California Oncology Weekly
"An Oncologists’ Source for Timely Information"
A publication of the
Medical Oncology Association of Southern California, Inc.
December 01, 2020
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TODAY! Submit your application to serve on the MOASC Board MOASC News
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TOMORROW! Wednesday, Dec. 2, MOASC presents 2 separate programs MOASC News/MOASC Programs
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Dec. 13 deadline to update billing information for CMS QPP Medicare News/CMS News
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TODAY! Please make your 2021 resolution to serve on the MOASC Board of Directors. The Board and Officers INVITE & ENCOURAGE YOU to get involved in the advancement of your profession. Join us in building a stronger association. Please submit your application and CV Today, December 1, 2020, by 6:00pm. Thank you for your serious consideration to give of your time to the association that supports you.
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Targeted Oncology is looking to highlight a MOASC physician member in their Targeted Therapies in Oncology publication. The article will be placed in the “Community Consult” column. This is an opportunity for you, as an oncologist, to share your insights on interesting cases with your peers. Share the cases in which your patients developed unique adverse events related to newly approved targeted therapies. Demonstrate how you and your team worked together to address these challenging cases, is of particular interest. Keep in mind, although this column lends itself to the case report format, the column doesn’t have to focus on a particular case. If you are facing a challenging clinical issue, Targeted Oncology can work with you to develop a two-page article addressing the clinical challenges. They are starting to plan for 2021 and will need a 4-month lead time to write something.
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Nominate your candidate(s) now for a MOASC Excellence Award. MOASC would like to recognize MOASC Members, and their staff, for their dedication to providing quality cancer care during the Pandemic of 2020. Frontline healthcare workers are the backbone of the health system. Selflessly, they take on significant personal risk, many times without adequate equipment to ensure that their patients continue to receive the care they need.
Nominate your colleagues (practice, physician, nurse or other healthcare worker) for their dedication, commitment and courage to continue providing care, thereby saving countless lives and making a difference in the community. Recognition are in the areas of Excellence in Leadership and Excellence in Healthcare. Please provide a brief summary of why you are nominating this individual or team. Awardees will be announced during the MOASC Annual Oncology Summit (Live/Virtual) on Saturday, March 27, 2021. Please submit your nominations by Friday, January 8, 2021. Thank you!
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MOASC Programs - Save the Dates -All Times are Pacific
TOMORROW! Wednesday, December 2, MOASC presents 2 separate programs.
DO NOT MISS EITHER!
12:30pm Bobbi Buell will drill down the Medicare Part B drug prices reduction Most Favored Nations Final Rule. This rule will take effect January 1, 2021.
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5:30pm Physicians are encouraged to attend the encore webinar, “Medicare for Oncologists during the COVID Crisis and Changes in 2021,” with Arthur Lurvey, M.D., Noridian Jurisdiction E Part B Medicare Medical Director, presenting.
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December 9, 12:00pm, MOASC Members are encouraged to attend the webinar, “Upcoming Changes to Medi-Cal and Managed Medi-Cal for 2021,” with Zu Afzal, PharmD, BCOP, Board Certified Oncology Pharmacist-Walgreens, presenting.
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In support of a lawsuit against Medi-Cal, the California Pharmacists Association is asking all community pharmacists impacted by the state’s clawback to complete a quick survey today! There are only days to collect data to illustrate the devastating impact the clawbacks will have.
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Physicians for a Healthy California (PHC) announced more than $38 million in CalMedForce awards across the state to support medical training and residency programs and help grow the physician workforce. The third round of CalMedForce funding, released by PHC and generated by the voter-approved Proposition 56 tobacco tax in 2016, will support 202 residency positions in 101 graduate medical education (GME) programs at hospitals and clinics, with an emphasis on those serving medically underserved groups and communities. All accredited residency programs in the state that meet guidelines are eligible to apply for funding. Even with the additional funding, the shortage of California residency programs poses an ongoing challenge for expanding the physician workforce.
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You are invited to Virtual Grand Rounds: The National COVID-19 Surge and Hope for 2021 - A Conversation with State & National Leaders. Tuesday, December 8, 2020.
12:00-1:30pm
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With support from California Health Care Foundation (CHCF), the journal Telemedicine and e-Health has released a call for research into the use of telehealth to meet the health care needs of underserved communities. The deadline for manuscript submissions is March 31, 2021.
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The California Environmental Protection Agency, Office of Environmental Health Hazard Assessment has released a new Proposition 65 fact sheet on Aloe vera. Most people would be surprised to learn that a form of Aloe vera is on the Proposition 65 list as causing cancer. The good news is that most consumer products made with this plant contain a form of Aloe vera that is not on the Proposition 65 list. The CalEPA new Aloe vera fact sheet sorts all this out, and explains what users of Aloe vera products need to know, particularly if they use the plant to make their own home remedies.
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A reminder that in 2016, AB 23941 created a Medi-Cal benefit called non-medical transportation (NMT). This report provides an overview of the implementation of the NMT benefit, the experience of Medi-Cal enrollees using the benefit, and recommendations to improve it. Please remember to use this service for your Medi-Cal patients.
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Noridian News
CR 12024 informs you of the new Calendar Year (CY) 2021 Medicare premium, coinsurance, and deductible rates.
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CR 11957 informs of updates, as needed, to the Claim Status and Claim Status Category Codes used for the Accredited Standards Committee (ASC) X12 276/277 Health Care Claim Status Request and Response and ASC X12 277 Health Care Claim Acknowledgment transactions. Make sure your billing staffs are aware of this update..
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Billing and Coding: Chemotherapy Administration - R28 coverage article has been revised and published for notice under contract numbers: 01112 (NCA), 01182 (SCA), 01212 (HI and Territories), and 01312 (NV).
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Denied claims can be reopened or appealed in the Noridian Medicare Portal (NMP).
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Part A/B Quarterly Medicare Updates include: CMS and Noridian Updates, January 2021 Quarterly Provider Updates, Change Requests (CR), Payment and Recurring Updates, Special Editions (SE), Resources and Educational Information.
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2021 Evaluation and Management Change Preparation Webinars, include: 2021 Change Summary, Office and Outpatient Services, Medical Decision Making, Time Component, and Resources.
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Region-specific events, webinars and training are found JEA, JEB, JAF and JFB.
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Locally-hosted coverage articles listed
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CMS News
On Friday, November 20, the Trump Administration HHS/CMS issued a regulation meant to curb drug prices. This regulation creates a Most Favored Nation (MFN) drug pricing model for Medicare Part B that ties drug prices to those paid by other countries. The MFN model could irreparably damage the cancer care system in the United States. Under this policy, community oncologists and their patients will find it increasingly difficult to purchase lifesaving drugs due to rising costs.
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A lawsuit was filed by the Pharmaceutical Research and Manufacturers of America, Council for Affordable Health Coverage and Partnership for Safe Medicines against HHS and the FDA over a plan to allow importation of certain prescription drugs from Canada. Pharma’s complaint is based on an HHS final rule designed to reduce costs for consumers, stating the policy threatens public health during a global pandemic.
Clinicians in the CMS Quality Payment Program have until Dec. 13 to update their billing information. This extension is for clinicians who are eligible for the 5% Advanced APM bonus for the 2018 performance year, and are on a list compiled by the agency.
Wednesday, December 16, 2020 CMS will conduct a live information session from 10:00am to 10:30am (PT). The session will provide a brief overview of the expanded reporting requirements going into effect on January 1, 2021 as a result of the SUPPORT Act and regulatory changes and share tips on how to prepare for successful compliance. Open Payments reporting entity system users and other compliance staff should attend. Once registered, you will receive an email with call access information.
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CMS, last week, finalized changes to outdated federal regulations that have burdened health care providers with added administrative costs and impeded the health care system’s move toward value-based reimbursement. The Physician Self-Referral Law, also known as the “Stark Law,” generally prohibits a physician from sending a patient for many types of services to a provider that the physician owns, is employed by, or otherwise receives payment from, regardless of what that payment is for. The old federal regulations that interpret and implement this law were designed for a health care system that reimburses providers on a fee-for-service basis, where the financial incentives are to deliver more services. However, the 21st century American health care system is increasingly moving toward financial arrangements that reward providers who are successful at keeping patients healthy and out of the hospital, where payment is tied to value rather than volume.
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CMS has outlined unprecedented comprehensive steps to increase the capacity of the American health care system to provide care to patients outside a traditional hospital setting amid a rising number of COVID-19 hospitalizations across the country. These flexibilities include allowances for safe hospital care for eligible patients in their homes and updated staffing flexibility designed to allow ambulatory surgical centers (ASCs) to provide greater inpatient care when needed. Building on CMS’s previous actions to expand the availability of telehealth across the nation, these actions are aimed at allowing health care services to be provided outside a hospital setting while maintaining capacity to continue critical non-COVID-19 care, allowing hospitals to focus on the increased need for care stemming from public health emergency (PHE).
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HHS Secretary Alex Azar publicly confirmed that a rule regulating how drug rebates are applied to Medicare Part D plans "is not projected to increase Federal spending, Medicare beneficiary premiums, or patients' total out-of-pocket costs," despite projections showing that the rule will increase Part D premiums and federal spending. Azar says he expects drugmakers to reduce their list prices, but pharmaceutical executives testifying at a congressional hearing pledged to do so only if rebates were banned in commercial plans as well.
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HHS will terminate the FDA's unapproved drugs initiative, which the department says has led to distorted markets and produced the unintended consequences of price spikes and drug shortages.
HHS Chief of Staff Brian Harrison said the move is in line with HHS' commitment "to putting American patients first by ending government programs like the Unapproved Drugs Initiative.”
The Institute for Clinical and Economic Review (ICER) released an Evidence Report assessing the comparative clinical effectiveness and value of nadofaragene firadenovec (Adstiladrin®, FKD Therapies Oy and FerGene) and oportuzumab monatox (Vicineum™, Sesen Bio) for the treatment of non-muscle invasive bladder cancer (NMIBC) that is unresponsive to Bacillus Calmette-Guerin (BCG) intravesical therapy.
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Steve Pearson, founder and president of the Institute for Clinical and Economic Review (ICER), discussed how to measure the value of life-saving drugs on America’s Health Insurance Plan's (AHIP) podcast The Next Big Thing in Health. Pearson also spoke about what lies ahead for value and prescriptions.
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Patients in the first three stages of colon cancer residing in states that expanded Medicaid under the Affordable Care Act were more likely to receive surgical treatment within 30 days compared with their counterparts in non-expansion states, while those in the final stage were more likely to receive palliative care to enhance their quality of life. The findings, published in the Journal of the American College of Surgeons, also showed states that expanded Medicaid had a higher rate of stage 1 colon cancer diagnosis, fewer urgent cases and more minimally invasive surgery than states that did not expand Medicaid.\
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Affiliate Association News
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ANCO News
Virtual Best of San Antonio Breast Cancer Symposium® – West, January 9, 2021
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ASH News
If you have not done so yet, register for the all-virtual 62nd ASH Annual Meeting & Exposition on December 5-8, 2020, to hear the experts discuss their latest groundbreaking research!
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Join ASH President Dr. Stephanie J. Lee in a special event with Grammy Award winner Keith Urban who will perform on the 62nd ASH Annual Meeting and Exposition virtual platform. ASH has announced a new “concert-only registration” option for those who would like to attend the Industry Salute to Hematology at the 62nd ASH Annual Meeting and Exposition but are not planning to attend the full ASH virtual meeting. Enter promo code CONCERT at the top of the Profile page in the registration system.
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Walgreens cordially invites MOASC Members to their webcasts on Medi-Cal’s Transition to Fee For Service on December 9, 2020 at 12:00pm PT. Upcoming changes to Medi-Cal and Managed Medi-Cal for 2021. Highlights of changes to the program effective January 1, 2020, plus Q&A. Presented by Zu Afzal, PharmD, BCOP, Walgreens.
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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 material contained in the California Oncology Weekly is intended as general information for 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 accepts no liability for any statements or articles herein. CPT codes are owned and trademarked by the American Medical Association. All Rights Reserved.
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