C a l i f o r n i a O n c o l o g y W e e k l y
"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 5 , 2017
This Weekly's Hot Topics
    • Cancer Screen Week, December 4-8, 2017. (Industry News)
    • 2018 Part B monthly premium and deductible will remain the same (CMS News)
    • New platform lets patients sell their health data. (National News)

California News 
Op Ed published in the Sacramento Bee about the lack of sufficient oversight and tough punishment by the Medical Board for physicians who commit sexual assault of patients. This has been an ongoing policy discussion in Sacramento. http://www.sacbee.com/opinion/op-ed/soapbox/article187223858.html#emlnl=Afternoon_Newsletter

Noridian News  
Noridian/JEMAC has posted more updates to its website:
* MLN Connects
Announcements-- Claims, Prices & Codes--Billing for Stem Cell Transplants-Reminder
Events--Publications--Quality Payment Program 2017: MIPS ACI Performance Category Web-Based Training Course-New 
* Laboratory NCD Edit Software for January 2018-Revised CR10309
* Payment Reduction for X-Rays Taken Using Computed Radiography-CR10188
* Mammography HCPCS Codes, Waiver of Coinsurance and Deductible for Preventive and Other Services, and Addition of Anesthesia and Prolonged Preventive Services CR10181 
Upcoming Noridian/JEMAC webinars include: 
* Preventive and Screening Services Webinar (December 6)
* Recoupment Timeline and Payment Options Webinar (December 7)
* Medicare Provider Enrollment Webinar (December 12)
* Modifier 59, NCCI, and MUE Webinar (December 13)
* Understanding National and Local Coverage Determinations Webinar (December 13)
* Telehealth Services Webinar (December 14)

  MOASC News

Hear MOASC President, Warren Fong, M.D.'s interview with Larry Marino, host of Sunday Morning Newsmakers, to discuss the 340B program on "Politics & Issues." Click HERE

A new issue has been added to our list of grievances! Please provide MOASC with your information through December 8th. MOASC will compile and forward to the California Insurance Commissioner or the Department of Managed Health Care for resolution. The number of contested denials handled by the department has nearly tripled! YOUR RESPONSE IS NEEDED! During the roundtable discussion at the  MOASC Educational Series program, the following topics were discussed:
  • United Health Care and a local IPA breach of contract regarding reimbursement for services rendered > 90 days.
  • UHC creating difficulty with NDC numbers and the N4 code,
  • Monarch/SCOA takes 160 days for payment,
  • Blue Shield wants records and takes 45+ days to review, even when office sends the records at the beginning of treatment.
ACTION: Are you experiencing these, or other, problems with the health plans from whom you seek reimbursement? Through December 8 th, please provide the MOASC Office  moasc@moasc.org  with examples of the specific payer issues. MOASC will compile and forward to the California Insurance Commissioner or the Department of Managed Health Care for resolution. Thank you.

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ANCO News  

ANCO's 2017  Annual Report is now available online at  www.anco-online.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 2017 & 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.
SAVE THE DATE: 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. Stay tuned for registration information.
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.

National  News

- Lawmakers are negotiating their year-end budget and HHS' new Medicare cuts to the 340B program is involved. Congress must pass the budget by Dec. 8 to prevent a government shutdown. 340B hospitals face $1.6 billion in annual Medicare cuts through the CMS' finalized hospital outpatient hospital prospective payment rule if Congress doesn't block or delay its implementation before Jan. 1, according to the American Hospital Association and Association of American Medical Colleges. A bipartisan group of House lawmakers want leadership to include a bill in the year-end budget patch that would essentially bar the cuts and new reporting requirements that hospitals say add extra administrative burden from going into effect.
Have questions about TRICARE benefits? Join Tricare for a Q&A webinar on Wednesday, Dec. 13, from 10 to 11 a.m. (PT). The "TRICARE Asked and Answered" webinar will include a panel of subject matter experts to answer your questions about TRICARE benefits, health plan options, dental plan options, upcoming changes to TRICARE, and more. Read the full article here
NIH's All of Us Research Program partners with the National Library of Medicine to reach communities through local libraries . Partnership aims to raise awareness about the program and improve participant access.
Telemedicine offers access to state-of-the-art cancer care in rural areas. The Gene Upshaw Memorial Tahoe Forest Cancer Center in California has established a virtual tumor board to help reduce fears in rural patients with cancer and offer them easier access to modern care and clinical trials . READ MORE
New platform lets patients sell their health data . Through the Health Wizz app, patients can aggregate their data and receive cryptocurrency in exchange for handing it over to pharmaceutical companies and others.  Read More
- The  UnitedHelathcare Network Bulletin for December is now available online at  https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/News/December-Interactive-Network-Bulletin-2017.pdf#page=3 and features articles about prior authorization requirements effective January 1.
The  Senate  tax reform legislation would trigger sequestration and threaten cuts to Medicare of approximately $25B. ANCO, MOASC, and ASCO urge member stop urge their  Senators to act to avoid Medicare cuts in the tax reform legislation via  http://cprengage.com/asco/?3
ASCO and seven other medical societies sent a letter to the leaders of the Senate Finance Committee, House Energy and Commerce Committee, and  House Ways and Means Committee  asking lawmakers to take action this year to remove Part B drug payments from the Merit-based Incentive Payment System (MIPS) score adjustment. The recently released CMS CY2018  Physician Fee Schedule  makes Part B drug reimbursement subject to MIPS adjustments. Read the letter at  www.asco.org/new-www.asco.org/files/content-files/blog-release/pdf/2017-Joint-MIPS-PartB-Letter.pdf.
- The FDA has issued a statement addressing  IV fluid and other drug shortages and outlining solutions at
The  United States Federal Drug Administration's Division of Drug Information  is hosting a complimentary webinar entitled Overview of the Regulatory Framework and the Development and Approval of Biosimilars in the U.S . The webinar will define the difference between biosimilar and interchangeable products, provide an overview of the regulatory framework for biosimilar products, and explain the general requirements of the approval pathway for biosimilars. Learn more and register at  http://collaborationcqpub1.fda.gov/content/connect/c1/7/en/events/shared/94630851/event_registration.html?sco-id=127063551&charset_=utf-8.

CMS News 
- Listen/View ACCC's 2018 OPPS/PFS Final Rules: What You Need to
https://attendee.gotowebinar.com/recording/viewRecording/3246328258799617539/4538641450016057608/execdir@anco-online.org ; read Bobbi Buell's analysis of the final rules at www.anco-online.org/BBMPFS2018Analysis.pdf.
The standard Part B monthly premium and deductible will remain consistent next year, 2018, at $134 and $183, respectively. Beneficiaries previously held harmless against premium increases may see an increase, but this would be offset by an increase in Social Security benefits. The standard deductible and premium for Part A will increase by $24 and $9, respectively. Read this fact sheet for more information.
Providers and health plans use a variety of different formats for conducting electronic transactions. HIPAA Administrative Simplification transaction standards work towards reducing the variable formats, making it easier for data to be shared and transferred. The 2016 CAQH Index estimates that industry-wide compliance with the adopted standards could save providers nearly $8 billion annually, with overall savings to the industry projected at more than $9 billion. The report analyzed the financial impact for the following transactions: Claim submission/receipt; Eligibility and benefits verification; Prior authorization;
Claim status inquiry; Claim payment (electronic funds transfer); Claim remittance advice; Claim attachments (standards not yet adopted).
Achieving the full benefits of Administrative Simplification requires industry-wide compliance. To that end, HHS will pursue proactive compliance reviews of health plans and clearinghouses for compliance with Administrative Simplification transaction standards. Practices will want to ensure YOUR clearinghouse is meeting these standards. You will want to encourage your clearinghouse to volunteer for the pilot by sending an email now to the HIPAAcomplaint@cms.hhs.gov mailbox. Any HIPAA-covered health plan or clearinghouse may volunteer. HHS will choose volunteers from emails received by December 13, 2017. HHS will inform you by December 27, 2017, whether or not you're selected to be part of the pilot.
The CMS is moving ahead with its plan to cancel bundled-payment models that were predicted to save Medicare millions. The agency insisted it still supports moving Medicare from a fee-for-service to value-based system.  Read More

Affiliate Association News 
At the 59th ASH Annual Meeting, experience these one-of-a-kind educational opportunities, and engage in new education sessions. Don't miss either of the two newly announced U.S. Food and Drug Administration (FDA)-sponsored sessions on new drugs. A joint session, co-sponsored by the FDA, will take place Sunday, December 10, and feature  new drug approvals in acute lymphoid leukemia and non-hodgkin lymphoma Then, on Monday,  December 11, the FDA will host another joint session which will feature  new drug approvals in acute myeloid leukemia At both sessions, speakers will give an in-depth analysis of newly approved drugs and their current and future roles in the treatment of these diseases.
- ASCO is hosting a series of  QOPI Reporting Registry webinars in December; for more information and to register, visit  www.instituteforquality.org/qopi/about/quality-reporting? 
ASCO has issued two new guidelines--an update on platelet transfusion for people with cancer and an update on the use of larynx-preservation strategies in the treatment of larynegeal cancer. Read the updates at  www.asco.org/practice-guidelines/quality-guidelines/guidelines/supportive-care-and-treatement-related-issues#/10171 and  www.asco.org/practice-guidelines/quality-guidelines/guidelines/head-and-neck-cancer#/10261, respectively.

ASCO seeks applications for volunteers at its ASCO Volunteer Portal  https://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.
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.
Registration is now open for the 2018 Community Oncology Conference! The Conference  will center on keeping patients and their needs paramount in transforming our nation's cancer care system. Over two packed days of learning and networking, community oncology practices and allied professionals will gain insights into how to overcome the challenges to patient care that they face on a daily basis. Balancing the many external and internal forces in community oncology requires constant adaption and teamwork. Attending the 2018  Community Oncology Conference  will help keep you current with all that it takes to deliver community cancer care, while remaining focused on expert, tailored care for every patient.  Register Today to Save Your Seat!
The abstract submitter is now open for the  2018 ASCO Annual Meeting. Submit an abstract by February 13, 2018, at 8:59 PM (PST) to be considered for presentation or publication at this year's Annual Meeting, held June 1-5, in Chicago, Illinois.
ASH has started accepting applications for the ASH Congressional Fellowship Program for 2018 - 2019. This year-long opportunity will place a hematologist on Capitol Hill to work in a Congressional office and help shape health care and hematology policy. This opportunity will be available for one ASH member starting in September 2018. For requirements, more information or to apply today, please visit the  Congressional Fellowship Program website.
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. This is your chance to evaluate your diagnostic techniques and therapeutic approaches and discuss with leading hematology experts and colleagues how new research and clinical updates can be translated into new patient care strategies. Attend the meeting in California on January 12-13, 2018 in San Francisco! For more information or to register, click here.
NCCN has published updates to the below.  For the complete updated versions, please visit  NCCN.org . Recent updates include: breast cancer (V3.2017), melanoma (V1.2018), multiple myeloma (V3.2018).

Industry News 

Pfizer Oncology is committed to helping patient get access to the medications they need.  Pfizer Oncology Together helps provide eligible patients with financial support, regardless of their insurance coverage.  Pfizer Oncology Together has a range of offerings to provide patients with financial support, regardless of their insurance coverage, including:
*            Uninsured: Patients who do not have any form of healthcare coverage
*            Commercially insured: Commercial, private, employer and healthcare exchange patients
*            Medicare/govt insured: Medicare, Medicaid, and other Government insured patients
*            Pfizer Oncology Together also offers one-to-one personalized office support and education to help office best navigate access and reimbursement issues Pfizer Oncology PfizerOncologyTogether.com Phone # (877) 744-5675 Fax # (877) 736-6506. Hours of Operation: Monday-Friday 8am-8pm ET. Please reach out to your Pfizer Representative for additional details .
The FDA approved Foundation Medicine's first-of-a-kind test that looks for mutations in hundreds of cancer genes at once, instead of just individual genes. The test, which the Centers for Medicare and Medicaid Services proposed covering, will give doctors a more complete picture of what's driving a patient's tumor. The Associated Press .
Yesterday, Genentech, the American Cancer Society, Stand Up To Cancer and Rally Health launched a new public health initiative called Cancer Screen Week, December 4-8, 2017. A multimedia press release on this announcement can be found here.
According to the American Cancer Society, screening significantly increases the chances of detecting certain cancers early, when they are most likely to be treated successfully. Individuals can visit http://www.GetScreenedNow.org to take the pledge to get screened and receive a personalized list of recommended screenings, plus a list of simple actions they can take to help lower their risk for certain types of cancers. People who take the pledge are urged to encourage their family and friends to take the pledge as well. Employers and providers can visit www.CancerScreenWeek.org to find turnkey, customizable campaign materials they can use to promote cancer screenings among their employee and patient populations. Governors from 12 states have signed proclamations to make the first week of December Cancer Screen Week and will encourage Americans to talk to their doctor and get their recommended cancer screenings.
- Mavupharma, a biotech startup based in Kirkland, Wash., says it has raised a $20 million Series A funding round to develop a unique class of drug that enables the body's immune system to fight cancer. The funding comes from Frazier Healthcare Partners, which led the round, and Alpine BioVentures. It is the first funding the startup has raised since it was founded in 2016.  GeekWire

In This Issue
Spotlight on Hematology 
 January 27, 2018
Huntington Beach, CA

Oncology Summit
March 3, 2018
Huntington Beach, CA

Medicare Reimbursement for Oncology 2018
(San Jose, January 3 & Sacramento, January 4)

Highlights of ASH (San Francisco, January 12-13)

Evolving Treatment Options in Lung Cancer (San Francisco, January 13)

(San Francisco, January 18-20) 

(San Francisco, January 25-27) 

Best of SABCS San Francisco (Berkeley, January 27)

(San Francisco, February 8-10) 

(Napa, March 16-18)

Kaiser Permanente National Oncology Symposium (San Francisco, April 27-28)  
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