a fourth year of Medicare physician payment cuts to fund the rural work GPCI floor, despite the commitments made under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) that physicians would be provided automatic, stable payment updates of 0.5 percent per year from 2015-2019.
- Don't get stuck with unnecessary denials or an upset patient. Do your homework before the patient arrives by obtaining updated insurance information and verifying eligibility at the time of scheduling, if possible, and making copies of the insurance card at the time of the visit. Don't forget that deductibles are typically based on the calendar year and will reset on January 1. Best practice is to communicate with patients upon scheduling to remind them that their plan has a deductible that may be resetting on January 1 and, if that is the case, that payment will be due at the time of service. If you offer an appointment reminder service, remind the patient if payment is expected at the time of service. Failure to collect deductibles, copays and coinsurance at the time of service can be very costly for a practice, as your ability to collect can decrease significantly after the patient leaves the office.
Taking these proactive steps to protect your practice by preventing denials, delays in payment and disgruntled patients goes a long way toward ultimately saving time and money.
Researchers find target to protect hearing during chemotherapy treatment.
- The Food and Drug Administration plans to target unproven alternative remedies that contain dangerous ingredients that have been linked to serious injury and death. A new proposal issued by the FDA would crack down on homeopathic medicines that pose the biggest safety risks to consumers, but under the plan most low-risk products would remain on the market.
The Associated Press
- Once again, it's time for physicians to decide if they want to make changes to their Medicare participation status. Physicians have until December 31, 2017, to make changes for the 2018 participation year. Physicians have three choices regarding Medicare: Be a participating provider; be a non-participating provider; or opt out of Medicare entirely.
Physicians who want to change their participation status for 2018 must send a letter to their Medicare contractor, postmarked by December 31, 2017.
Affiliate Association News
- You are invited to the
2018 ASCO Annual Meeting in Chicago from June 1-5, 2018.
First, reserve your hotel now to ensure the best accommodations and experience. Hotels book very quickly. When you visit the website, you will need to sign in. If you are an ASCO member or have previously created a guest account, at www.ASCO.org you should sign in using those credentials. If you are not a member, you will be asked to create a guest account. The process should not take long to complete. After you've signed in or created an account, you can reserve your hotel room.
- ASCO's Quality Training Program seeks to educate oncology providers in designing, implementing, and leading successful quality improvement activities in their practice settings. In addition, ASCO hopes to train oncologists to assume quality leadership positions and champion quality initiatives inside and outside their respective practices. In 2018, sessions will be held regionally in Miami, Florida and Alexandria, Virginia. Participants who complete the course are also eligible for MOC and CME credits. If you have any questions, please contact Gene Cunningham.
- 2018 Highlights of ASH®. Get a synopsis of the top hematology research presented at the latest ASH annual meeting and learn how it can help improve your patient management and care strategies at Highlights of ASH. For more information or to register, click
- A recording and the slides from ASCO's Quality Payment Program: Preparing for 2018, Surviving in 2017 webinar will be available soon at
- The second annual
ASCO-SITC Clinical Immuno-Oncology Symposium, January 25-27 in San Francisco, will feature more than 40 expert faculty discussing the latest clinical and translational advances in immuno-oncology. These specialists will facilitate in-depth discussions on cutting-edge research currently shaping the clinical application of immunotherapy, as well as provide insight into what this research means for future patient care.
- ASCO is accepting applications for its one-year Health Policy Fellowship, which provides a meaningful and unique opportunity for the Society's members and volunteers to develop expertise in health policy. For the first, the Fellowship is open to all oncologists at any stage in their career. Applications are being accepted through January 19 at
Similarly, ASH is accepting applications for the 2018-2019 ASH Congressional Fellowship Program through January 31. Learn more at
- ASCO seeks applications for volunteers at its ASCO Volunteer portal
http://volunteer.asco.org. Your application will be used for all upcoming Volunteer Corps opportunities and 2018 committee consideration. Apply by January 31, 2018 for 2018 committee consideration.
- Flagship Research is seeking for Oncologists and Hematologists for a paid research study!
They will be conducting a phone/web interview with Doctors treating adult patient, Flagship Research is interested in learning more about your thoughts and opinions of TRK-related tumors (non-small cell lung, primary brain, sarcoma, advanced thyroid, salivary gland, pancreatic, and colorectal). Details are as follow:
60 minute phone/web interview;
Dec. 26th thru Jan. 26, 2018; Times: Various;
From your home or office.
If you are interested in participating in this study, please call
toll-free number at: 844-718-0692, ask
the NATIONWIDE ONCOLOGY PROJECT.
You are also welcome to email: firstname.lastname@example.org
. Please include you
name and phone number in the email and they will give you a call back as soon as possible.
NCCN has published updates to the below.
For the complete updated versions, please visit
. Recent updates include: acute lymphoblastic leukemia (V5.2017), anal carcinoma (V2.2017), bladder cancer (V2.2017), cancer-related infections (V1.2018), cervical cancer (V1.2018), colon cancer (V2.2017), gastric cancer (V5.2017), palliative care (V2.2017), prostate cancer (V2.2017), rectal cancer (V3.2017), soft tissue sarcoma (V1.2018), T-cell lymphomas (extra nodal NK/T-cell lymphoma, nasal type; V1.2018), uterine cancer (V1.2018).
- Lilly Oncology informs ANCO and MOASC that CMS has assigned HCPCS code J9285 (10mg) to Lartruvo effective for dates of service on or after January 1.
- Pfizer Biosimilars informs ANCO and MOASC that the United States Food and Drug Administration has approved Ixifi, a chimeric human-murine monoclonal antibody (mAb) against tumor necrosis factor, as a biosimilar to Remade for all eligible indications of the reference product.
Spotlight on Hematology
January 27, 2018
Huntington Beach, CA
March 3, 2018
Huntington Beach, CA
(San Francisco, January 13)
(San Francisco, January 18-20)
(San Francisco, January 25-27)
(Berkeley, January 27)
(San Francisco, February 8-10)
(Napa, March 16-18)
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