California Oncology Weekly
"An Oncologists’ Source for Timely Information"
A publication of the
Medical Oncology Association of Southern California, Inc.


May 25, 2021
This Weekly's Hot Topics

  • This Friday, May 28, is melanoma and skin cancer detection & prevention awareness day. The National Council on Skin Cancer Prevention, with the CDC, developed a toolkit to aid in the promotion of messaging and activities for Don't Fry Day. Share with your patients, family and friends.
  • Skin cancer is a common cancer and one of the most preventable. Check your skin for warning signs and talk to others. 
MOASC News

MOASC has joined a growing coalition formed to protect kids from getting hooked on flavored tobacco. The Campaign to Protect California Kids will be advocating to uphold California’s flavored tobacco ban, which is under attack by tobacco companies. Coalition members include, American Cancer Society, American Academy of Pediatrics California, California School Nurses Organization, American Heart Association and American Lung Association to name a few. In 2020, the California Legislature passed SB 793, a bill which banned the sale of most flavored tobacco products in California. In an attempt to overturn SB 793, tobacco companies filed and qualified a referendum for California’s November 2022 statewide ballot. A “yes” vote on the referendum will uphold the current flavored tobacco ban and a “no” vote will repeal it. The implementation of SB 793 is suspended pending the outcome of the referendum.
Your Membership in MOASC is an investment in your patients. MOASC has advanced oncology in California, and influenced national dialogue for the past 31 years. MOASC provides access to California oncology colleagues, clinical education and support for your delivery of oncology patient care, no matter the setting or the stage of your career.
Contact the MOASC Office at moasc@moasc.org, or 909-985-9061 ext. 1, for more information on the MOASC benefits for you.
California News
When the state reopens on June 15, social distancing will no longer be required and businesses can operate at full capacity. Secretary of California Health and Human Services commented that the state is at a place, with this pandemic, where the requirements of the past are no longer needed for the foreseeable future, and the state's workforce regulators are still developing safety rules that will apply to employers.
On May 14, 2021, Governor Gavin Newsom released his revised proposal for the 2021-2022 state budget. The $267.8 billion budget, includes $75.7 billion in surplus and $25 billion in new federal COVID-19 relief funding from the American Rescue Plan Act (ARPA). The May Revision protects the Proposition 56 (tobacco tax) supplemental Medi-Cal provider payments, and continues other health and human service programs that had been threatened by last year’s budget reductions. CMA is disheartened, however that the Governor continues to promote a policy that reimburses for audio-only telehealth at only 65%.
 
The California Dialogue On Cancer (CDOC) has been engaged in a lot of planning after the approval of California's Comprehensive Cancer Control Plan, 2021-2025.  The CDOC will start the 2021-2025 Cancer Plan Webinar Series in June with their Treatment and Survivorship webinar June 15, 12-1pm. 
CDOC webinar focusing on Cancer Survivorship Research, June 29, 12-1pm.
CDOC partners at the California Rural Indian Health Board will present the lifelong journey of chronic disease and cancer survivorship at their Journey of Wellness Conference, June 9, 9am - 12 pm and June 23, 9-11am
CDOC webinar on Health Equity, on July 8, 2-3pm, providing a broad overview of various sections of the 2021-2025 cancer plan that relate to reducing cancer related health disparities and achieving health equity. 
CDOC Workgroups are beginning to meet! If you are interested in working with your fellow colleagues on interventions aligned with the cancer plan, join a CDOC Workgroup: Health Equity, Colorectal Cancer or Survivorship. To learn more and join a workgroup, send an inquiry via email to cdocshare@gmail.com.
Medicare News 
Noridian News
The questions & answers from the April 14, 2021, Part B Ask the Contractor Teleconference are cumulative.
Noridian Programs
May 26, the Ordered, Referred, and Prescribed Services webinar includes: Ordering/Referring Requirements, Claim Editing for Ordering/Referring Provider, Ordering/Referring Services, Signature Requirements, Medical Records Documentation, Resources and Reminders.
May 26, Additional Documentation Request (ADR) Responsiveness webinar includes: ADR Inquiry, Submit Documents, Check Status, ADR Decision, Resources 
May 27, the Noridian Medicare Portal (NMP) Eligibility webinar includes: Hours of Availability, Eligibility, MBI Lookup, Resources 
June 2, the Dual-Energy X-Ray Absorptiometry (DEXA) Scan Top Trending Errors Webinar This event includes: DEXA Scan Overview, Coverage, Medical Review (MR) Findings, and Resources.
June 3, the Modifier 59, National Correct Coding Initiative and Medically Unlikely Edits webinar includes: National Correct Coding Initiative (NCCI), Procedure to Procedure (PTP) CCI Edits, Modifier 59, Medically Unlikely Edits (MUEs), CCI Examples, Resources and Reminders.
June 16, the Provider Enrollment and Identity and Access: Connections Part 2 includes: Provider Enrollment and Identity and Access: Connections Part 2, Connections, Access Roles, Managing connections.
 June 17, the Appeals Basics Part A and Part B Providers webinar includes: Overview, Levels of Appeals, When to Submit an Appeal, Resources and questions.
June 23, the Noridian Provider Outreach and Education (POE) staff is hosting a Live Chat webinar with Provider Enrollment.
June 30, the Provider Enrollment Options webinar includes: Opt Out, CMS 855O and CMS 855I with CMS 855R.
CMS News
CMS released the second final annual notice of benefit and payment standards for Affordable Care Act plans for the 2022 plan year. The rule lowers maximum out-of-pocket costs by $400, reverses a planned change to web broker display requirements and expands qualifications for special enrollment periods.
The Government Accountability Office urged Congress to wait until the end of the pandemic before making decisions about a permanent expansion of telehealth coverage in Medicare and Medicaid, saying more research in long-term quality and spending data is still needed.
National News
Venture capital investors are buying into the idea of helping patients pay medical bills in small increments over time, funding companies such as PayZen, Affirm, Klarna, Walnut and PrimaHealth Credit. The model can help providers that need revenue, but it will not be a good solution for patients, financial technology analyst Robert Le said. 
The HHS Office of the Office of the National Coordinator for Health Information Technology (ONC) says health care providers should work with their IT vendors to specify how they want to record race and ethnicity data, consistent with the CDC’s Race & Ethnicity code technology, for the populations they serve. ONC acknowledged that while data can be helpful in the pursuit of health equity, it understands that datasets can perpetuate inequity as well. 
A study by CVS Health, released for ASCO’s conference, found that an oncology clinical decision support tool based on NCCN guidelines approved 83% of prior authorization requests in real time and reduced care costs. From April to December 2020, 279 prior authorization requests were submitted by a large health system through a clinical decision platform tool for prior authorizations. Of those submissions, 83% were automatically approved in real time, according to the study. None of the submissions were ultimately denied, according to the researchers, and those not approved automatically were reviewed via a partnership with the NCCN.
UnitedHealthcare (UHC) recently implemented changes to its Advanced Practice Health Care Provider (APHC) policy that requires nurse practitioners (NPs), physician assistants (PAs) and clinical nurse specialists to bill under their own NPIs, eliminating the ability to bill for services as “incident-to” the physician services thereby limiting reimbursement for such services to 85% of the physician fee schedule. UHC will only reimburse services billed as “incident-to” a physician’s service if the APHC provider is ineligible for their own NPI number and the “incident-to” guidelines are met. The policy change for UHC commercial products was effective March 1, 2021, and for exchange products was effective on May 1, 2021.
Affiliate Association News
ANCO News
ANCO announces a new series of events titled: ANCO Connections. This is a series of monthly roundtable presentations on the day-to-day issues of importance to the cancer community by local and national thought leaders. The hour-long real-time programs include interactive Q&As and networking breakout sessions, so attendees can talk about what they’ve heard.
ASCO News
 
ASCO has launched a new "Cultural Literacy" course. This course collection is designed to help oncologists increase their cultural literacy, humility, and competence. Learners will explore case scenarios that involve patients from diverse populations, communication strategies to minimize bias and discrimination, as well as best practices for improving access to care and patient outcomes.
2021 ASCO Annual Meeting will be a virtual meeting held June 4-8, and will feature a dynamic program of educational and scientific sessions, showcasing what is possible when the cancer care community comes together to advance cancer research, treatment, and equity for every patient, every day, everywhere. 
In celebration of the virtual 2021 Evening to Conquer Cancer event hosted by Conquer Cancer, the ASCO Foundation, any donation made between now and June 5, 2021 – the night of the big event – will have double the impact!
COA News
 
Prepared cancer advocates are effective cancer advocates. That's why the best and brightest advocacy stars have July 21 marked on their calendars - they're attending the second annual virtual 2021 Community Oncology Advocacy Summit: The Power of Advocacy
National Cancer Survivors Day Foundation

June 6, 2021 is National Cancer Survivors Day®! Raise awareness for this important Celebration of Life. Cancer survivors and supporters around the world will unite to recognize cancer survivors, raise awareness of the ongoing challenges cancer survivors face, and celebrate life. This day will mark the 34th annual National Cancer Survivors Day®.
NCCN News
 
The National Comprehensive Cancer Network (NCCN) has published updated patient guidelines for mantle cell lymphoma (MCL), B-Cell Lymphomas version 3.2021.
Industry News
ADC Therapeutics announced that NCCN Guidelines® included loncastuximab tesirine-lpyl (ZYNLONTA™) for the treatment of adult patients with relapsed or refractory large B-cell lymphoma after two or more lines of systemic therapy, including diffuse large B-cell lymphoma (DLBCL) not otherwise specified, DLBCL arising from low-grade lymphoma, and high-grade B-cell lymphoma.
Bristol Myers Squibb announced that the FDA has approved Opdivo®(nivolumab, injection for intravenous use) for the adjuvant treatment of completely resected esophageal or gastroesophageal junction (GEJ) cancer with residual pathologic disease in patients who have received neoadjuvant chemoradiotherapy (CRT).
Coherus Biosciences announced that Anthem designated UDENYCA® and the reference product as co-preferred pegfilgrastim for:
1. Managed Medicaid Medical Benefit in:
CA*, GA, KY, MD, NJ, NV, NY, SC, VA, WI, and Western NY effective March 1, 2021
IN, TN effective April 1, 2021
2. Commercial Medical Benefit effective January 1, 2021
3. Medicare Medical Benefit effective January 1, 2021
The Janssen Pharmaceutical Companies of Johnson & Johnson announced today the FDA has granted the accelerated approval of RYBREVANTTM (amivantamab-vmjw) for the treatment of adult patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) exon 20 insertion mutations.
Industry Meetings
May 25, Incyte presents the final of three live disease education webinars for patients diagnosed with a myeloproliferative neoplasm (MPN). Please share with your patients and peers.
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.