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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.
January 27, 2015 
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California News
| - SB128, The End-of-Life Options Act, was introduced on January 21. The bill would give patients with terminal illness the right to seek life-ending medication from their doctor and would require that the medication be self-administered, that the patient is mentally competent, that two physicians confirm the prognosis that the patient has six months or less to live, that the patient's physician discuss alternatives and additional treatment options, that the patient submits a written request and two oral requests made at least 15 days apart, and that two witnesses attest to the request. Pharmacists and physicians would be given legal immunity for participating and would be able to opt out.
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- Medicare claims processing contractors (MACs) have published the 2015 Medicare Physician Fee Schedule (MPFS; https://med.noridianmedicare.com/web/jeb/fees-news/fee-schedules/mpfs) and have released 2015 claims for payment.
- Noridian/JEMAC has posted updates to its website (http://med.noridianmedicare.com/web/jeb
* MLN Connects Provider eNews--
Announcements Share Your ICD-10 Story Products
Certifying Patients for the Medicare Home Health Benefit
The Basics of Internet-based PECOS for Physicians and Non-Physician Practitioners Fact Sheet--Reminder
Avoiding Medicare Fraud and Abuse: A Roadmap for Physicians Web-based Training Course--Revised * Obinutuzumab (Gazyva) Wastage Billing Instructions-- *Coverage Article Retired--Effective January 1, 2015
* FDG PET for Solid Tumors--Second Revisions
* Open Public Meeting Announcement--February 4, 2015
- Forthcoming Noridian/JEMAC workshops (http://med.noridianmedicare.com/web/jeb/education/training-events) include:
* Incident To, Non Physician Practitioner, Locum Tenens, & Reciprocal Billing (January 28)
* Medicare Secondary Payer (Februrary 11)
* Incentive Programs (February 12)
* New Provider New Biller (February 19)
* Modifier 50 Clarification and Changes (February 24)
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- California Health and Human Services Agency Secretary Diana S. Dooley announced
January 26, 2015 that Jennifer Kent, has been appointed by Governor Brown as the next Director of the Department of Health Care Services (DHCS).
-In 2014, many Medi-Cal providers provided care to patients who had submitted an application for health insurance, but had not yet received a response, and many providers are currently seeing patients that have a pending Medi-Cal application. The Department of Health Care Services (DHCS) recognizes that delays in billing may have occurred due to the delays in Medi-Cal application processing. Therefore, DHCS will accept untimely claims for services that are provided to Medi-Cal recipients while their applications are pending and will not deny claims solely based upon a delayed submission. In order for claims to be paid, recipients must have eligibility in the Medi-Cal Eligibility Database System (MEDS) for the month in which services were rendered. Though timeliness may be overridden, all claims are subject to the appropriate edits and audits of the Medi-Cal program requirements to qualify for full reimbursement.
Timeliness overrides will apply for late claims submitted on or after January 1, 2014, to December 31, 2015, for dates of service on or after January 1, 2014, to December 31, 2015. The timeliness override is limited to claims where eligibility determinations were delayed due to Medi-Cal's implementation of the Patient Protection and Affordable Care Act (ACA).
Providers are required to insert an attestation statement reason for late eligibility determination by notating the delay reason code "10" with a description of "Delay in determination of Medi-Cal eligibility" in the comment section on the applicable claim. This policy applies to paper and electronic claims for most provider types, also includes appeals or Claims Inquiry Forms (CIFs) for an adjustment of a claim reduced for timeliness.
Detailed claim completion instructions are located in the Medi-Cal Provider Manuals.
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- TOMORROW'S MOASC LunchTime Series Teleconference on Wednesday, January 28, 2015 at 12:00pm, will be on "PHYSICIAN IN TRANSITION 2015 Six Timely Considerations for You and Your Practice," will be presented by Charles M. Denny, M.A. dialogue will include: Downsizing or Right-sizing the practice - Dealing with facilities, staff, reimbursement, patient issues and other related considerations; Practice mergers - A mixed bag of different practice cultures trying to fit the two together successfully; some have worked well, others are still deliberating; Recruiting physicians and surgeons - to share the load now and eventually take over the practice. There are many good candidates available - eager fellows and other experienced providers; Practice evaluations and sales - the challenge of getting a realistic price and finding an interested and qualified buyer; Negotiating a successful practice sale to hospitals and other institutions - even with the hospitals holding most of the negotiating cards; Employment Contracts - for the physician who just wants to focus on practicing medicine and may be thinking about closing his/her practice to take a salaried job with a bigger group or other healthcare entity. TO REGISTER, please contact the MOASC Office moasc@moasc.org.
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-Call To Serve! MOASC's Board of Directors needs you! Here is your chance to help lead the association dedicated to furthering the profession of oncology care in California. MOASC is currently seeking member oncologists to serve in the following leadership positions:
Treasurer
Board of Directors
Regional Representatives
The benefits are many: A significant role in advancing your profession; An opportunity to enhance the value of MOASC to the oncology community; Access to up-to-date information about the challenges facing your profession; The chance to exchange ideas and perspectives with other volunteer leaders.
MOASC values and seeks diverse leadership. It seeks leaders from all types and sizes of practice settings. From the academic to the institution to the community setting, the Nominating Committee has identified a number of desired attributes that will be part of the selection process for new Board members. Demonstrated leadership commitment and involvement with MOASC and the oncology community. Commitment to participate in board meetings. Visionary and strategic thinker. Demonstrated ability of new and innovative programs within their sphere of influence. Examples include, but are not limited to: incorporating strategy, leadership, future focus, risk taking, and an entrepreneur spirit.
We want and need to hear from you. If you are interested in serving, or know of potential board members you would like to recommend, please contact the MOASC Office moasc@moasc.org Nominations must be received no later than February 20, 2015. Thank you!
  
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- ANCO hosted its SABCS Highlights 2014 on January 15. Download presentations at www.anco-online.org/sabcshl2014.pdf.
- Read the results of ANCO's 2014 Patient Survey at http://www.anco-online.org/pxsrvy.html
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MOASC Contracting Network (MCN) News
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-The MCN/Aetna Oncology Pathways are well underway! Cardinal Health provides PathWare™, a web based decision support tool . The PathWare™ application delivers real time access to the approved oncology treatment pathways, as well as program compliance scores for your oncology patients.
It is IMPERATIVE that you utilize the PathWare™ software to receive enhanced reimbursements:
Aetna patients
Breast, Lung or Colon Cancer
New Starts
Change of therapy
For more information, you can reach Nichole East, MCN Office at neast@moasc-mcn.com or Cheryl Thomas, Cardinal Health at cheryl.thomas@cardinalhealth.com
-MCN/Aetna/Cardinal Health Oncology Pathways Steering Committee Members and participants in the Oncology Pathways program, are invited to the next Oncology Clinical Pathways™ Steering Committee Webinar Meeting being held on Tuesday, February, 24, 2015 5:30 PM PST. Your continued support and participation in the program is extremely appreciated.
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- A new report from the Institute of Medicine (IOM) provides recommended guidelines about what data should be shared at key times in a clinical trial. In its report, Sharing Clinical Trial Data: Maximizing Benefits, Minimizing Risks, an IOM committee concludes that sharing data is in the public interest, but a multi-stakeholder effort is needed to develop a culture, infrastructure, and policies that will foster responsible sharing. Read the report at www.nap.edu/catalog/18998/sharing-clinical-trial-data-maximizing-benefits-minimizing-risk.
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CMS News
-If you are an eligible professional participating in the Medicare EHR Incentive Program, you
have until February 28, 2015 to attest to demonstrating meaningful use of the data collected during your EHR reporting period for the 2014 calendar year. If you are participating in the Medicaid EHR Incentive Program, please refer to your state's deadlines for attestation information. The CMS Attestation System is open and fully operational, and includes the2014 Certified EHR Technology (CEHRT) Flexibility Ruleoptions. Medicare eligible professionals can attest any time to 2014 data until 8:59 p.m. Pacific Time on February 28, 2015.
Reminder: You must attest to demonstrating meaningful use every year to receive an incentive and avoid a Medicare payment adjustment.
Payment Adjustments
Payment adjustments were applied beginning January 1, 2015 for Medicare eligible professionals that did not successfully demonstrate meaningful use in 2013 (or 2014 for first-time participants) and did not receive a 2015 hardship exception.
Medicare eligible professionals that did not successfully demonstrate meaningful use in 2014 and do not receive a 2016 hardship exception will have payment adjustments applied beginning January 1, 2016. The application period will open in early January 2015. For more information,please review the payment adjustment tip sheet.
If you are eligible to participate in both the Medicare and Medicaid EHR Incentive Programs, you MUST demonstrate meaningful use to avoid the payment adjustments. You may demonstrate meaningful use under either Medicare or Medicaid.
If you are only eligible to participate in the Medicaid EHR Incentive Program, you are not subject to these payment adjustments.
Attestation Resources
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Affiliate Association News
-Fellows from California are cordially invited to attend the upcoming COA conference, April 23 - 24, 2015. COA is extending, to the Fellows, the COA member rate. COA expects the 2015 Community Oncology Conference to be bigger than the 2014 version, which was a huge success. By popular demand, COA is going back to Orlando. The highlight of the 2015 Conference will be sessions on oncology payment reform, picking up where the successful Payer Exchange Summit on Oncology Payment Reform left off from the fall of 2014. The 2015 Conference will have workshops dedicated to key aspects of oncology payment reform and you'll learn more about private pay and Medicare programs, in the field and proposed the unique three-track format is back, with the clinical sessions focused on aspects of immuno-oncology, the business sessions on keeping your practice on the cutting edge, and the advocacy track on the latest issues impacting cancer care. You can obtain all of the information at the conference website, www.coaconference.org. Fellows can register using the COA practice member rate. It will be a great education and aid in your decision-making. All oncologists and support staff are encouraged to attend this most informative program.
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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 151109, San Rafael, CA 94915 | P (415) 472-3960 | F (415) 472-3961 | www.anco-online.org |
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