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.

  
September 9, 2014

Nurse Practitioner's, Physician Assistant's, Oncology Nurses and Pharmacists should not miss any opportunity for professional and personal development, not to mention visiting with fellow professionals, at MOASC's Clinical Support program, Friday, September 19th in Pasadena. Contact [email protected] for more information.

 

 

California News

 

 

- CMA's Practice Resources September 2015 www.cmanet.org/cpr is now available online and features articles entitled: No on Prop 46--get engaged; United to make some changes to Premium Designation program, but concerns remain; Change in prior authorization form for prescription medicines becomes effective October 1; Noridian denies 300,000 claims for E&M services in error; System error causing some Anthem Blue Cross claims to be underpaid; The Coding Corner: Time as the controlling factor in E&M coding.

 

A data breach affecting 2,995 patients was reported by AltaMed Health Services in California after a temporary staff member inappropriately accessed the facility's electronic and paper health records in what could be an identity theft ring. Compromised data included patient names, insurance information, dates of birth and Social Security numbers.

 

- UnitedHealthcare's Network Bulletin September 2014;https://www.unitedhealthcareonline.com/ccmcontent/P

roviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/

News/NB_September_2014_Interactive.pdf  is now available online.

 

- WellPoint will host a series of webcasts on its Cancer Care Quality Program Treatment Pathways on September 19, September 25, and October 3. Click on the date for which you wish to register. Learn more about the Program at www.cancercarequalityprogram.com.

 

AIM Specialty Health, a member of WellPoint, has four openings for Oncology Physician Case Reviewers. The program was launched on July 1, 2014 and available for physicians who can work part-time in Glendale, CA (3 - 5 days/week M-F). It is essentially a high level educator role, speaking to physicians calling into WellPoint for approvals, tell them about best practices, evidence based medicine, and more. If you're interested, please forward a copy of your CV and when you can talk to Krista Grant, Sr. Physician Recruiter, AIM Specialty Health, 262.289.2103 (ph),  262.754.5350 (f), [email protected].

- ANCO and MOASC urge practices to speak with their patients about why it is important to vote No on Proposition 46, the anti-MICRA November ballot proposition. Download, print, and distribute a one-page flyer for patients at  

 

Noridian News

 

 

- Noridian/JEMAC's website www.med.noridianmedicare.com/web/jeb has posted the following updates: ICD-10 Testing--Acknowledgement Testing with Providers; September Web-based Workshops; Endeavor Now Offers Claim Comments as Part of Claim Status Results;  

 

 

MOASC News

 

 

- Nurse Practitioners, Physician Assistants, Oncology Nurses & Pharmacists are invited to the MOASC Clinical Support Program scheduled for Friday, September 19, 2014 at The Sheraton Pasadena. Topics include: Oral Adherence; Compassion Fatigue - Building Resilience in Oncology Nurses; The Art of Active Listening (AAL). Please RSVP to Danielle Overman at [email protected] by Friday, September 12, 2014.

 

- Due to overwhelming interest and realization of needing to be prepared, MOASC is providing an encore presentation of, "Medicare Physician Fee Schedule (PFS) 2015 Proposed Rule, the Value Based Modifier and Changes to Physician Quality Programs." Presented byKelly Davies, Healthcare Policy & Advocacy Director, Southern CA, Strategic Customer Group, Johnson & Johnson Health Care Systems Inc. For more information on the 2015 proposed rule, click here. Physicians may lose up to 9% in Medicare revenue come 2017! You cannot afford to miss this encore presentation on Wednesday, September 10, 2014, 12:00pm - 1:00pm PST.

To RSVP contact Danielle Overman at [email protected].

 

- Thank you to those who have responded to our request for feedback. Please be assured that your comments and recommendations are being acted upon. For those who have yet to take the survey, PLEASE do so! MOASC is always looking for ways to help our members - please take a few minutes to fill out this brief survey regarding your MOASC membership. The mission of MOASC is to ensure access to quality and affordable care for cancer patients within their communities. Thank you for your time. Take the survey now!!


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ANCO News

 

 

- ANCO is organizing a Hematological Malignancies Update on September 27 in Menlo Park with Bruno Medeiros, MD, Stanford University, and Joseph Tuscano, MD, UC Davis. The latest research on novel treatment modalities for ALL, AML, CLL, and NHL, along with case studies for each diagnosis will be presented. Download the meeting announcement/registration form at www.anco-online.org/3Q2014MeetingAnnouncement.pdf. A final Hematological Malignancies Update will take place on November 15 in San Francisco. Watch for these announcements in mid-October.

 

- ANCO and the SullivanLuallinGroup have cooperated on Patient Surveys for the past several years and another Patient Survey is planned for 2014. ANCO will use its negotiating leverage to offer members expert and reliable Patient Surveys at steep discounts. ANCO funds the set-up fee so that members may participate at discounted per physician rates. An announcement of the 2013 ANCO Patient Survey will be mailed, e-mailed, and FAXed to all ANCO community-based member practices by the end of May. For more information, please visit www.anco-online.org/pxsrvy.html.

   

 
National News 

 

 

Last week, the Federation of State Medical Boards released model legislation to create an interstate compact for physician licensure that aims to facilitate the licensing of doctors across state borders. Though the move is seen as facilitating the growth of telemedicine and speeding increased healthcare access to residents in rural areas, and the American Medical Association applauds the compact, the Health IT Now Coalition says FSMB could do more to enhance telehealth services.

 

The American Medical Association has submitted codes that could finally lead to Medicare reimbursement for end-of-life and advanced care conversations.  It's now up to the Centers for Medicare and Medicaid Services to decide whether to establish payment and cover the service. CMS said in a written statement that it would now either: establish payment and cover the service as described by the code; not pay for the specific code but indicate that Medicare will cover the service as part of another code; or deny payment because Medicare does not cover the service.  CMS will accept comments from nursing homes, hospitals, and physician groups prior to making a decision. The answer is expected in November, when CMS releases its final 2015 physician fee schedule. 

 

 

CMS News 

 

 

Tomorrow, Wednesday, September 10 is the last day that physicians can review, and if necessary dispute their financial interactions as reported under the Physician Payments Sunshine Act. The Sunshine Act is a provision of the Patient Protection and Affordable Care Act that requires drug and medical device manufacturers and group purchasing organizations (GPOs) to report their financial interactions with licensed physicians - including consulting fees, travel reimbursements, research grants and other gifts. Any payments, ownership interests and other "transfers of value" will be reported to CMS for publication in an online database. This data will be made public via the Open Payments website beginning on September 30. Physicians should be aware that there is a two-step registration process for the Open Payments program. The first step requires physicians to register at the CMS Enterprise Portal, a step many physicians may have already completed as the gateway enables access to a number of other CMS programs. Step two is to register in CMS' Open Payments system. Physicians and authorized representatives can submit questions to the CMS Help Desk at [email protected]. Live Help Desk support is also available by calling (855) 326-8366, Monday through Friday, from 5:30 a.m. to 4:30 p.m. Pacific time, excluding Federal holidays.

 

- On August 17th, The New York Times published an article on, what CMS calls, chronic care management (CCM) services, which were first proposed in the 2014 Medicare Physician Fee Schedule rule. The code will be payable beginning in 2015. The creation of a CCM service code was an extension of CMS's ongoing efforts to coordinate care and strengthen its commitment to primary care. Despite the obvious connection of the program to primary care, CMS does not limit billing CCM services to primary care providers. CCM reimbursement will be available to oncologists beginning in 2015. ASCO has been tracking and commenting on the implementation of the CCM code since it was proposed in CY2014 MPFS rule. These activities have included substantive comments in response to the CMS proposal to create the CCM code. Last year, ASCO argued that all physicians that meet the requirements for CCM services should be able to seek reimbursement under the code, and pointed to the significant role of oncologists in care coordination as an example. CMS agreed with this position, stating that "specialist physicians can bill for these services if they meet the requirements." Nothing in the CY2015 proposed rule would limit billing of CCM to primary care physicians. ASCO also commented that CMS should allow CCM services to be billed by more than one provider. This would recognize the role of the team in coordinating care and would not create a race to secure a beneficiary's informed consent to receive the service. ASCO opposed contemplated proposals that would require practices to become certified medical homes or achieve some other accreditation to deliver CCM. CMS did not finalize any accreditation standard and has not proposed one in the CY2015 proposed rule. CMS has made additional proposals to the CCM code in the CY2015 proposed rule, which ASCO is currently analyzing.

 

The Centers for Medicare & Medicaid Services (CMS) has corrected the implementation effective date for reopening of claims beyond timely filing. When a provider needs to correct or supplement a claim, and the claim remains within timely filing limits, providers may submit an adjustment claim to remedy the error.   But when the need for a correction is discovered beyond the claims timely filing limit, an adjustment bill is not allowed and a provider must utilize the reopening process to remedy the error. In an effort to streamline and standardize the process for providers to request reopenings, CMS petitioned the National Uniform Billing Committee (NUBC) for a "new" bill type frequency code to be used by providers indicating a Request for Reopening and a series of Condition Codes that can be utilized to identify the type of Reopening being requested. These institutional reopenings must be submitted with a "Q" frequency code in the 4th position of the Type of Bill to identify them as a reopening. The NUBC adopted these new codes and bill type frequency change effective with claims received on or after April 1, 2015Click Here for a copy of the September 3, 2014 Transmittal from CMS.

Click Here for the MLN Matter Article related to this topic.

 

- Read ACCC's comments to CMS on the proposed CY2014 OPPS rule and the Physician Fee Schedule at http://www.accc-cancer.org/advocacy/pdf/2015-proposed-OPPS-comments.pdf

and http://www.accc-cancer.org/advocacy/pdf/2015-proposed-PFS-comments.pdf , respectively.

 

- The Medicare Payment Advisory Commission (MedPAC) has also commented on the proposed CY2014 Physician Fee Schedule. It recommends that CMS not focus on the performance of individual physicians in its quality measurements programs because "it may not be worth the resources required." MedPAC also recommended that physicians form groups for quality measurement. Read MedPAC's comments at http://www.medpac.gov/documents/comment-letters/08282014_comment_letter_2015_pt_b_rule_final.pdf?sfvrsn=0 . Read COA's comment letter to CMS on the proposed 2015 Physician Fee Schedule here.

 

- Leading up to the October 1, 2015 ICD-10 compliance deadline, CMS has announced three ICD-10 testing weeks: November 17-21, 2014; March 2-6, 2015; and, June 1-5, 2015. These weeks are intended to create provider interest and awareness of ICD-10 testing implementation. For more information, go to http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8858.pdf

 

Affiliate Association News


 

- ASCO has released a new clinical practice guideline to help identify the optimal treatment of women with HER-2-negative (or unknown) advanced breast cancer. Read the new guideline at http://jco.ascopubs.org/content/early/2014/09/02/JCO.2014.56.7479


- If you completed your final subspecialty training between 2005 and 2010 and want to shape the future of ASCO as well as the practice of oncology, then ASCO's Leadership Development Program is for you. Participants in this year-long program will learn valuable leadership skills and gain extensive exposure to the roles and mission of ASCO, its Leadership, and the Society's powerful place in developing the future of cancer care. This program requires a time commitment for travel and training. To learn more about ASCO's
Leadership Development Program, go to www.asco.org/leadership .

 

Attend the 11th Annual American Health Care Congress' Stakeholder Health Forum, December 10th-11th at the Sheraton Pasadena Hotel in Pasadena, CA. The Forum brings together health care executives from across the healthcare industry to discuss: Strategy, Diversification, Value migration, Clinical integration, Payment methodologies, Care redesign, Population health

And more... Learn actionable tools for transformation and stay informed on the innovative strategies that are moving health care forward to address consumerism, reform, cost, and outcomes. To learn more about this year's program and about our distinguished speaking faculty, visit the link to newly released agenda. Early Registration Rates Now Available.Mention promo code JAHOSP for the additional $100 in savings. For an immediate reservation or pre-reservation, contact me directly at 781-939-2454 or reserve online.  Forward to colleagues- groups of 3 or more are eligible for every 4th delegate to attend for free.

 

 

Industry News

 

 

- Celgene works with QuantiaMD to launch a resource center on PTCL and CTCL. This educational resource is designed to provide the physician community with an understanding of the classification, diagnosis of subtypes, and disease management of peripheral T-cell lymphoma (PTCL) and cutaneous T-cell lymphoma (CTCL).  Physicians can choose to "follow" the resource center and receive alerts when new information is added.  To visit the T-cell Lymphoma Resource Center, please click here:  http://quantiamd.com/home/ptcl_ctcl. Please call your Celgene Hematology Oncology Consultant for more information.

 

- Merck informs ANCO and MOASC that the United States Food and Drug Administration has approved Keytruda for the treatment of advanced or unresectable melanoma in patients not responding to other therapies.

 

Join Innovatix Lunch 'N Learn/Government Affairs Webinar, Election Year Politics and New Policy Changes Impacting Health Providers, on September 17, 2014 10:00am Pacific Time. Space is limited,  .  If you have any questions please contact Caitlin Ferchaw at [email protected]  or (888) 258-3273.

 

Pharmacyclics, Inc. has made some exciting changes to the YOU&i™ Instant Savings Program.  New and current eligible patients will benefit from a lower out-of-pocket cost per month and a higher yearly maximum benefit of $10 per month.  All other program rules, including eligibility requirements, will remain. Maximum yearly benefit will now be $24,600 or 25% of WAC (Wholesale Acquisition Cost) - that is an increase from $18,695 or 19% or WAC.

Program changes are effective immediately - eligible patients signed up today will pay $10 per month. Patients that are currently enrolled in the program will pay $10 per month beginning with their next prescription. If you have any further questions, feel free to contact John Logan, MBA

National Account Executive, Cell: 602-312-3611, Office: 480-491-2356  [email protected].


 

   

 

In This Issue
California News
Noridian News
MOASC News
ANCO News
National News
CMS News
Affiliate Association News
Industry News
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MOASC CALENDAR

  

"Medicare Physician Fee Schedule 2015 Propsed Rule" Repeat Teleconference

(September 10, 2014)

 

MOASC Oncology Nurse Program

(September 19, 2014)

 

MOASC Administrators Program 

(October 22, 2014)

 

MOASC Billing Program

(November 4, 2014)

 

MOASC Advisory Summit 

(November 14, 2014)

 

 

 

ANCO CALENDAR

   

Hematological Malignancies Update (September 27, Menlo Park)

 

Hematological Malignancies Update (November 15, San Francisco)

 

ASH Annual Meeting (December 6-9, San Francisco)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
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 151109, San Rafael, CA 94915 |  P (415) 472-3960 | F (415) 472-3961 | www.anco-online.org