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.
August 29, 2017
This  Weekly's Hot Topics


  • Medicare regulations on bundling and unbundling of chemotherapy services. (Noridian News)
  • ATTEND the 2017 ASH Meeting on Hematologic Malignancies (MHM) (Affiliate News)
  • Anthem/AIM prior authorization process for Oncotype Dx. (Industry News)

California News 

- The Sacramento Bee published an op-ed from Deborah Goldberg, a mother living with cancer in Los Altos, about the importance of hope and innovation to those battling cancer, and the potentially negative impact of regulations like SB 17 on patients like Deborah. Deborah urges legislators not to support legislation that would stifle investment in innovation and take away the hope of new therapies for people with cancer. If you are interested in tweeting, here are some samples: .@sacbee_news on the importance of hope to those living with cancer: http://bit.ly/2ixJtGa #NoOnSB17.
- Californians Allied for Patient Protection (CAPP) The Coalition to Protect MICRA, invite you to join them for an evening reception in honor of Senator Scott Wiener on Monday, September 25thfrom 5:30 p.m. - 6:30 p.m. The reception will be held at the San Francisco Dental Society (2143 Lombard Street, San Francisco, CA). Please click here to view the invitation. CAPP asks that you share the invitation with your colleagues and encourage them to attend. Please RSVP to Tina de Vere White (tdeverewhite@micra.org). Thank you for your continued support of CAPP.
Forthcoming CMA webinars include:
* MACRA: Guidance on the Merit-Based Incentive Payment System (MIPS; September 20)
* Assembly Bill 72: How to Challenge the Interim Payment for Out-of-Network Services at In-Network Facilities (September 27). Learn more and register at www.cmanet.org/events

Noridian News  
Noridian/JEMAC has posted more updates to its website: http://med.noridianmedicare.com/web/jeb:
* MLN Connects
Claims, Pricers & Codes --
Events--PQRS: Feedback Reports and Informal Review Process for PY2016 Results Call-September 26; Physician Compare Call-September 28
Publications-- Care Management Listening Session: Audio Recording and Transcript-New; Medicare Parts A&B Appeals Process Booklet-Revised; Chronic Care Management Services Changes for 2017 Fact Sheet-Reminder
* September Webinars-Register Now
* Claim Status Category and Claim Status Codes Update CR10132
- Recent CERT reviews have revealed errors regarding insufficient documentation for Chronic Care Management (CCM) services. Read the complete update
- The Physicians Guide to Medicare Part D MTM Programs SE1229 has been released, and is intended to make you aware of Medicare Part D MTM programs that will affect your patients, and introduce you to three MTM forms that your patients are likely to share with you. Read the complete update
- Medicare has specific regulations regarding bundling and unbundling of chemotherapy services. Read the complete update
-  August Webinars - Register Now  
Noridian is hosting free, web-based workshops (webinars). This article includes a listing of this month's webinar topics. 
Read the complete update
webinars include:
* Duplicate Claims (September 13)
Visit  http://med.noridianmedicare.com/web/jeb/education/training-events for more information and to register.

DHCS/Medi-Cal News  
- Specialty drugs can be covered under the pharmacy benefit, the medical benefit, or both depending on the benefit design of the payer . The medical benefit specialty drug pipeline is very robust with near-term (2016) oncology agents.
Drug Blincyto (blinatumomab) is covered by Medi-Cal with Jcode, J9039 -Injection, blinatumomab, 1 microgram. The NDC for Blincyto 35mcg powder for injection is 55513-0160.
Dosing Limits:
  1. Quantity Limit (max daily dose) [Pharmacy Benefit]: 35 mcg (1 vial) daily per 28 days.
  2. Max Units (per dose and over time) [Medical Benefit]: 980 billable units' per42 days.
This drug, J3090, was added to the Medi-Cal fee schedule in October 2016. Reimbursement is restricted to patients 18 years of age and older. Modifiers SA and SB are allowed.
In December 2016 Retroactive Claims were adjusted due to 2016 Pharmacy Rates Update. http://files.medi-cal.ca.gov/pubsdoco/epc/2016/25492_P35814.pdf
  MOASC News
- SAVE THE DATE! Join us for the 2017 Clinical Staff, Oncology Billing & Administrator Programs.   November 8, 2017- Clinical Staff Program (Nurses, pharmacists, NPP's) and November 9, 2017- Administrators Program and Billers Program, at the DoubleTree Suites by Hilton Anaheim Resort, from 8:30am to 12:30pm. Topics to be presented and discussed are: Pharmacy Standards/USP Regulations; Immunotherapy and Targeted Therapy; MACRA/MIPS; Pain Management; A/R & Billing Updates, and more.  For more information contact the MOASC office at  moasc@moasc.org or 909-985-9061 x1.

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ANCO News  

- The Conquer Cancer Foundation of the American Society of Clinical Oncology is now accepting applications for the 2018 Young Investigator Award (YIA).  The Association of Northern California Oncologists (ANCO) is funding one 2018 YIA for a qualified northern California applicant, and urges all eligible northern California physicians to apply. The YIA is a one-year, $50,000 grant that provides research funding to promising physicians to support their transition from final years of training to faculty appointment and to encourage and promote quality research in clinical oncology. Applications in all areas of cancer research are accepted from U.S. and international applicants. For 2018, CCF has dedicated funding for the following areas: breast cancer, northern California researchers, global oncology, kidney cancer, lung cancer, pediatric cancer, sarcoma, and supportive care. Other areas of interest include cholangiocarcinoma, chronic lymphocytic leukemia, gynecological caners, and melanoma. YIA applications opened on July 1 and are due by 11:50PM ET on September 21. Eligibility criteria, award details, and the request for proposals are available on the CCF website ( www.conquer.org/YIA). For questions about the YIA or assistance with your application, please e-mail grants@concquer.org.  
ANCO's 2017 Professional Education Meeting will take place on September 6 at the San Jose Fairmont and feature talks on QPP/MACRA, ASCO's COME HOME Project, USP 797/800, and California Legislative/Regulatory Updates. Download the meeting announcement and registration form at  www.anco-online.org/ProfEduc2017.pdf.
ANCO's 3Q2017 Hematologic Malignancies Update will take place on September 9 at the Stanford Park Hotel in Menlo Park. Watch for a meeting announcement in late July. Bruno Medeiros, M.D., Stanford University, Charalambos Andreadis, M.D., University of California, San Francisco, and Brian Sworder, M.D., Ph.D., Stanford University, will review the latest research on novel treatment modalities for leukemia and lymphoma, along with case studies for these diagnoses. These Updates are supported by Janssen Biotech, Merck, Pfizer Oncology, and Pharmacyclics. Download the meeting announcement and registration form at  www.anco-online.org/3Q2017HemeMalig.pdf.
Stanford Cancer Center's MDS Center is co-sponsoring the MDS Foundation's Educational Patient-Caregiver Forum on Saturday, October 28. The Forum takes place at 875 Blake Wilbur Drive, Room 2013, Stanford CA 94305 from 9:30AM through 2PM.
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 to register your interest in receiving registration and housing information when it becomes available in the Fall. 

National  News

- COA, as well as MOASC, have received many queries regarding USP<800>. Following is the response from COA attorneys at Frier Levitt.
"...USP <800> does not go into effect until July 1, 2018, however given the vast changes contained within USP <800>, some of which may require capital expenditures, it is advised that pharmacies should begin to evaluate their ability to become compliant with USP <800> standards to ensure compliance as of July 1, 2018. Additionally, some State Boards of Pharmacy, such as California, have already implemented regulations incorporating certain USP <800> standards. Further, given the predominate use of hazardous drugs by an oncology practices, USP <800> will also have effects on medical offices and practices who, too, should begin readying for compliance..."

CMS News
- The Quality Payment Program's first performance period began on January 1, 2017 and ends on December 31, 2017. Participation in MIPS can start as early as January 1, 2017 or as late as October 2, 2017. The first payment adjustments based on performance go into effect on January 1, 2019 . CMS encourages subscribers of the PQRS listserv to sign up for the new CMS Quality Payment Program listserv. The Quality Payment Program is part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and includes two tracks - Advanced Alternative Payment Models (APMs) and the Merit-based Incentive Payment System (MIPS).
MIPS will replace three Medicare reporting programs: EHR Incentive Program (Meaningful Use); Physician Quality Reporting System and Value-Based Payment Modifier.
The Quality Payment Program listserv will provide news and updates on: New resources and website updates; Upcoming milestones and deadlines; CMS trainings and webinars.
Subscribe to the Quality Payment Program listserv to receive reminders for all of these important deadlines.
To subscribe, visit the Quality Payment Program website and select "Subscribe to Updates" at the bottom of the page or in the footer. The Resource Library includes program resources to help you learn more about the Quality Payment Program and how to participate.
The Department of Health and Human Services has delayed until July 2018, the 340B final rule, which would penalize pharmaceutical companies that knowingly overcharge hospitals for drugs purchased through the program.  A panel that advises HHS on outpatient hospital payments wants the CMS to drop a draft rule that could cut up to $1.65 billion out of the 340B discount drug program. Yesterday, the Advisory Panel on Hospital Outpatient Payment asked the CMS to rescind its proposal to pay hospitals 22.5% less than the average sales price for drugs acquired under the program. 340B aims to reduce operating costs for hospitals that see a disproportionate share of low income patients. The outpatient payment panel was created by a federal law that dictates HHS must assess how policies affect hospitals. The panel, made up of industry leaders, has proved influential.  

Affiliate Association News 
- The 340B program provides an important safety net for high numbers of uninsured, poor, or vulnerable patients, by giving discounts on prescription drugs to certain hospitals and health clinics. Unfortunately, abuse of the 340B program is hurting the cancer care system and the very patients it is supposed to help - cancer patients, who face quotas, wait lists, and significantly higher costs for care at 340B hospitals. 
Fortunately, reform of 340B reform is on the horizon. As reported in last week's California Oncology Weekly, CMS proposed changes to help stop hospital abuse of the 340B program.
CMS' proposed changes to 340B will reduce drug costs by nearly 30 percent and is estimated to save seniors at least $180 million a year. At the same time, the government will save at least $900 million a year reducing excessive drug reimbursements. 
It is time to reform 340B, so it works how it was originally intended. Go to www.CommunityOncology.org/340B
ASCO needs your help to improve payment for oncology services and is surveying practices to understand the patient services practices provide that are not separately compensated. Please complete the survey by September 1 at  https://www.surveymonkey.com/r/H5KQYQG.
ASCO urges all practices to participate in the 2018 Practice Census before the September 8 deadline. To participate, please go to  https://apps.asco.org/oncology-practice-central/survey/#/
Applications for  ASCO's Leadership Development Program will be accepted through September 24. Through the Program, participants will gain extensive exposure to the roles and mission of ASCO, its Leadership, and the Society's powerful place in developing the future of cancer care. Applicants must have completed their final subspecialty training between 2008 and 2013. Learn more and apply at http://www.asco.org/training-education/professional-development/leadership-development-program.
Well beyond the CMS-envisioned 4% median financial penalty for oncology practices, ASCO submitted comments to CMS on the 2018 QPP proposed rule arguing that ASCO's data show that the median financial penalty under the proposal would range from 14-23%.ASCO urged CMS to refrain from implementing such a policy at any point in time. In addition, ASCO urged CMS to implement multiple oncology-focused APMs, including its own PCOP model. Read ASCO's comments on the 2018 QPP proposed rule at  www.asco.org/sites/new-www.asco.org/files/content-files/QPP-2018-Proposed-Rule-Comments.pdf. Also read ASH's comments at www.hematology.org/Advocacy/Testimony.aspx.

Industry News 

- Genomic Health informs MOASC & ANCO of the new Anthem/AIM prior authorization process and how to complete a Prior Authorization request for
Oncotype Dx . Effective July 1, 2017, Anthem's AIM subsidiary will perform Prior Authorizations (Pas) for all genomic tests. Under the new rules:
  • The Oncology Office is required to initiate the PA.
  • The PA process MUST be started online at the AIM portal for ALL patients as this is the ONLY way to know which patients can be completed online.
  • The practice must be registered on the AIM portal before attempting to do a PA. 
To register on AIM's portal go to:  www.providerportal.com . Make certain that the "testing module" language appears inside your account view.
Currently only certain Anthem patients (those that are "fully-insured") can have PAs completed online. 
The portal will indicate, once the patient's insurance information is entered, if the PA process can be completed online or if the old system must be used.
As of Jan 1, 2018 PAs will be completed on the portal for all patients.
Complete the PA online if the portal so indicates and then either 1) fax the approval PA number you are given to Genomic Health at 866-383-1932, or 2) upload the approval to Genomic Health's physician portal.
If you are not allowed to complete the PA on the AIM portal, you must either complete the PA on Genomic Health's physician portal, or use the paper form and fax to GHI at the above number
For Medicare Advantage patients you do not currently need to use the AIM portal as described above.  Instead, complete as usual the Anthem PA on Genomic Health's physician portal and submit PA approval with your Oncotype order either by fax (866-383-1932) or upload on GHI's portal.  
However, effective November 1, 2017 you will need to use the AIM for your Medicare Advantage patients.
Please contact Jack Spicer, MD, Medical Director, Managed Care Medical Affairs, Genomic Health at jspicer@genomichealth.com if you have any questions.

- Helsinn Cares is committed to providing healthcare professionals, patients, and caregivers with the resources and information needed for access and reimbursement support.  With this goal in mind, Helsinn Cares helps support patient access:
* By providing tools and resources for physicians, nurses, and office staff for reimbursement and access support for patients, and by providing services and support for patients and caregivers that help with access, reimbursement, and patient assistance.
Three programs available for patients, one or more may be right for your patients:
Pay $0 Savings Program; Quick Start Voucher Program, and Patient Assistance Program.
Helsinn is committed to helping every patient obtain the Helsinn medication they need.
For answers to specific questions on Helsinn Cares ( www.helsinnreimbursement.com ) or please call 1-84HELSINN-U (1-844-357-4668, select prompt 2) or fax: 1-844-357-4669. For medical information, please call: 1-855-541-3495. Helsinn Cares

- AMGEN  informs MOASC and ANCO of two recent approvals by the U.S. Food and Drug Administration (FDA) for BLINCYTO┬« (blinatumomab).  On July 11, 2017, the FDA granted full approval to BLINCYTO┬« (blinatumomab) for the treatment of relapsed or refractory B-cell precursor acute lymphoblastic leukemia ( R/R B- ALL) in adults and children, regardless of Philadelphia chromosome status.1,2. On May 3, 2017, the FDA also approved the 7-Day infusion option for BLINCYTO. For more information, go to the full  Prescribing Information for BLINCYTO. 
Pfizer Oncology  informs ANCO and MOASC that the United States Food and Drug Administration has approved Besponsa  for the treatment of adults with relapsed or refractory B-cell precursor acute lymphoblastic leukemia (ALL).
Pfizer Oncology informs ANCO and MOASC of the availability of online resources to support employers interested in managing cancer in the workplace. These online resources were developed in collaboration with Anthem, Cancer and Careers, and USBLN and are designed to either help support employees who are living with cancer so they can remain in the workplace or help transition them back to work. For more information, please contact your Pfizer Oncology Key Account Manager.

In This Issue
Professional Educational Series 
 November 8-9

(San Jose, September 6) 
3Q2017 Hematologic Malignancies Update
(Palo Alto, September 9)

2nd Annual Research Symposium (University of California Hematologic Malignancies Consortium, San Francisco, September 15)
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