January is Cervical Cancer Awareness Month |
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Medi-Cal Rx Update MOASC News
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TOMORROW! Improving Patient Collections Experience MOASC News/MOASC Programs
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Thursday, January 20, Exploring A First-In-Class Therapy for CLL and Newly Diagnosed AML Pivotal Phase 3 Data that supports Treatment Decisions and Patient Care. MOASC News/MOASC Programs
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January 20-21, Multidisciplinary Head and Neck Cancer Care Conference MOASC News/MOASC Programs
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Ending Thursday! Save 20% registration for COA Conference Affiliate Association News/COA News
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Medi-Cal Rx Update
MOASC continues to acquire clarity regarding Medi-Cal Rx. Early last week, there was a call conducted by Medi-Cal Rx. Following that meeting, the California Department of Health Care Services (DHCS) sent out the following guidance to the contracting healthplans:
“…We have sent notice to all MCPs yesterday. Below is the messaging we provided. Please do keep us informed if there continues to be concerns/confusion.
This communication is to remind Medi-Cal Managed Care Plans (MCPs) of their obligations to provide access to physician administered drugs (PAD) which are prescription drugs administered by a health care professional in a clinic, physician’s office, or outpatient setting.
MCPs who have excluded prescription drugs that were formerly available through the medical benefit or have directed their subcontractors or network providers to no longer bill for prescription drugs through their medical claims should take immediate action to reinstate coverage for PADs.
DHCS has received concerning reports of denials or impeded access to specific drugs such as chemotherapeutic agents, anti-rejection medications for organ transplants, and long-acting contraceptives. Many of the drugs administered by clinicians in medical settings are unavailable in most standard pharmacies or specialty pharmacies. Therefore pharmacies are not able to bill for PADs through Medi-Cal Rx and directing members to go to their pharmacy to obtain PADs is not appropriate.
The Medi-Cal FFS delivery system makes all medically necessary prescription drugs -administered in an outpatient office or clinic setting by a health care professional - available through the medical benefit. DHCS’ intent was to ensure the Medi-Cal managed care members have the same access to these prescription drugs as Medi-Cal FFS members when establishing the scope of benefit for Medi-Cal Rx.
MCPs are required to not carve-out but instead retain PAD as a medical benefit, even though some may also be available as a pharmacy benefit when it is medically appropriate. In certain select cases, when medically appropriate, DHCS may ALSO authorize a pharmacy to dispense and bill for PADs. However, this is an exception and this flexibility is not intended to replace coverage of PAD as a medical benefit. These prescription drugs always remain a medical benefit even when they are also available as a pharmacy benefit.
DHCS sent out a survey to MCPs yesterday asking about your current policies related to PADs. However, this communication is to clarify existing requirements. DHCS will also review our policies for consistency and make any necessary updates for clarity…”
The California Medical Association (CMA) informed MOASC they were directly told of an instance regarding Molina and AlphaCare/NMM. The CMA reached out to Molina and they were incredibly responsive. Molina reached out to the practice and to the delegated group to clarify. Molina also ensured they would be responsible for payment if there were any issues with NMM/Alphacare.
Please continue to let MOASC moasc@moasc.org know of any adverse Medi-Cal Rx issues. Thank you.
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MOASC Programs - Save the Dates - All Times are Pacific
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Half of patients are more stressed about billing than quality of care. Focus on what matters. High deductible health plans (HDHPs) have shifted the already-complex payer reimbursement burden onto the shoulders of consumers who are unprepared to bear it.
Consumers, on the one hand, need increased support to understand their bills and figure out how to pay them. On the other hand, patients with more skin in the game are becoming more demanding about the quality of their customer experience.
These changes necessitate a new patient payment model that focuses on delivering convenience and clear communication to patients, driving both quicker payments and increased patient satisfaction…
…TOMORROW! Wednesday, January 19, 2022, 12:30pm PST, join in MOASC’s LunchTime Series Webinar, Improving Patient Collections Experience. PayGround’s Patient-First platform enables patients (and their dependents) to manage ALL bills in one place from across ALL their providers, helping them understand their responsibility while providing multiple payment methods to fulfill that responsibility. This leads to an average 23% patient collections improvement and 6.7 days average reduction in A/R days.
PayGround has already been adopted by multiple MOASC members and the average yearly savings is estimated to be just over $10,000 in the first year.
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Thursday, January 20, 2022, 5:30pm-PST, M. Yair Levy, M.D., Director Hematologic Malignancies Research, Baylor University Medical Center, Dallas, TX will present, Exploring A First-In-Class Therapy for CLL and Newly Diagnosed AML Pivotal Phase 3 Data that supports Treatment Decisions and Patient Care.
This program is generously supported by Abbvie.
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January 20-21, 2022 University of California San Diego presents their Multidisciplinary Head and Neck Cancer Care Conference and 5th New Horizons in Immunotherapy.
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Cedars Sinai presents their 22nd Annual Educational Meeting in Gastroenterology, February 25-26, 2022. This two-day virtual activity is intended for gastroenterologists and all other healthcare professionals who treat patients with gastrointestinal disorders. In addition to lecture format presentations, the course will include the following interactive virtual instructional formats: debate and panel discussions, Q & A sessions, case discussions, and interactive video presentations.
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January 26, 2022, 6:00pm- PST, MOASC presents their Lung Cancer Series Webinar on the Management of Metastatic EGFR Mutated Non-Small Cell Lung Cancer. This lively discussion on the management of metastatic EGFR mutated non-small cell lung cancer will provide a great opportunity to learn from key opinion leaders and network with colleagues. Submit your questions and cases, in advance, for discussion with key opinion leaders in the field. Hear the latest clinical trial data, apply it to your patients, consider real-world scenarios and how to mitigate barriers to treatment.
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MOASC is pleased to join Rockpointe in presenting “Nonmelanoma Skin Cancers: Current and Emerging Checkpoint Inhibitors for Treating Advanced Basal Cell and Squamous Cell Carcinomas.” Available until August 2022, this is an on-demand, free CME/CE-certified, webcourse available to MOASC members and to anyone who would like to participate. Members are provided with at least 3 opportunities on or around December 1, 2021, March 1, 2022 and July 1, 2022.
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Career News
Sign up now to receive the MOASC Job Flash™! Please activate your new job alert.
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MOASC Clinical Trial Database is on the MOASC website at www.moasc.org
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California’s COVID-19 workplace rules changed last Friday, 01.14.2022, with more stringent requirements taking effect for employee testing and mask-wearing. One of the biggest changes has to do with employees who have to get a COVID-19 test after exposure in the workplace.
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Blood shortages forced the Los Angeles County Department of Health Services to shut down one of its trauma centers to new patients for hours earlier this week — a step it had not taken in over three decades.
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Under Gov. Gavin Newsom’s budget proposal unveiled last week, California would expand Medi-Cal to people in the U.S. illegally. California would allow all income-eligible residents to qualify for the state’s health care program for low-income people regardless of immigration status. To pay for everything, Democrats have introduced a separate bill that would raise taxes on businesses and individuals by about $163 billion per year, according to an analysis by the California Taxpayers Association, which opposes the bill. Voters would have to approve the tax hikes. Assembly member Ash Kalra, a Democrat from San Jose and the author of the proposal, said Tuesday it could be 2024 before that proposal made it to the ballot.
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The California Medical Association (CMA), through the Physicians Advocacy Institute (PAI), has filed joint amicus curiae briefs in support of two lawsuits challenging federal regulators’ approach to dispute resolution under the No Surprises Act. The lawsuits both take issue with the fact that the federal agencies responsible for implementing the No Surprises Act failed to follow clear direction from Congress on how arbiters should resolve surprise medical billing disputes between physicians and insurers under the law.
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Anthem Blue Cross has clarified that for California providers, it will continue to reimburse telehealth services billed with either POS 02 or POS 10 at the in-office place of service rate, as currently required by the California Department of Managed Health Care (DMHC). This clarification aligns with a DMHC all plan letter (APL) that reminded DMHC-regulated health plans of the continued requirement to reimburse providers at the same rate for telehealth services.
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California Dialogue on Cancer’s 2021-2025 cancer plan is now available upon request! If you would like the entire copy of California’s Comprehensive Cancer Control Plan, 2021-2025, please click here or send an email to cdocshare@gmail.com. CDOC will ask a few quick questions to learn about how you plan to utilize it, and the full pdf file will be sent to you via email. Cancer plan objectives and strategies can still be accessed via www.cdoconline.net.
As January is Cervical Cancer Awareness Month, this month, CDOC highlights a survivor from the Primary Prevention chapter of their cancer plan. Each month we will highlight a section, implementation project, survivor, and other relevant work related to the cancer plan. If you are implementing an intervention out of the 2021-2025 cancer plan you'd like featured, send an email to cdocshare@gmail.com. View the various objectives and strategies in the cancer plan to guide your work by clicking here
There are 791 potential medicines currently in development, all of which are in clinical trials or awaiting review by the FDA. 168 for rare cancers and 120 for rare blood cancers, which together account for 35% of the 791 rare disease medicines in development.
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The Medicare Payment Advisory Commission (MedPAC), last Thursday, voted unanimously to recommend that Congress stick with current law regarding Medicare's physician fee schedule. The influential federal advisory panel endorsed flat across-the-board Medicare payment levels for clinicians for 2023. As passed in 2015, MACRA mandated a 0.0% increase for the Medicare physician fee schedule from 2020 to 2025. Congress in late 2020, though, overrode MACRA and mandated for 2021 a one-time increase in payments of 3.75%. The American Medical Association (AMA) objected to the MedPAC vote. In AMA's calculations, adjusting for inflation in practice costs, Medicare physician payment has declined 20% from 2001 to 2020. The discrepancy between what it costs to run a practice and payment is sparking consolidation and driving physicians out of rural and underserved areas. An AMA analysis, released this month, showed an acceleration of a trend away from private practice, defined as a practice wholly owned by physicians. The 2020 results found less than half, 49.1%, of doctors involved in patient care worked in a private practice. This marked the first time private practice was not the dominant approach since the AMA analysis began in 2012.
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Claims Denied Incorrectly Containing Therapy Codes - Resolved 01/05/22 Alert. Between 11/17/21 and 12/01/21, some claims that contained therapy codes were denied in error. The issue only impacts ICNs with eighth digit of an 8.
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January 19 - Avoiding Costly Appeals, this webinar will review the top appeal issues, how you can avoid costly appeals, and improve efficiencies to reduce administrative burden
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January 20- Medicare Part B Drugs and Biologicals, this webinar will review Part B coverage of drugs and biologicals, proper claim submission, and common coding issues.
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January 25 - Reducing Unprocessable Claim Rejections When claims are submitted with invalid, incomplete or incorrect information, the claims processing system will detect these errors and will reject claims as unprocessable. The goal is to assist providers in submitting claims correctly the first time. Join this webinar to review the common errors found and what appropriate next steps should be taken.
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January 25 - Proper Medicare Part B Claim Submissions This webinar is intended to educate providers and office staff members on how to complete a clean claim to avoid claim rejections, developments, or denials. This webinar will guide you through the CMS-1500 claim form and the electronic equivalent loops and segments. It will review some common errors found in claims submission, which will help you in submitting claims correctly the first time. If you are a paper or electronic claims submitter, new to submitting claims or just need a refresher on claim submissions, this webinar is for you.
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Evaluation and Management Updates Webinar - February 17, 2022
This event includes: Evaluation and Management Codes 99202-99215, AMA Errata and Technical Corrections, and Resources
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Within the revised 2022 Physician Fee Schedule (PFS) implemented January 3, 2022, CMS clarifies patient locations permitted for telehealth. |
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The Biden administration has no plans to change the definition of "fully vaccinated" against the coronavirus to include getting a booster shot. "Individuals are considered fully vaccinated against COVID-19 if they've received their primary series, that definition is not changing," per Centers for Disease Control and Prevention.
Last week, the Supreme Court blocked the Biden administration's COVID-19 vaccine-or-test requirement for businesses with at least 100 workers. However, justices kept in place CMS' vaccination mandate for eligible staff at healthcare facilities participating in the Medicare and Medicaid programs. The President called on employers to proceed with their own requirements "to protect their workers, customers and communities."
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Affiliate Association News |
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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 Northern California (Best of SABCS West Coast) at The InterContinental San Francisco on Saturday morning, February 12, 2022. Hope S. Rugo, M.D., UC San Francisco, is the Regional Director for Best of SABCS West Coast.
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ANCO invites you to join them for their 22nd Multidisciplinary Management of Cancers meeting, March 11-12, 2022 at Silverado Resort & Spa, Napa, CA. This conference will present the most current information on multidisciplinary approaches in clinical oncology. Tumor board cases and panels include: breast cancer, CNS, gastrointestinal cancers, genitourinary cancers head & Neck cancers, hematologic malignancies, lymphoma, melanoma and thoracic cancer.
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The ASCO GI Cancers Symposium will take place both in person January 20-22, 2022 in San Francisco, CA, and online, and will offer new, practice-changing findings in GI cancer treatment, research, and care.
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On December 22, ASH sent a letter to the Chief Medical Officer of CVS Health opposing a recent decision by CVS to limit some commercial health plan formularies to only one direct oral anticoagulant (DOAC), rivaroxaban (Xarelto), and warfarin. ASH's letter pointed out that CVS’s decision to limit formularies to one DOAC may force beneficiaries to switch their anticoagulation therapy; and that in order to treat patients in a clinically appropriate and safe manner, physicians need access to all DOACs. The CVS formulary change went into effect on January 1 of this year. ASH is continuing advocacy on this issue. Please reach out to Leslie Brady (lbrady@hematology.org) if this has impacted you or your patients
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This Thursday, is the last day to save 20% on your registration through January 20, 2022 for the 2022 Community Oncology Conference, March 17-18. Community oncology has persevered for two years, providing high-quality cancer care to a nation consumed by COVID-19. Our doors have remained open, providing uninterrupted care to those with cancer. The COA community will come together, safely, at the 2022 Community Oncology Conference to recognize the value of community oncology, network, and learn from the shining stars who are blazing the path forward for our field. I’ll be there. Will you? Registration is Open! You are invited to join thousands of colleagues, virtually, or at the Gaylord Palms Hotel in Kissimmee, Florida, for two days of learning and networking.
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CURE News
CURE’s sister franchise, Physician’s Education Resource (PER) has two upcoming CME opportunities. As MOASC is a partner, PER is offering 35% discounted registration for MOASC physicians.
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19th Annual Winter Lung Cancer Conference
Date: February 4-6, 2022 | 7am – 12pm EST
Location: Eden Roc Miami Beach, Miami Beach, FL
This event will be Live, In-person & Virtual
Program chairs: Rogerio C. Lilenbaum, MD, Mark A. Socinski, MD, Julie R. Brahmer, MD, MSc, FASCO
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39th Annual Miami Breast Cancer Conference
Date: March 3-6, 2022
Location: Fontainebleau Miami Beach, Miami Beach, FL
This event will be Live, In-person & Virtual
Program chairs: Patrick L. Borden, MD, Debu Tripathy, MD, Hope S. Rugo, MD, FASCO
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Daiichi Sankyo cordially invites MOASC Members to join their upcoming presentation entitled: Compassion Fatigue Helping Oncology Nurses Care for Themselves While Caring for Patients on Monday, January 24, 2022 at 6:30pm. This program will include a discussion on: Defining and measuring compassion fatigue; Strategies for coping and change; Relevant resources.
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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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