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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- TODAY is the last day to register & submit data for ASCO's QOPI Round 2 reporting.(Affiliate Association News)
- TOMORROW, at 11:00am Pacific, Know Your State. (MOASC News)
- TOMORROW, 1:00pm Pacific, 2019 Medicare-Final Rules. (Affiliate Association News)
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California News
- The Anthem/Blue Cross Provider News (December 2019) is now available online at https://www.anthem.com/ca/provider/news/ and includes information about Case Management Program; Coordination of Care; Introducing the New Clinical Criteria Page for Injectable, Infused, or Implanted Drugs; Clinical Practice and Preventive Health Guidelines Available Online; An Overview of Our Medical Necessity Review Process; Restructure of AIM Advanced Imaging Clinical Appropriateness Guidelines; Update to AIM Clinical Appropriateness Guidelines; Anthem Works to Help Ensure Appropriate Billing of E&M Services;
- The deadline to enroll in a health insurance plan on the federal marketplace in California is Jan. 15. In addition, people who've been affected by the wildfires in California may qualify for a special enrollment period that gives them even more time, according to a spokesperson for Covered California, the state's marketplace.
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- Noridian/JEMAC has the following updates on their website
- MLN Connects Provider eNews:
Announcements
: CMS Takes Action to Lower Prescription Drug Costs by Modernizing Medicare
Events
: SNF PPS: New Patient Driven Payment Model Call-December 11; National Provider Enrollment Conference-March 12
Publications:
* RARC, CARC, MREP, and PC Print Update CR11038
* MolDX: NSCLC, Comprehensive Genomic Profile Testing LCD Retirement-Effective September 24, 2018
* ICD-10 and Other Coding Revisions to NCDs CR11005
* New Provider New Biller Review Entities and Appeals Part 1 of 2 (December 12)
* Evaluation and Management Modifiers (December 12)
* New Provider New Biller Review Entities and Appeals Part 2 of 2 (December 13)
* Evaluation and Management Modifiers (December 13)
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- TOMORROW, Wednesday, December 5, 2018 at 11:00am Pacific, MOASC's LunchTime Series presents the interactive tool, "Know Your State." Learn more about a resource for educating your patients about medication access and affordability options in California and the other 49 states. Sponsored by Johnson & Johnson, topics within the tool include: Medicaid expansion, state pharmaceutical assistance programs (SPAPs), Low-income subsidy (LIS) eligibility information, state health insurance assistance programs (SHIPs), standard prior authorization (PA) forms, National Foundations and other nonprofit resources, oral parity laws, advocacy connector, biosimilar legislation, continuity of care and state legislature resources. Join by calling (908) 316-2436 conference ID 73711760. Contact the MOASC Office if you have any questions [email protected].
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Have you received a letter from Anthem Blue Cross of California stating that effective 2/1/2019 oral prescription drugs dispensed in the physician office will be denied, and that these drugs must be provided by a licensed pharmacy? MOASC needs to hear from you!
The letter references the
Availity
website to access the updated fee schedule which was last revised for 2017. Upon YOUR feedback, MOASC will communicate with Anthem, and utilize all known resources to move Anthem from this position. Thank you for your expedient feedback to
[email protected]
.
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Last week, MOASC Chair, Dr. Robert Moss, brought to our attention that the California Medical Board has been actively "reviewing death certificates"
with regard to "possible opioid overdose" and requiring "a written opioid prescription agreement" in patients' charts. Here are links to the documents. If you have any other questions, please contact
[email protected]
.
Sample of Controlled Substances
Opioid Message
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Thank you to the MOASC Members who contributed to the 2018 ANCO/MOASC Staff Salary Survey.
Your $50 gift card will arrive in time for holiday shopping!
Results from the ANCO/MOASC 2018 Staff Salary Survey are now available online at
www.anco-online.org/salsrvy.html
. Read the report, review the results, and download the data.
In summary, there were slightly more physicians and slightly fewer non-physician employees in the practices reporting for 2018 versus 2016. The average hourly rate for Small Office Manager, Administrator/Executive Director, Billing Coordinator/Manager, File Clerk, Financial Counselor, Oncology Nurse, Physician Extender, Radiation Oncology Technologist, Receptionist, and X-Ray Technician increased from 2016 to 2018. The average hourly rate for Bookkeeper, IT, Chief Radiation Oncology Technologist, Radiation Oncology Physicist, Research Manager/Coordinator, and Transcriptionist decreased from 2016 to 2018. Other average hour rates remained essentially the same (i.e., plus/minus less than $1/hour).
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Read MOASC comments submitted to USP regarding the USP <797> <800> proposed standards. MOASC USP Comments
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Don't miss a thing in 2019, mark your calendars
for MOASC's 2019 custom events
designed for oncologists and staff:
Jan
19th
Spotlight On Hematology
with UCI in Huntington Beach.
30th
LunchTime Series
Teleconference at 12:00pm-PST.
Feb 23rd Oncology Summit 8am - 12:00pm Huntington Beach.
Mar 27th LunchTime Series Teleconference at 12:00pm-PST.
Apr 24th LunchTime Series Teleconference at 12:00pm-PST.
Jul 31st LunchTime Series Teleconference at 12:00pm-PST
Aug
TBD
Spotlight On Oncolo
gy with UCI
28th LunchTime Series Teleconference at 12:00pm-PST.
Sep 26th Educational Series (Admin & Oncology Billers Program)
Dates are subject to change and programs may be added
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- ANCO's 2018 Annual Report is now available online at www.anco-online.org/AR2018.pdf and was mailed to all ANCO physician members the last week in November.
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Results from the ANCO/MOASC 2018 staff salary survey are now available online. Read the report, review the results, and download the data at
www.anco-online.org/salsrvy.html.
- Membership renewal notices for 2019 were mailed to all members the last week in November along with annual election ballots and the 2018 Annual Report. If you have not yet done so, then please return your 2019 membership dues to ANCO now to ensure your inclusion in
The ANCO Directory of Members
. Be sure to to provide ANCO with your e-mail address and the name(s) and e-mail address(es) of office and/or nurse manager contact(s). Those not renewing their membership by June 30 will be deleted from the Directory of Members and will no longer be eligible for ANCO benefits or receive ANCO information.
- ANCO will host a webinar entitled
Medicare Regulations 2019
on January 3 at 12:30PM. Roberta Buell, MBA, onPoint Oncology, will provide a comprehensive update of changes for Medicare reimbursement--including fee schedule, coding/billing, and incentive program updates. Download the webinar announcement at www.anco-online.org/MedicareUpdate2019.pdf; register at https://bit.ly/2DmARLi.
- ANCO, in association with the Organizing Committee of the San Antonio Breast Cancer Symposium and Encore Medical Education, will host the Best of San Antonio Breast Cancer Symposium San Francisco (Best of SABCS San Francisco) at The Claremont Hotel on Saturday morning, January 26. Hope S. Rugo, MD, UC San Francisco, is the Regional Director for Best of SABCS San Francisco. Learn more and register at www.bestofsabcs.com/best-of-sabcs-san-francisco/.
- Registration is now open for the 19th Multidisciplinary Management of Cancers: A Case-based Approach, taking place at the Silverado Resort and Spa in Napa on March 15-17, 2019. Go to http://www.multicancers.org to register and arrange for housing.
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National News
- The Trump administration released a report outlining more than 50 recommendations for health care, including expanding use of health savings accounts, allowing increased use of telemedicine and accelerating the state licensing process for insurers. The report also called on Congress to overhaul the Affordable Care Act, including repealing the employer mandate, removing barriers to expansion of physician-owned hospitals, and gave states a blueprint for repealing certificate-of-need laws and urged them to push against industry consolidation.
- A federal judge told pharmacy giant CVS Health and the insurer Aetna that they have to keep their management separate until he weighs in on their $70 billion merger.
- ASCO and Friends of Cancer Research applaud the National Cancer Institute's (NCI) recent revision of its clinical trial protocol template to broaden eligibility criteria for cancer clinical trials. The protocol template was expanded to help increase the opportunity for participation in NCI-funded clinical trials for patients with certain health care conditions, as well as to provide an opportunity for patients younger than age 18 to participate in adult clinical trials in certain circumstances. View the new Cancer Therapy Evaluation Program protocol templates, guidelines, and updated language on eligibility criteria at
- The UnitedHealthcare Network Bulletin (December 2018) is now available online at www.uhcprovider.com. The December 2018 Network Bulletin features articles about Network National Laboratory Services Care Providers for 2019; Unitedhealthhcare Preferred Lab Network to Launch July 1, 2019; Changes in Advance Notification and Prior Authorization Requirements; 340B Drug Pricing Program Expanding in 2019.
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CMS News
- Center for Medicare & Medicaid Innovation Director Adam Boehler told the Office of the National Coordinator for Health IT's annual conference that a big part of his job is to "blow up fee-for-service" health care payments. Sen. Lamar Alexander, R-Tenn., said the change to value-based payments cannot happen all at once and called for giving states flexibility to experiment and determine the best approaches.
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The annual updated version of the National Correct Coding Initiative Policy Manual for Medicare Services is effective January 1, 2019.
CMS has released their Quarterly Update to the NCCI PTP Edits, Version 25.0.
CR 11044 updates the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edits, which relate to Chapter 23, Section 20.9 of the Medicare Claims Processing Manual (Pub. 100-04). Some updates of interest are:
- NCCI Policy Manual for Medicare Services - Effective January 1, 2019
- Chapter 23 - Fee Schedule Administration and Coding Requirements
- Modifier 59 Article: Proper Usage Regarding Distinct Procedural Service
- HCPCS General Information
- CMS understands that if you're a clinician living or practicing in an area affected by Hurricane Florence and Hurricane Michael, you may experience difficulties collecting and submitting data for the Merit-based Incentive Payment System (MIPS) on time during the 2018 MIPS performance period. Most recently, for those affected by Hurricane Florence, Hurricane Michael, and California Wildfires, CMS has tried to lessen your burden by not requiring you to submit an application to reweight the performance categories under MIPS.
- CMS' proposal to give Medicare Part D plans more authority to negotiate drug prices by allowing them to exclude drugs in protected classes if their prices increase faster than the rate of inflation or if new formulations don't offer significant innovation, was praised by industry leaders. The CMS proposal will enable Part D coverage providers to work even harder to lower costs for the patients they serve, while preserving access to the medications these patients need.
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Affiliate Association News
- TOMORROW, December 5, 2018 from 1:00 - 2:00 PM Pacific, ASCO is hosting a webinar, to outline the recently published 2019 Medicare-Final Rules Update Reimbursement. Please register now and encourage your members to do the same.
- Registration is open for the
ACCC 45TH ANNUAL MEETING & CANCER CENTER BUSINESS SUMMIT (AMCCBS)
, a national thought leadership forum where the intersection of
BUSINESS, QUALITY, TECHNOLOGY,
and
POLICY
leads to solutions for a changing healthcare industry.
Hosted by the Association of Community Cancer Centers (ACCC), Cancer Center Business Summit, and Foley & Lardner LLP, AMCCBS is a dynamic event for key stakeholders immersed in the business and policy of cancer care. Join healthcare executives, business leaders, and multidisciplinary providers-from C-suite executives, oncology specialists, directors and administrators-to professionals in health IT, public policy, research, pharmacy and biotechnology, academia and consultancy, from March 20 - 22, 2019, in Washington D.C.
- ASCO's Journal of Oncology Practice (JOP) has published an article entitled Cost Differences Associated with Oncology Care Delivered in a Community Setting Versus a Hospital Setting: A Matched-Claims Analysis of Patients with Breast, Colorectal, and Lung Cancers. The article explores how access to high-quality cancer care remains a challenge for many patients with a larger barrier being the increasing cost of treatment. Read the article at
- A new provisional clinical opinion (PCO) from ASCO addresses identification and management of patients and family members with possible predisposition to pancreatic adenocarcinoma (PDAC). ASCO PCOs are intended to offer timely clinical direction to ASCO's membership and other health care providers. Read the new PCO at
- NCCN has published the following updates at www.nccn.org: acute myeloid leukemia (V3.2018), AIDs-related Kaposi sarcoma (V2.2019), B-cell lymphomas (V1.2019), central nervous system cancers (V2.2018), thyroid carcinomas (V2.2018).
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- Bayer Healthcare Pharmaceuticals informs ANCO and MOASC that the United States Food and Drug Administration has approved Vitrakvi for adult and pediatric patients with solid tumors that have a neurotrophic receptor tyrosine kinase (NTRK) gene fusion without a known acquired resistance mutation, that are either metastatic or where surgical resection is likely to result in severe morbidity, and who have no satisfactory alternative treatments or whose cancer has progressed following treatment.
- Astellas Oncology informs ANCO and MOASC that the United States Food and Drug Administration (FDA) has approved Xospata for treatment of adult patients who have relapsed or refractory acute myeloid leukemia (AML) with a FLT3 mutation as detected by an FDA-approved test. The FDA also approved an expanded indication for a companion diagnostic to include Xospata. The LeukoStrat CDx FLT3 Mutation Assay is used to detect the FLT3 mutation in patients with AML.
- Pharmacyclics invites you to their webinar on December 12, 2018 about Important Considerations for Patients with CLL. The 2018 updates to the iwCLL guidelines include several major changes or additions, including the increased importance of clinical staging, prognostic markers, and prognostic scores. To RSVP, to the 4:00 PM Pacific webinar go to: http://bit.ly/register_7PMET or 6:30 PM Pacific webinar go to: http://bit.ly/register_930PMET. To view the invitation click HERE
- Pfizer Oncology has addressed a healthcare provider field letter addressing the devastating wildfires in California and offering assistance to ensure that patients in the affected areas maintain access to their medicines. Specifically, for help with Pfizer's oncology medicines, call Pfizer Oncology Together at (877) 744-5675; for help with Pfizer's other medicines, call Pfizer RxPathways at (844) 989-PATH (7284).
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MOASC CALENDAR
Spotlight On Hematology
(January 19, 2019)
Oncology Summit
(February 23, 2019)
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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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