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.

  
October 28, 2014
            

 

California News

  

 

- Wellpoint will begin implementing its Cancer Care Quality Program Treatment Pathways in November 2014. ANCO and MOASC urge members to review the breast, colorectal, and lung cancer treatment pathways at www.cancercarequalityprogram.com. Send your comments to ANCO [email protected] and MOASC [email protected].  

 

- The cost of patient care at hospital-owned medical groups in California is 10-20% higher than the cost at independent physician groups according to a study published in the Journal of the American Medical Association. Researchers at UC Berkeley analyzed the medical spending of about 4.5M HMO patients at 158 medical groups between 2009 and 2012 and found that medical costs were 19.8% higher at medical groups owned by large health systems compared with a physician-owned group. Meanwhile, costs for locally hospital-owned groups were 10.3% higher than independent physician groups.

 

-California has the highest workers' compensation costs in the country, according to a new report, the Sacramento Business Journal reports. The Workers' Compensation Premium Rate Ranking Summary was conducted by Oregon's Department of Consumer and Business Services.

Findings. The report found that California businesses spend $3.48 for every $100 of payroll on expenses related to workers' compensation. In comparison, businesses in North Dakota -- the state with the lowest costs -- spend 88 cents out of every $100. The median cost for all 50 states was $1.85, making California's costs about 188% of the median. According to the Business Journal, workers' compensation costs are on the rise in California, with the state ranking fifth-highest in 2010 and third-highest in 2012 (Bridges, Sacramento Business Journal, 10/24).

Jerry Azevedo, spokesperson for the Workers' Compensation Action Network in California, said that workers' compensation premiums have increased by 41% since 2009.  Azevedo said workers and their employers do not benefit much from the program. Instead, he said much of the money is paid to lawyers, brokers and other administrative costs, and that California's workers' compensation system is incredibly inefficient, for as much as employers pay.

Meanwhile, Christine Baker, director of the California Department of Industrial Relations, said the findings are skewed because the variety of industries and other factors are not comparable to the "reality" of workers' compensation in California. 

 

 

Noridian News

 

 

- Noridian/JEMAC has posted the following updates to its website

(http://med.noridianmedicare.com/web/jeb): MLN Connects Provider eNews (National Provider Calls--Transitioning to ICD-10; Electronic Funds Transfer Upgrades to the Internet-based PECOS System; Open Payments: Know the Numbers and Decode the Data; CMS is Accepting Suggestions for Potential PQRS Measures; New FAQs for PQRS; Cutting-edge Colorectal Cancer Screening Now Covered); CMS 1500 Claim Form Instructions Version 02/12--Revised; Noridian Medicare A/B and DME Comprehensive Error Rate Testing Symposium--California; HCPCS Codes for SNF CB--2015 Annual Update; Upcoming Web-based Workshops (Medicare Part B Claim Submission); Quality Improvement Initiatives; eRx Incentive Program Payments--Now Available; and, November Web-based Workshops. 

 

 

DHCS/ Medi-Cal News

 

 

On October 27, 2014, the Department of Health Care Services (DHCS) notified providers that it has reviewed all Assembly Bill 97 (AB 97) Ten Percent Pharmacy Payment Reduction and State Plan Amendment (SPA) 12-014 Applications received and postmarked by the May 31, 2014 cutoff. This stakeholder update stated on the DHCS Pharmacy Benefits Division's AB 97 provider exemption webpage, applications received and postmarked on or before May 31, 2014 will be given exemption consideration retroactive to June 01, 2011; applications postmarked after May 31, 2014 will be given consideration for exemption effective the first day of the quarter in which they were received.  Providers who submitted an application by May 31, 2014 will be notified of DHCS's determination via first class mail within the next few weeks.   Individual drugs, or therapeutic categories of drugs meeting one or more of the following criteria will be considered for exemption:

1. Drugs for which immediate or rapid negative clinical impact(s) will occur if consistent and ongoing access is impeded (e.g. drugs used to treat cancer, life-threatening infections, end stage renal disease, hemophilia, etc.)

2. Drugs for which documentation exists that the ten percent provider payment reduction will result in reimbursement below the acquisition cost generally available to the Medi-Cal pharmacy provider community.

3. Drugs that are only dispensed through limited or specialized networks of pharmacy providers.

4. Drugs that are used to treat unique clinical conditions with relatively low prevalence in the Medi-Cal population. 

For all matters concerning the AB 97 payment reductions, providers are encouraged to check the AB 97 webpage regularly for exemption updates. Note: DHCS will continue to accept and review pharmacy provider exemption applications on an ongoing basis.  To contact Pharmacy Benefits Division with questions about AB 97 pharmacy payment reductions and exemptions, please send an email to: [email protected]

 

Providers submitting claims via Internet Professional Claim Submission (IPCS) must select the appropriate ICD-CM Type under the claim info tab, before entering a diagnosis code. When changing the ICD-CM Type, you must first clear the diagnosis code field, select the appropriate ICD-CM type, and then re-enter the new diagnosis code. The IPCS User Guide has been updated to reflect the changes mentioned above and is accessible on the User Guides page of the Medi-Cal website.

  

 

MOASC News

 

 

- MOASC has two very exciting meetings coming up in the next month! For information on any program, please look below and click the links to RSVP:

~~The MOASC Oncology Billing Program is our annual program for billers and other interested office staff. Bobbi Buell will be speaking, as well as Cheryl Bradley from Noridian/Medicare and a representative from Medi-Cal. November 4, 2014, 7:30am - 3:00pm, The Sheraton Pomona - Fairplex Pomona. For more information and to RSVP, click here.

~~The MOASC Oncology Summit is a full day event for MOASC physician members. There are three advisory boards available for physicians to attend, as well as a reception and dinner program. The keynote speaker is Dr. Lawrence Piro, who will discuss "Physician Hospital Partnerships: What they look like, whether they work and should you consider one?" November 14, 2014, The Intercontinental Hotel - LA - Century City. For more information and to RSVP, click here. Space is limited, you may also R.S.V.P. to the MOASC Office via phone 800-310-3553 ext. 1 or via email [email protected].

 

JOB BOARD:

Nurse Practitioner: Nurse Practitioner- Busy Oncology practice in La Jolla looking for a compassionate nurse practitioner to work in a high paced hospital and office setting. Must have good IV skills. Excellent communication and organization skills are a must. Proficient in electronic records. We offer competitive salary and benefits. Oncology background is preferred. Email resume to Attn Office Manager at [email protected]


BILLING QUESTION OF THE WEEK:
Can offices bill 96413 and 96415 if one hour and fifteen minutes are spent giving the patient IV Chemotherapy? 
No. 96413 can be billed for the first hour, but 96415 can only be billed for each additional hour IF the intervals are greater than thirty minutes. 

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ANCO News

 

 

- ANCO is organizing a Hematological Malignancies Update on November 15 in San Francisco with Jeffrey Lee Wolf, M.D., University of California, San Francisco, and Bruno Medeiros, M.D., Stanford University. The latest research on novel treatment modalities for ALL and AML, and multiple myeloma, along with case studies for each diagnosis will be presented. The program takes place at the Hyatt Fisherman's Wharf and begins at 8:30AM with breakfast. This meeting is supported by Celgene. Space is limited to the first 50 physician or nurse registrants only. Meeting announcements were mailed in early October. To register for the meeting, please send your name, affiliation, and e-mail address to [email protected] (Subject: 4Q2014 Clinical Meeting) or download and FAX the registration form at 

www.anco-online.org/4Q2014MeetingAnnouncement.pdf

 

- ANCO will host a professional educational webcast on November 19 entitled Does Your Practice Measure Up? ANCO's Patient Satisfaction Survey Program Can Help You Find Out. During this webcast, Thomas P. Jeffrey, President, SullivanLuallinGroup, will discuss patient satisfaction as measured through surveys. In today's health care environment, measuring patient satisfaction is no longer optional; it is a requirement to stay viable. The webcast announcement was mailed in early October. To register for this webcast, please send your name, affiliation, and e-mail address to [email protected] (Subject: 4Q2014 Professional Education Webcast) or download the webcast registration at www.anco-online.org/4Q2014.pdf

 

- Four seats on the ANCO Board of Directors are up for election in 2014. ANCO seeks nominations for candidates for these seats. This year's election will take place via mail ballot in December. Candidates with the top four vote totals will serve for three years (i.e., 2015-2017, inclusive). Nominate an ANCO member (including yourself) to stand for election to the Board via e-mail/FAX to the ANCO office at [email protected]/(415) 472-3961 no later than November 14.


 

- ANCO member, Primo N. Lara, Jr., M.D., UC Davis, is a candidate for ASCO's Nominating Committee--Undesignated Specialty Candidates in ASCO's forthcoming annual election. Voting opens on October 29 and closes on November 26 with results announced in mid-December.


 

National News 

 

 

MedPAC analyzed data on opioid abuse for Medicare Part D enrollees. Both the findings and potential policy implications could affect practicing hematologists who routinely prescribe opioids. read article

 

The Obama administration is delaying requirements for insurance companies to disclose records about enrollment data, claims denied and the amount consumers pay for specific services, reports Robert Pear for The New York Times.

 

Providers are charging fees to patients for services that used to have no cost at all, saying the charges are needed to offset reduced reimbursements from insurers, r
eports Elisabeth Rosenthal for The New York Times.

 

 

CMS News 

 

 

- CMS has released a simplified Open Payments tool at www.cms.gov/OpenPayments/Explore-the-Data/Explore-the-Data.html) that is intended to be easier for the public to use and allowing all data on a physician to be found at a single place.


- In the next few weeks, ASCO in collaboration with multiple specialty societies will randomly distribute an AMA Relative Value Scale Update Committee (RUC) survey of the therapeutic injection CPT codes 96372, 96374, and 96375 and the chemotherapy injection CPT codes 96401, 96409, and 96411. The survey will run from October 29 through November 12. CMS relies on specialty societies and RUC's recommendations as a basis for setting payment levels for physician services. Your input is very important and ASCO urges you to participate if you receive a copy of the survey.

 

Eligible professionals and eligible hospitals that have not fully implemented 2014 Edition certified EHR technology (CEHRT) for an EHR reporting period in 2014, should join CMS this Thursday, October 30 from 11:00 a.m.-12:00 p.m. PT for a National Provider Call providing guidance and instructions on how the provisions of the 2014 CEHRT Flexibility Rule can help you report for 2014. 

 

 

Affiliate Association News


  

ASCO just released a newly updated survivorship care plan form, which oncology professionals use to provide survivors with detailed information about the given treatment, the need for future check-ups and tests, and potential long-term late effects. The new version has been streamlined and can be downloaded in Cancer.Net's Survivorship section or found as part of the 

ASCO Answers Guide to Survivorship (PDF).

 

- ASCO wants to hear from you on drug shortages and is conducting a survey of members in collaboration with the Hematology/Oncology Pharmacy Association (HOPA). Previous surveys indicated that ASCO members are encountering serious problems with the accessibility of life-extending oncology drugs. The current survey is intended to help ASCO and HOPA understand the extent of the ongoing problem and examine the impact of legislative and administrative efforts to mitigate drug shortages. Complete the survey at www.surveymonkey.com/s/DrugShortages2014.See related topic under "Industry News" below.

 

- ASCO has endorsed the joint College of American Pathologists (CAP)/International Association for the Study of Lung Cancer (IASLC)/Association of Molecular Pathology (AMP) clinical practice guideline on molecular testing for selection of patients with lung cancer for therapies targeting epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK). Learn more at

www.asco.org/press-center/asco-endorses-capiaslcamp

-guideline-egfr-and-alk-molecular-testing-patients-lung-cancer.

 

- ASCO has jointed more than 70 organizations in a letter to CMS in support for annual screening for lung cancer with low-dose computed tomography (LDCT) in accordance with the United States Preventive Services Task Force's Grade B recommendation. In April 2014, MedCAC gave a low-confidence vote for Medicare coverage of LDCD for lung screening. Read the letter at www.asco.org/sites/www.asco.org/files/lcs_stakeholder_

letter_09_26_14_final.pdf.

 

- ASCO is seeking candidates for the position of founding Editor-in-Chief for a new online-only, open-access journal focusing on cancer care, research, and care delivery issues that are unique to limited health care-resource countries and settings. By November 3, 2014, interested candidates should submit a curriculum vitae and completed application. Learn more now.

 

- ASH is proud to host the premier hematology event of the year. You should register today and join your colleagues in San Francisco, CA, for the 56th ASH Annual Meeting on December 6-9. Advance registration is open for a limited time. Register today to receive discounted registration rates and to book your housing. Advance registration here ends November 5 at 8:59 p.m. (PT).

 

- According to COA, the recent 60 Minutes piece entitled The Eye Popping Cost of Cancer Drugs ignored data supporting the quality and cost efficiency of community oncology providers, ignoring those facts in order to fit what seemed to be a pre-determined conclusion. COA blasted 60 Minutes in letter about the inaccuracies and the adverse impact false information can have on cancer patients. 60 Minutes acknowledged the letter in their broadcast on October 19. Read COA's letter at www.communityoncology.org/site/blog/detail/2014/10/06/60-minutes-acknowledges-coa-blasted-it-for-reporting-inaccuracies-in-cancer-drug-costs-show.html.


 

  
Industry News


  

 

- Eisai informs ANCO and MOASC that the United States Food and Drug Administration has approved a fixed-combination capsule of netupitant and palonestron (Akynzeo) to treat nausea and vomiting in patients undergoing dance chemotherapy.


- Innovatix informs ANCO and MOASC that their Contract Advantage Tool (CAT) reflects current Innovatix/Premier contract prices honor through their distributor partner, FFF.

 

- Some influenza-vaccine makers have delayed shipments to U.S. doctors and pharmacies because of production problems, forcing health-care providers to put off vaccinations as flu season gets under way. Contact Patrick  Walsh [email protected], for information on how to acquire the vaccines during this shortage.

 

- Millennium informs ANCO and MOASC that the United States Food and Drug Administration has approved Velcade, in combination with rituximab, cyclophosphamide, doxorubicin, and prednisone (VR-CAP) for previously untreated patients with mantle cell lymphoma. VR-CAP is the fist and only FDA-approved regimen for the treatment of patients with previously untreated mantle cell lymphoma.

 

Sargas Pharmaceutical Adherence and Compliance (SPAC) International has developed innovative software and mobile applications to keep the physicians and patients engaged from the time a script is initiated through the entire treatment period. Please visit www.spacinternational.com to learn more. Medicare proposes to pay $42 per patient per month for  patients with two chronic diseases. Physicians will have to bill and collect on their own for these services. Patients will have to pay 20% co-payment for these services.

In This Issue
California News
Noridian News
DHCS/ Medi-Cal News
MOASC News
ANCO News
National News
CMS News
Affiliate Association News
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MOASC CALENDAR

 

MOASC Billing Program

(November 4, 2014)

 

MOASC Oncology Summit 

(November 14, 2014)

 

 

 

ANCO CALENDAR

   

Head and Neck Cancer and Endocrine Surgery (UC San Francisco, November 14, Stanford)

 

Minimally Invasive Thoracic Surgery and Thoracic Oncology Symposium (Stanford Cancer Institute, November 14, Stanford)

 

Hematological Malignancies Update (November 15, San Francisco)

 

Does Your Practice Measure Up? (November 19, Webcast) 

 

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