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Lose 5.1% or gain 7.06% in 2022 find out more. MOASC News/MOASC Programs
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COVID-19 vaccination required of practices that participate in Medicare and Medicaid. Medicare News/CMS News
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Build Back Better “reconciliation” bill summary. National News
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In response to IV Iron Policies recently published by Anthem and UnitedHealthcare, MOASC is in communication with the two insurers. President, Ashkan Lashkari, MD encourages practices who administer IV iron to take a stand as insurance carriers are making the administration of IV iron in the office a logistical nightmare. Insurers are preferring that physicians use agents that are associated with greater potential side effects (Infed, Feraheme) over others, with less adverse effects, such as Injectafer. The cost to the physician of puchasing such agents are so exhorbitant that physicians are often left with a deficit. The greatest unnecessary risk to the medical provider is the potential hypersensitivity reactions that may develop in the office.
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MOASC supports Debra A. Patt, M.D. for the ASCO Board. Please take time to vote, and encourage your partners to vote, in the ASCO election. The voting period closes on Tuesday, December 7, 2021, at 12:00pm PST, all ballots must be received by this time.
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MOASC Programs - Save the Dates - All Times are Pacific
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Do you know that the 2022 Medicare Physician Fee Schedule Final Rule can “break you” by 5.1% OR “make you” as much as 7.06%? DO NOT MISS TOMORROW, November 10, for the virtual Oncology Accounts Receivable Track 2, of the MOASC Annual Management Series for Oncology Administration & Accounts Receivable Management, 11:45am to 3:15pm. Topics will include: 2022 Billing Updates; Overview of Medicare Regulations; Billing tips for Advanced Practice Providers, and How to Increase Revenue.
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Thank you to the following sponsors for their continued generous support of access to oncology care through education: AstraZeneca, BeiGene, Bristol Myers Squibb, Grail, Inc., Oncopeptides, Pfizer Oncology, Takeda Oncology, AbbVie, Astellas, Daiichi Sakyo, Inc., Incyte, Johnson and Johnson, Merck, Novartis, ADC Therapeutics, Agios Pharmaceuticals, Exact Sciences, Foundation Medicine, Gilead, G1 Therapeutics, Guardant Health, Kite Pharma, Lilly Oncology, MorphoSys, Inc., Myovant Sciences, Pharmacyclics, Sanofi-Genzyme, Seagen, Stemline Therapeutics.
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The University of California San Diego cordially invites you to their Great Debates in Advanced Cutaneous Squamous Cell Carcinoma (CSCC), December 4, 8:30am. This virtual meeting will provide a multidisciplinary management approach for patients with advanced CSCC. Topics will focus on updates in risk assessment, pathology, radiation therapy medical & surgical management, featuring case presentations alongside plenary sessions followed by a question and answer opportunity. Target audiences include: dermatologists; medical, radiation and surgical oncologists; otolaryngologists; plastic surgeons; pathologists, and physicians and allied health professionals caring for patients with cutaneous squamous cell carcinoma.
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Career News
City of Hope Medical Group Seeks Medical Oncologists to Join our Main Campus in Duarte and Our Expanding Network:
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Duarte (main campus) | Women’s Health (Breast) Medical Oncology 60-80% clinical effort
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Antelope Valley | General Medical Oncology 95% clinical effort
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Corona | General Medical Oncology 95% clinical effort
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Glendale | General Medical Oncology 95% clinical effort
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West Covina/Glendora | General Medical Oncology 95% clinical effort
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Simi Valley | General Medical Oncology 95% clinical effort
Interested candidates must submit an official application via the City of Hope Physician Careers Internet site: Physician Careers. Additionally, applicants can forward a curriculum vitae and letter of interest to MDRecruitment@coh.org.
Thank you!
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California recently passed AB359, expanding the definition of CME to include practice management education, which aligns with other state and national guidelines and results in better services to patients.
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Join the 2021 ACS CAN California Virtual Policy Forum, Cancer Research Through A Health Equity Lens, on November 18, 5:00pm–6:30pm PST. This event will feature presentations from cancer researchers on cutting-edge science at the forefront of breakthroughs in diagnosis, treatment, care and survivorship coupled with policy proposals that ensure these advancements are available for all. Esteemed panelists will share how their work contributes to health equity in cancer research. A moderated panel and Q&A to follow.
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The California American Cancer Society Cancer Action Network (ACS CAN) has published their advocacy report.
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On January 1, 2022, the California Department of Health Care Services (DHCS) will transition all Medi-Cal pharmacy services from managed care to fee-for-service (FFS). The Medi-Cal pharmacy benefits and services administered by DHCS in the FFS delivery system is collectively referred to as “Medi-Cal Rx.” The goal of Medi-Cal Rx is to standardize the pharmacy benefit under one delivery system and improve access to pharmacy services with a network that includes a large majority of the state’s pharmacies.
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MolDX: Inivata™, InVisionFirst®, Liquid Biopsy for Patients with Lung Cancer- This Local Coverage Determination (LCD) has been revised and published for notice under contract numbers: 01112 (NCA), 01182 (SCA), 01212 (AS, GU, HI, NMI), and 01312 (NV).
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Advancing the Quality Payment Program and MIPS Value Pathways
To further improve the quality of care for people with Medicare, the PFS final rule makes several key changes to CMS’ Quality Payment Program (QPP), a value-based payment program that promotes the delivery of high-value care by clinicians through a combination of financial incentives and disincentives.
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New/Modifications to the POS Codes for Telehealth - R 12427 provides updates to the current Place of Service (POS) code set by revising the description of existing POS code 02 and adding new POS code 10. Make sure your billing staff knows of the updates.
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November 12- Additional Documentation Request (ADR) Prepay A/B. This webinar is intended for Medicare Part A and B Providers and will include: • ADR Inquiry • Prepay Documentation Submission • ADR Decision • Resources.
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November 15-COVID-19 Vaccine CMS Webinar for Rural Communities
Intended for community partners and providers working in rural areas, this webinar will offer attendees the opportunity to learn more about federal COVID-19 resources, toolkits, and information. Attendees will also receive information on healthcare workforce mandates, healthcare coverage related to the vaccine, and more.
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The Biden Administration has required COVID-19 vaccination of eligible staff at health care facilities that participate in the Medicare and Medicaid programs, by December 5, 2021. Facilities covered by this regulation must establish a policy ensuring all eligible staff have received the first dose of a two-dose COVID-19 vaccine or a one-dose COVID-19 vaccine prior to providing any care, treatment, or other services. All eligible staff must have received the necessary shots to be fully vaccinated - either two doses of Pfizer or Moderna or one dose of Johnson & Johnson - by January 4, 2022.
CMS has posted the presentation slides and recording of the stakeholder call of November 4, regarding the COVID-19 Omnibus Vaccine Rule (IFC-6).
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The next stakeholder call will be held tomorrow, November 10, 12:30pm-1:30pm PST.
After registering, you will receive a confirmation email containing information about joining the webinar. *Please note CMS can only accommodate 10,000 participants so register early to guarantee your participation.*
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CMS is taking action to close health equity gaps by providing Medicare patients living with End-Stage Renal Disease (ESRD) with greater access to care. Through the ESRD Prospective Payment System (PPS) annual rulemaking, CMS is making changes to the ESRD Quality Incentive Program (QIP) and the ESRD Treatment Choices (ETC) Model, and updating ESRD PPS payment rates. The changes to the ETC Model policies aim to encourage dialysis facilities and health care providers to decrease disparities in rates of home dialysis and kidney transplants among ESRD patients with lower socioeconomic status, making the model one of the agency’s first CMS Innovation Center models to directly address health equity.
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In requesting an update on CMS’ efforts to streamline prior authorization protocols across programs, including Medicare Advantage (MA) plans, a bipartisan group of senators pushed CMS to make changes to reduce administrative burden for providers, protect seniors from unnecessary delays in access to treatment. The senators commended the Administration’s commitment to ensuring timely access to health care and are encouraging the administration to take additional steps to strengthen prior authorization policies and make them more efficient for all Americans, including MA beneficiaries.
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The final rule is expected soon to CMS’ proposed 2022 Physician Fee Schedule to extend telehealth flexibilities through 2023 instead of through the end of the COVID-19 public health emergency, which is expected to run through this year. Physician groups in comments on the rule called for a permanent solution beyond the dates set by CMS. Groups also submitted comments on MIPS Value Pathways (MVPs), ACO policies, and pending payment cuts.
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There has been many questions about the drug pricing provisions in the Build Back Better “reconciliation” bill. Provided by COA, here is a highlight summary of the provisions.
- Each year, HHS Secretary identifies 100 brand-name Part B & D drugs without price competition, 9 years for small molecules & 12 for biologicals. But that now is changed in the bill; years are less.
- Starting in 2025, Secretary will “negotiate” up to 10 drugs, 15 drugs in 2026 and 2027; 20 drugs per year, thereafter.
- Orphan drugs and those less than $200 million are exempted.
- Certain small biotech drugs are also exempted 2025-2027.
- Medicare Part D formulary restrictions.
- Manufacturers that don’t “negotiate” with CMS will be levied an excise tax.
- Part B & D rebate inflation caps (drugs can’t increase in price over the inflation rate or manufacturers provide a rebate).
- Redesign of Part D & patient max out-of-pocket caps
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Coverage is Available for COVID-19 Vaccinations for Eligible Children Ages 5 through 11.
Following the FDA recent action authorizing the Pfizer-BioNTech COVID-19 Vaccine for the prevention of COVID-19 in children 5 through 11 years of age and a recommendation from the Centers for Disease Control and Prevention (CDC), the Centers for Medicare & Medicaid Services (CMS) is reminding eligible consumers that coverage is available without cost-sharing under Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and in the commercial market for this critical protection from the virus. As with all vaccines, the Pfizer-BioNTech COVID-19 Vaccine was tested thoroughly in this age group prior to its authorization for emergency use.
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Women diagnosed with breast cancer under the age of 35 face a higher risk of the disease spreading, according to the first global study of its kind.
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CME-CE programs to assist Oncologists diagnose & treat advanced nonmelanoma skin cancers. NMSC, which account for at least 30% of all cancer diagnoses, are an increasing health burden. Approximately 5 million adults are treated in the United States each year for basal cell carcinoma (BCC) or cutaneous squamous cell carcinoma (CSCC), and the incidence of these cancers is increasing globally. Although they are treatable with surgery or radiotherapy, locally advanced or metastatic forms of these carcinomas are life-threatening, difficult to treat, not amenable to those standard options, and historically have had few treatment options
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In the height of flu season, more practices are providing vaccines to their cancer patients. Here is a billing tip: ICD-10-PCS code 3E01340 applies to intramuscular injections of influenza vaccines, while ICD-10-CM code Z23 captures the flu immunization encounter and J10.-captures influenza infections identified as A, B, C or H1N1, with the fourth digit identifying associated manifestations, per a senior health care consultant for Revenue Cycle Solutions.
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Affiliate Association News |
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Four seats on the ANCO Board of Directors are up for election in 2021. ANCO seeks nominations for candidates to stand for election to these seats. This year's election will be conducted via election runner online in December. Candidates with the top four vote totals will serve for three years (i.e., from 2022-2024, inclusive). You may nominate an ANCO member (including yourself) to stand for election to the Board via e-mail to director@anco.org no later than November 15.
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ASCO News
Please take time to vote in the ASCO election. Please encourage your partners to vote in the ASCO election. The voting period closes on Tuesday, December 7, 2021, at 12:00pm PST, all ballots must be received by this time.
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Please help, the deadline is November 15th! ASH is developing resources for emerging CAR T-Cell therapy complications and would like to learn more about your experiences with diagnosing and/or treating these complications. ASH is undergoing this active effort within its Subcommittee on Emerging Gene & Cell Therapies. Please complete the survey to tell ASH about any clinical cases that you may have seen that depict either:
A complicated/unusual reaction experienced by a patient treated with CAR-T therapies.
A challenging patient referral or unique consideration/approach in bridging to CAR-T therapies.
Information from this survey will inform the Society’s strategy for developing novel and useful resources for investigators and clinicians (both in the research and clinical settings) interested in this field. In addition, we strongly believe that your input is critical to informing future research and clinical practice in these areas with the overall goal of improving outcomes for patients with relapsed/refractory malignancies who are receiving CAR T-cells.
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ASH is looking forward to your participation in this year’s Scientific Workshops at the 63rd ASH Annual Meeting and Exposition! Several workshop organizers are actively soliciting speakers, so if you are interested in attending and/or presenting in any of the workshops this year, please visit the ASH website for additional details The workshops, which are scheduled to take place as in-person events on Friday, December 10, will feature interactive discussions focused on the latest scientific developments in different fields of hematology. They will also be broadcast on the ASH annual meeting virtual platform to accommodate virtual participants.
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Abstracts accepted for oral and poster presentations at the 63rd ASH Annual Meeting & Exposition are now available! These abstracts represent important, novel research in the field and are considered the best of the thousands of abstracts submitted. To view the top science selected for oral and poster presentation.
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Learn more about ASH’s resources on precision medicine and the new webinar series on the ASH website.
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COA endorses Debra A. Patt, M.D. for the ASCO Board. Please take time to vote, and encourage your partners to vote, in the ASCO election. The voting period closes on Tuesday, December 7, 2021, at 12:00pm PST, all ballots must be received by this time.
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Tomorrow, COA will be submitting their letter to CMS and CMMI to Extend the Oncology Care Model (OCM) past the scheduled termination date of the model on June 30, 2022, and to announce this extension immediately.
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In honor of Veteran’s Day this Thursday, Merck would like to remind you that there are many things to keep in mind when it comes to screening and detection for lung cancer. Please see attached resource that provides information about the importance of lung cancer screening.
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Merck announced new data from studies evaluating KEYTRUDA, Merck’s anti-PD-1 therapy, at the Society for Melanoma Research (SMR) 2021 Congress. Presentations demonstrate the company’s scientific expertise and continuing commitment to delivering meaningful advances for patients with melanoma. Key data include exploratory 7-year follow-up from KEYNOTE-006, the pivotal trial that supported the indication for KEYTRUDA in advanced melanoma, and updated findings from the KEYNOTE-716 trial that is evaluating KEYTRUDA as an adjuvant treatment for patients with resected stage IIB or IIC melanoma.
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Premier Alternate Site GPO invites you to their virtual National Meeting, December 2 & 3. With keynote speaker headliner Captain Chesley “Sully” Sullenberger, “Miracle on the Hudson” Pilot and Safety Expert, featured session speakers will cover trending topics in four unique tracks: Clinical and Compliance Outcomes, Legislative & Regulatory Updates, Business Management and Operations, and Supply Chain Strategies.
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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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