California
Oncology
Weekly
"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
.
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This Weekly's Hot Topics
- Anthem Blue Cross terminates Medicare Advantage contract with Hill Physicians California News
- Telemedicine membership plan coming to California. National News
- Medicare open enrollment begins today. CMS News
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- The California Medical Association's Center for Economic Services (CES) has published updated profiles on each of the major payors in California
including Aetna, Anthem Blue Cross, Blue Shield of California, HealthNet, UnitedHealthcare, and Medi-Cal. CMA members can download CMA's Payor Profiles free of charge.
- On October 1, the Department of Health Care Services' (DHCS) transitioned all fiscal intermediary duties from Conduent to DXC Technology. Learn more at
- The Coalition to Protect MICRA (CAPP) invites you to join them for an evening reception in honor of Assembly Member Christy Smith on Wednesday, October 23, from 5:30 PM to 6:30 PM. The reception will be held at Oakmont of Valencia (24070 Copper Hill Dr., Valencia, CA 91354).
Please click here to view the invitation.
If you are not far from Valencia, please share this invitation with your colleagues and staff and encourage them to attend. Please RSVP to Kristina Gelaber
kgelabert@micra.org
. Thank you for your continued support of CAPP.
- California's state attorney general, Xavier Becerra, outlined draft rules for new privacy legislation that would take effect at the start of 2020. The law would give consumers greater control over their data, and let Californians "pull the curtains back" regarding information collected about them. Tech companies have estimated it will cost them about $55 billion to comply with the measure.
- If practices receive Medi-Cal reimbursement for a drug that is below acquisition cost, please submit NADAC Requests for Medicaid Reimbursement Review. This process will require CMS to do a review of that particular drug's reimbursement rate. Here is the process for submitting a reimbursement appeal to NADAC:
Email to
info@mslcrps.com
or by phone at 855-457- 5264 or fax the form/invoices to 844-860-0236
.
You will need to do this for each medication you dispense.
Send the California Pharmacists Association via
nchiappe@cpha.com
a copy of forms and invoices as well so CPhA can collect data on the underpayments.
It is important to CPhA that you share how long it takes for this process to be adjudicated and the newly adjudicated price, and if it is at actual acquisition cost or if the drug continues to reimburse below after appeal.
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- Noridian/JEMAC has the following updates on their website
Announcements:
New Medicare Card: 80% of Claims Submitted with MBI; Quality Payment Program: MIPS Dates and Deadlines; Propose Use of the KX Modifier for Part B Immuno-suppressive Drug Claims
Publications:
Provider Enrollment Rebuttal Process; Implementation of the Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM)-Revised; International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs)- January 2020 Update-Revised; Medicare Enrollment for Providers Who Solely Order or Certify-Reminder;
* MRI and CT Scans of the Head and Neck LCD-R4
* MolDX Draft LCDs-Published for Review and Comments
* Modernizing and Clarifying the Physician Self-Referral Regulations Proposed Rule
Forthcoming Noridian JEMAC meetings/webinars/workshops
* Using the Medicare Beneficiary Identifier Webinar (October 16)
* What's New in the Fourth Quarter 2019-After Hours Webinar (October 24)
* Open Enrollment Webinar (November 6)
Have you received a Comprehensive Error Rate Testing (CERT) audit letter? Timely response is critical to the success of reducing the overall national improper payment rate.
Read the complete update
For more information and to register visit:
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- Mark your calendars for November 14, 2019, to attend the "MOASC Educational Series Program." The day will present: Bobbi Buell bringing the MOST UP-TO-DATE billing changes from across the board with southern California benchmarks and specific California healthplan issues;
Carynne Godfrey,
from Noridian, addressing specific Medicare changes; Dawn Holcombe presenting current USP800 (eff. 12/1/19) and USP797 news and further actions; Arthur Lurvey, MD, FACP, FACE, California Medicare Contractor, Noridian, Medical Director, speaking on new E&M codes for physicians' awareness coming in 2021; and Remedios Turner, from Medi-Cal, reviewing state initiatives of coverage. Presenters will also address new imaging rules; payment changes; classification of physician relationship to patient; off-label coverage, and more. Please RSVP no later than November 1, 2019 to
moasc@moasc.org
- Mark your calendars NOW for the Annual MOASC Oncology Summit, Saturday, March 14, 2020 at the Hyatt Regency Huntington Beach. The MOASC Oncology Summit continues to highlight cutting-edge topics presented by world-renowned physicians. You will not want to miss our 2020 program!
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ANCO has Moved!
Please note we have moved our offices. Our new mailing address is:
ANCO,
Post Office Box 2954,
Alameda, CA 94501. The ANCO telephone number remains the same--
415-472-3960 (Office); our e-mail addresses are
director@anco.org and
courtney@anco.org. And,
also note the ANCO's FAX number has been disabled.
- Follow ANCO on Twitter at
@ANCO News
.
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National News
- HR2279/S2546, the Safe Step Act of 2019, would ensure patients with private insurance have reasonable protections against harmful step therapy practices.You are encouraged to contact your Congressional Representatives and Senators to support HR2279/S2546.
- Some physicians are pursuing licenses in all 50 states so they can offer telemedicine services anywhere as regulations change. Multistate licensing increases access to care by enabling physicians to treat patients where there are not enough providers available.
- Parsley Health acquired $26 million in Series B private funding to expand its personalized telemedicine services and hire more physicians. Established in 2016, the New York City-based firm said it will introduce their telemedicine membership plan in California and New York with the intent of bringing the service nationwide within six months.
- A cloud-based machine learning tumor analysis system was significantly faster than conventional tumor boards in making treatment decisions based on biomarkers in a study involving 1,725 patients, researchers reported in the Journal of the American Medical Informatics Association. The virtual molecular tumor board, which ranks treatment options and notes applicable clinical trials within a two-hour drive, would make specialized care available to more patients.
- An experimental machine-learning algorithm differentiated subtypes of pancreatic cancer from MRI images, potentially offering an alternative to invasive tissue biopsies for molecular profiling as well as enabling early and targeted treatment. The method was highly accurate and specific in identifying two groups of molecular subtypes of pancreatic ductal adenocarcinoma.
- HHS' Administration for Community Living is working to create a National Volunteer Care Corps that would help the elderly with household chores and medical appointments and provide companionship to reduce isolation and give family caregivers a break. The Care Corps project is expected to have $19 million in funding over five years and this fall will seek proposals for providing nonmedical care for older adults and people with disabilities, with the goal of awarding grants to up to 30 organizations next year.
- Partnering with the Food Bank of Lincoln, Bryan Health in Lincoln, Neb., provides patients with food insecurity two-backpacks full of healthful food when they are discharged from the hospital. The hospital is providing the food and the backpacks in the Hope Against Hunger program, while the food bank is providing volunteers and organizational support.
- Roche's cancer treatment Rituxan, and Pfizer's painkiller Lyrica topped the list, at #2 & #3, of seven drugs whose price increases in 2017 and 2018 collectively cost patients and health insurers $5.1 billion,
according to a report from the Institute for Clinical and Economic Review. The price hikes for seven drugs -- including Amgen's Neulasta, -- amounted to more than twice the medical inflation rate and were not supported by clinical evidence, ICER said.
Celgene's Revlimid®
(lenalidomide) is one of two drugs assessed that did have new important positive clinical evidence. Importantly, however, ICER's determination that new evidence exists for these two treatments should not be interpreted to mean that the new evidence justifies the level of price increase; a full cost-effectiveness assessment was not conducted.
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CMS News
- Medicare open enrollment begins today, October 15, and ends on Dec. 7. Over 60 million seniors are expected to switch plans or stay with their existing coverage. Seniors are increasingly opting for Medicare Advantage plans, many of which offer new supplemental benefits such as transportation assistance, home meal delivery and home improvements.
- Physicians have until December 31, 2019 to review and dispute their 2018 open payments data reported by CMS earlier this year. To learn more and review your data go to
https://openpaymentsdata.cms.gov
.
- CMS' Open Payments System has been updated with three new enhancements.
These enhancements consist of an updated physician matching, a new compliance portal, and an ability to view all system-generated emails associated with an organization.
Physician Matching Enhancements:
new ability to validate physician information and download results at any time during or outside the submission period.
Compliance Portal
:
Functionality for the CMS Open Payments Compliance team to upload copies of any compliance related communications that may be sent to reporting entities.
System Generated Emails
:
Ability to view all system generated emails messages associated with an organization. The
Open Payments System Enhancement document
provides detailed information about each of the new enhancements and improvements that directly affect end users of the Open Payments System.
- A provision in a bill introduced by House Speaker Nancy Pelosi, D-Calif., that would permit HHS to negotiate prices for as many as 250 drugs per year would save Medicare $345 billion from 2023 to 2029 and lower pharmaceutical industry revenues by $500 billion to $1 trillion over 10 years, according to a preliminary analysis from the Congressional Budget Office. A separate analysis from the CMS Office of the Actuary found Pelosi's plan would reduce health care spending by $480 billion and save US households $158 billion over 10 years through lower premiums and reduced cost-sharing on drugs.
- Proposed changes to the Physician Self-Referral Law and the Federal Anti-Kickback Statute would enable health systems and health care providers to collaborate on cybersecurity, such as allowing hospitals to donate cybersecurity software to referring providers. HHS will change how it enforces the Physician Self-Referral Law, or the Stark Law, and will allow exceptions for health care providers in agreements meant to reduce costs and improve patient health. COA applauds these, and other proposed changes to modernize the physician self-referral law (the Stark law) and the Federal anti-kickback statute.
- HHS will change how it enforces the Physician Self-Referral Law, or the Stark Law, and will allow exceptions for health care providers in agreements meant to reduce costs and improve patient health.
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Affiliate Association News
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-
The Silent Killer: Prostate Cancer in the African American Community,"
this Thursday, October 17th, 6:30pm - 9:00pm in Los Angeles. This documentary explores the misconceptions about prostate cancer among African-American men. Following the screening, there will be a roundtable discussion about what's being done in Los Angeles and California to address prostate cancer disparities in the African-American community. Light dinner and movie snacks provided. This event is FREE but attendees MUST register.
Silent Killer Flyer.
- The Alliance to Advance Patient-Centered Cancer Care will host a free webinar, Securing Strategic Partnerships That Improve Access to Cancer Care, featuring The Ohio State University James Comprehensive Cancer Center and the Georgia Cancer Center for Excellence at Grady Health System. These organizations will share their creative solutions to improve patient-centered cancer care. This webinar takes place on October 24, 2019 from 2 to 3 p.m. (ET). Please register by October 22, 2019 and refer to the AAPCCC website for questions about the webinar. Read More
- Join the Inland Empire Oncology Nursing Society fundraiser event for The Leukemia & Lymphoma Society's Light The Night, on October 26, 2019 at the Auto Club Speedway of California in Fontana, money raised through Light The Night allows The Leukemia & Lymphoma Society (LLS) to fund treatments for patients who are suffering from all forms of blood cancers. In 2018, LLS helped advance 19 of 21 approved blood cancer therapies. Beating cancer is in our blood.
Donate NOW!
- Attend the 2019 Innovatix + Essensa National Meeting & Expo October 28-30 in Atlanta! As a MOASC purchasing member, you pay no registration fee for the conference or the sessions. There is still time to register for this annual event providing three highly
anticipated days of learning, networking, and business development. Make sure you don't miss out on this exclusive opportunity,
REGISTER TODAY
. Please review the
National Meeting web page
for additional details and register to attend today before space or time runs out!
REGISTER TODAY
-The
ACCC 36th National Oncology Conference
is October 30 - Nov. 1 in Orlando.
There's still
time to register
. From session presenters to Innovator Award winners, featured sessions and networking breaks, you'll find replicable, innovative strategies for the effective delivery of cancer care.
- Research To Practice will hold their First Annual Oncology Nursing Retreat taking place this year November 8 - 10
, 2019
at the Diplomat Beach Resort Hotel in Hollywood Beach, Florida. This educational meeting will focus on covering a plethora of common solid tumors & hematologic cancers with expertise from a stellar faculty panel of clinical investigators and nurse practitioners (33 in total). There is no fee for oncology nurses to participate.
For more information and to register:
http://www.researchtopractice.com/Meetings/CNERetreat2019
.
- ASH will host a webinar entitled Leveraging New Technologies: The Ins & Outs of E-Consults and Telemedicine on November 21 at 2PM PT. Registration will open soon; for more information please email Katherine Stark at
kstark@hematology.org
.
- Round 2 registration is now open, and data submission will run through December 3, 2019, for ASCO's Quality Oncology Practice Initiative. QOPI is an oncologist-led, practice-based quality assessment program for outpatient oncology clinics. Register for QOPI at
- Register to secure your place at the 61st ASH Annual Meeting and Exposition in Orlando, December 7-10, 2019. To register, you will need to sign in using your ASH username
moasc@moasc.org
and password. If someone else is registering for you, please provide them with your credentials to avoid delays. If you have forgotten your credentials, you may reset them on the ASH website using the "Forgot your
Username
or
Password
" links. Please note that SPARGO, Inc. is the only official housing and registration provider for the 61st ASH Annual Meeting and Exposition. For more information on housing and registration fees, please visit the
ASH website
.
View the preliminary program online
.
- The American Cancer Society's Cancer Action Network is participating in a joint initiative with ASCO, ACCC and ONS to seek provider input on clinical trial enrollment. ANCO and MOASC encourage all members to complete the survey at
https://www.surveymonkey.com/r/CancerCT3
.
- ASCO and COA are collaborating on the development of an Oncology Medical Home (OMH) certification program. The OMH is a care delivery model and practice transformation tool to support practices with oncology payment reform. ASCO and COA wants your feedback on the ASCO/COA OMH Certification Program at
https://www.surveymonkey.com/r/R6X9RQG
.
- NCCN has published updated guidelines at:
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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
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 2954, Alameda, CA 94501 | P (415) 472-3960 | www.anco.org
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