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.
 

November 10, 2015  
California News
- The California Medical Association (CMA) has published its 2015 Legislative Wrap-up entitled CMA Powerfully Benefits and Protects the Community available at www.anco-online.org/CMALegWrapUp2015.pdf.
 
- AB679 extends by six months the registration deadline for the Controlled Substance Utilization Review and Evaluation System (CURES). All individuals practicing in California who possess both a state regulatory board license authorized to prescribe, dispense, furnish, or order controlled substances and a Drug Enforcement Administration (DEA) Controlled Substance Registration Certificate now have until July 1, 2016 to register for CURES.
 
- The Medical Board of California is asking physicians who need to renew their medical licenses in the next few months to do so early to avoid delays associated with scheduled upgrades to the BreEZe online licensing system. Licenses expire on the last day of the licensee's birth month during the second year of a two-year term. Renewal notices are sent out 90 days in advance of the expiration date. Individuals hold a professional license with December 2015 or January 2016 expiration dates who wish to renew their licenses are strong encouraged to renew as early as possible, preferably before the end of November 2015.
 
- CMA's Practice Resources (CPR) for November 2015 is now available online at http://www.cmanet.org/cpr/cpr-archives/2015/november-2015 and features articles entitled Be prepared for Covered California changes in 2016; Anthem Blue Cross providers can now update demographics electronically; Noridian conducting numerous prepayment reviews; UnitedHealthcare to offer webinars to physicians participating in Core Network; Askl the expert: I an exchange patient is in the 90-day grace period and fails to pay the premium, is the plan required to pay for services provided?; Providers who refer, order, or prescribe for Medi-Cal must enroll in DHCS; Blue Shield fee schedule changes took effect November 1; The Coding Corner: Decision for treatment calls for separate E/M reporting.  
 
- The open enrollment period for the third year of Covered California, California's health benefit exchange, began November 1, 2015, and continues through January 31, 2016. All 10 health insurance companies that offered coverage in 2015 will continue to offer coverage in 2016, with two new health insurance companies, United Healthcare (UHC) and Oscar, entering into the marketplace for 2016 in select regions.
 
-The California Chronic Care Coalition (CCCC) is on a mission to inform patients in California about their rights as health care consumers and we need your help! Daily, patients navigate obstacles obtaining the care they need, such as:
Scheduling appointments with specialists
Accessing life-saving medicines
Attaining tests and examinations
MyPatientRights.org, is an online resource to help patients identify when, why and how to file a complaint with their health plan and/or the California Department of Managed Health Care (DMHC) to demand the care they need and deserve.
The mypatientrights.orgPartner Toolkitprovides all the resources you need to educate your patient network about their patient rights. The information is free and easy to access.
PowerPoint slides- for group presentations
Flyer/Insert/Handouts- for patient and community events
Website badge- promote on your website and encourage your networks to do the same.
Please contact Beth Hadley athadleybeth22@gmail.comor 916-690-0757 for more information or to discuss ways to work together to provide these resources to your patients.
 
- UnitedHealthcare's Network Bulletin (November 2015) is now available at http://unitedhealthcareonline.com > Quick Links > Network Bulletin and highlights Link--your new gate to UnitedHealthcare's online tools; the UnitedHealthcare Premium Designation Program; and, the individual exchange open enrollment period.


 
Noridian News

- Not all new anti-cancer drugs should be billed using chemotherapy administration codes, so says Noridian Medical Director. MOASC & ANCO are currently in discussion with Richard W. Whitten, MD, MBA, FACP, Contractor Medical Director; VP Health Policy, Noridian Healthcare Solutions, regarding Noridian's recommended position that not all new anti-cancer drugs should be billed using chemotherapy administration codes. More specifically, Dr. Whitten suggests that the infusion of some new anti-cancer drugs is not as complex as older chemotherapy drugs and, therefore, the chemotherapy administration codes cannot be used to code and bill for their use and reimbursement. Noridian provided a list of some anti-cancer drugs that they have determined may not meet the CPT standards for chemotherapy administration (e.g., PD-1 drugs). Dr. Whitten's specific response is, "... There is no issue with chemotherapy (J9XXX) drugs, the issues are with some of the monoclonals, as we discussed at the time.  The other attendees appeared to recognize that if all monoclonals and other biologics are allowed access to the chemotherapy administration codes, the risk for ASH/ASCO is that the differential developed for and applied to the chemotherapy administration codes will likely be removed or reduced.  This is why ASCO has testified specifically along these lines on this issue at the AMA House (opposing the resolutions from GI, ID and Allergy/Immunology seeking the broader access for all such drugs)..."
If you are interested in reading ANCO's & MOASC's response and Dr. Whitten's slides, please contact moasc@moasc.org .
 
- Noridian/JEMAC has posted the following updates to its website http://med.noridianmedicare.com/web/jeb
 
* MLN Connects Provider eNews
ICD-10--Qualifiers for ICD-10 Diagnosis Codes on Electronic Claims; Get ICD-10 Answers in One Place
Announcements--Physician Fee Schedule: Policy and Payment Changes for CY2016
Calls & Events--Medicare Quality Reporting Programs: 2016 Physician Fee Schedule Call-Registration Now Open
Claims, Prices, and Codes--Colorectal Cancer Screening Claims Processing Issue
* ICD-10 News: Checking Your Medicare FFS Claim Status
* Provider Enrollment Requirements for Writing Prescriptions for Part D Drugs-Second Revision
* ICD-10 Common Electronic Claim Denials: Post-Implementation
* ICD-10 LCD Navigation Tips
* Medicare B News JE October 2015 Bulletin-Now Available
* Claims Processing Guidance for Implementing ICD-10-A Re-issue of MM7492-Fourth Revision SE1408
* Prolonged Service in the Office or Other Outpatient Setting, 99354 a Widespread Service Specific Probe Review Notification
* Positron Emission Tomography Scans Coverage-R1
* Appeals I, II, and III Workshops (November 10-12)
* CCI and MUE Workshop (November 20)



DHCS/Medi-Cal News

- DHCS is continuing to develop policy to implement Senate Bill 1004 (Hernandez, 2014).  SB 1004 requires DHCS to establish standards and provide technical assistance for Medi-Cal managed care plans for the delivery of palliative care services.  DHCS posted online a draft Medi-Cal palliative care concept paper and held a webinar on October 5 to present the proposed eligible condition and definition of palliative care services.  DHCS has received a number of stakeholder comments on the paper and has posted them on the SB 1004 website.  DHCS is currently reviewing stakeholder comments and considering revisions to the concept paper.  Please visit the above website to view the concept paper, stakeholder feedback, and materials from the October 5 and previous stakeholder meetings.
 
- As part of the Medi-Cal EHR Incentive Program, DHCS recently awarded contracts totaling $37.5 million (90 percent federal financial participation) to four vendors to provide technical assistance to eligible professionals wishing to implement and use in a meaningful way certified electronic health record technology.  The California Technical Assistance Program (CTAP) is modeled after the federal Regional Extension Center (REC) program administered by the Office of the National Coordinator, and will include specialists and larger groups previously excluded under the REC program.  The successful CTAP vendors are the California Health Information Partnership and Services Organization, Health Information Technology Extension Center for Los Angeles, CalOptima, and Object Health, which will serve 7,500 eligible professionals, increasing the number of unique professionals participating in the Medi-Cal EHR Incentive Program to 16,882.  As of October 1, more than $1.1 billion in incentive payments have been made to eligible professionals and 252 eligible hospitals.
 
- On October 31, DHCS and the Centers for Medicare & Medicaid Services (CMS) announced a conceptual agreement that outlines the major components of California's 1115 Medicaid waiver renewal, along with a temporary extension to December 31 of the existing waiver while we specify the details of the renewal through the official Special Terms and Conditions.  The total initial federal funding in the renewal is $6.218 billion, with the potential for additional federal funding in the global payment program to be determined after the first year.  The conceptual agreement includes the following core elements:  Independent assessment of access to care and network adequacy for Medi-Cal managed care members; and independent studies of uncompensated care and hospital financing; Global Payment Program for services to the uninsured in designated public hospital (DPH) systems; delivery system transformation and alignment incentive program for DPHs and district/municipal hospitals, known as PRIME (Public Hospital Redesign and Incentives in Medi-Cal); Whole Person Care pilot program that would be a county-based, voluntary program to target providing more integrated care for high-risk, vulnerable populations. In addition, the waiver extension and renewal will continue the programs currently authorized in the current waiver, including the Drug Medi-Cal Organized Delivery System, Coordinated Care Initiative, and Community-Based Adult Services.



 MOASC News

- MOASC is pleased to partner with Research to Practice for the Year in Review (YIR) Meeting at the Fairmont Miramar Hotel & Bungalows, Santa Monica, on Saturday, November 21. Please click on the link for more information. http://www.researchtopractice.com/Meetings/YIR2015/CAYear in Review CME Meeting. 
 
- If you missed MOASC's last meeting of the year, some of the handouts are available from the key experts & industry stakeholders on how oncology is faring and what you need to know to move into 2016. If you would like copies of the handouts, please contact the MOASC Office at moasc@moasc.org. 
 
- MOASC has openings on the Board of Directors. Physician Members who are interested in providing direction and assistance to your state oncology organization are encouraged to contact the MOASC Office at moasc@moasc.org.
 
- MOASC is also soliciting Administrators and Non-Physician Clinical Staff to fill the two positions on the board of Directors that represent your interests in the oncology practice. MOASC believes that the administrator and clinical staff bring fresh ideas and new points of view. Thank you for your participation & SUPPORT!
 
Board Job:
- Immediate full time position available for a Medical Assistant/Front Office Administrator in busy Oncology/Hematology practice. Must have a minimum of 2 years of experience. Oncology experience is a plus!
Duties include:
Use computer applications to include EMR; Answer telephones; Greet patients; Update & file patient medical records; Schedule appointments; Handle correspondence; Greet & bring patient to the exam room & maintain efficient patient flow; Take vital signs and enter them immediately into the EMR & on the flowsheet; Review current medications and document them; Take medical histories, i.e. allergies, report to MD/RN any acute complaints; Prepare patients for examinations; Assist physician during exams; Collect & prepare laboratory specimens (i.e. bone marrow slides, packaging specimen for reference lab pick up/drop off, storage of tubes); Perform basic laboratory tests; Draw blood; EKGs; Assist RN in preparing flushes, priming saline bags
Stock exam rooms & assist with inventory control; Maintain cleanliness of exam rooms and infusion room; Assist MD/PA in admin duties upon request; Input lab values on EMR & flow sheet; Reconcile pharmacy claims; Assist Pharmacy Tech.
Please email resume with salary requirements. No phone calls please.
Joanne Ferri, Practice Administrator
Compassionate Oncology Medical Group
Robert L. Leibowitz, MD
Shahrooz Eshaghian, MD
2080 Century Park E, Suite 1005
Los Angeles, CA 90067
 

 
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ANCO News
 
- Download the presentations from ANCO's Molecular Diagnostics & Clinical Decision Making meeting at www.anco-online.org.

- ANCO is pleased to be a sponsor of the 16th Multidisciplinary Management of Cancers: A Case-based Approach which returns to the Silverado Resort and Spa, Napa, on March 18-20, 2016. The meeting is presented in collaboration by the Stanford Cancer Institute, UC Davis Comprehensive Cancer Center, and UCSF Helen Diller Family Comprehensive Cancer Center. For more information, visit http://cme.stanford.edu/multicancers.

- ANCO is surveying practices to learn early lessons from the transition to ICD-10. Download and complete the survey at www.anco-online.org/EarlyLessonsICD10.pdf. CMS ICD-10 resources are available online at www.cms.gov/Medicare/Coding/ICD10/index.html?redirect=/icd10; ASCO ICD-10 resources are at www.asco.org/practice-research/icd-10; ASH ICD-10 resources are at www.hematology.org/Clinicians/Practice-Policy/2325.aspx; and, CMA ICD-10 resources are at www.cmanet.org/icd10. 
 
- Effective January 1, 2015, AB219 (the Health Care Coverage: Cancer Treatment Act) limits a patient's total co-payment and coinsurance for an oral cancer medication to $200 per 30-day supply. It has been brought to ANCO's attention that some private payor pharmacy benefit plans may be in violation of the provision of AB219. Read more about and take ANCO's AB219 survey at www.anco-online.org/AB219Survey.pdf.
 
- Four seats on the ANCO Board of Directors are up for election in 2015. ANCO seeks nominations for candidates to stand for election to these seats. This year's election will be conducted via mail ballot in December. Candidates with the top four vote totals will serve for three years (i.e., from 2016-2018, inclusive). The ANCO Board of Directors governs the Association, developing advocacy strategies and policies, approving educational meeting proposals and activities, and considering membership benefits. The Board meets in person approximately once each year in the San Francisco Bay Area and via bimonthly teleconference. Expenses associated with attending Board meetings are reimbursed. Communication with the Board is also conducted via FAX broadcast and e-mail. You may nominate an ANCO member (including yourself) to stand for election to the Board via FAX to the ANCO office at (415) 472-3961 or e-mail to execdir@anco-online.org no later than November 13, 2015.


 
National News

- ASCO has submitted comments to the Food and Drug Administration (FDA) on its proposed rule for the nonproprietary naming of biologic products, specifically biosimilars. ASCO encourages the FDA to use a biosimilars naming convention that ensures safety and does not add any administrative burden for physicians and pharmacists. Read ASCO's letter at www.asco.org/sites/www.asco.org/files/fda_biosimilairs_comments.pdf  
 
- ACCC and ASCO have submitted comments on proposed 340B drug discount program guidance. ACCC emphasized the importance of preserving cancer patient access to appropriate sites of care and cautioned that any new administrative and accountability requirements adopted for 340B program participants should be implemented with sufficient stakeholder input and reasonable time frames. ASCO's comments centered on clarifying the original intent of the program and covered entities, increasing transparency of funding and oversight, maintaining patient access, and increasing high-quality cancer care and the opportunity for patients to benefit from equally in all settings where cancer care is delivered. Read ACCC's comments at www.accc-cancer.org/advocacy/pdf/2015-ACCC-340B-Comments-to-Guidance-10-27.pdf; read ASCO's comments at www.asco.org/sites/www.asco.org/files/asco_340b
_ombibus_comments_letter.pdf.
 
- In case you missed it, a recent study in JAMA Internal Medicine, "Association of Financial Integration Between Physicians and Hospitals with Commercial Health Care Prices," looked at the spending and pricing changes for outpatient and inpatient services and their association with the increase in hospitals acquiring physician practices. 340B Spotlight: ICYMI - New study on hospital-physician practice consolidation  
 
 
 
CMS News 

- CMS has released the final 2016 Medicare Physician Fee Schedule. One of the biggest changes in the CMS final rule is the assignment of codes to pay physicians for end-of-life consultations. In addition, the final rule includes a .5% overall increase in Medicare reimbursement in 2016 for all providers. CMS estimates that in CY2016 the hematology/oncology specialty will face a 0% impact. It is important to note that the actual impact on individual physician practices will depend on the mix of services provided. Read the CMS Fact Sheet at www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2015-10-30-2.html; read Bobbi Buell's summary of the final rule at www.anco-online.org/BB-MedicareFinalRules.pdf. 
 

     
Affiliate Association News  
 
- Research to Practice for the Year in Review (YIR) Meeting will be at the Fairmont Miramar Hotel & Bungalows, Santa Monica, on Saturday, November 21. Please click on the link for more information.
 
- Interested in becoming involved in the leadership of ACCC and helping to shape the future direction of the organization? ACCC is now accepting nominations for the 2016 Board of Trustees election. If you or someone you know is interested, please send in a nomination (including the nominee's name and program affiliation) to Careen Campbell at ccampbell@accc-cancer.org or via FAX at (301) 770-1949. Nominations must be received by November 30.
 
- Don't wait to register now to ensure the best available housing for the premier event in hematology! ASH invites you to attend the 57th ASH Annual Meeting and Exposition from December 5-8, 2015, at the Orange County Convention Center in Orlando, FL. This year's meeting will debut some new offerings and continue to showcase the full spectrum of hematology, from discoveries to new therapies to outcomes analyses. Register as an individual.
Register as a group.
To register as an individual, you must sign in using your current ASH username (moasc@moasc.org) and password.   
  
- In a new policy statement on site neutrality--providing equal reimbursement for the same services delivered in any care setting--ASCO calls for comprehensive physician payment reform to support the full scope of services required by patients with cancer, rather than jeopardizing patient outcomes by reducing the available resources in a particular cancer care setting. The statement, published in the Journal of Clinical Oncology, asserts that the traditional approach to physician payment under Medicare reflects a narrow, outdated view of the needs of individuals with cancer and makes recommendations for delivering high-quality, high-value care. Read the new policy statement at http://jco.ascopubs.org/content/early/2015/10/23/JCO.2015.64.061.

- ASCO's new Health Policy Fellowship program has opened its application period. The program aims to provide physicians with the necessary skills to shape cancer policy. ASCO is actively recruiting oncologists in the early phase of their careers who have a keen interest in acquiring stronger health policy skills and have leadership, civic, policy, or advocacy experience. For more information, go to www.asco.org/advocacy/health-policy-fellowship;
applications are due by December 15.  

- ASCO and the American Association of Cancer Institutes (AACI) have launched a survey to assess administrative and/or regulatory burdens associated with conducting and managing clinical trials. The survey is part of the ASCO/AACI Best Practices in Cancer Clinical Trials Initiative whose goal is to promote practical solutions to meeting existing regulatory and administrative requirements on research. The Challenges to Conducting and Managing Clinical Trials survey should take 10-15 minutes to complete, will be open through November 15, and is available at www.surveymonkey.com/r/MF9PHBF.
 
- Be a part of ASCO's new collaborative learning network, PracticeNET, to gain valuable insights into your practice's business operations and quality of care. This new initiative, from ASCO's newly formed Clinical Affairs Department, uses existing data from your practice management system to offer customizable reports that measure practice-wide and individual performance against a national database of other PracticeNET participants. For more information, and to enroll, visit asco.org/practicenet.
 
- ASCO is convening a learning cohort representing its target audience and membership. This group will engage with ASCO on a regular basis over a nine-month period beginning in November to provide feedback on ASCO's CME program portfolio as well as highlight resources/strategies outside of ASCO products and services that are used to address learning needs. If you are interested in participating, then please contact Allyson Baer at (571) 483-1388 or allyson.baer@asco.org.
 
- CancerLinQ™ is a cutting-edge health IT platform that securely connects and powerfully analyzes real-world cancer care data from many data sources. Guided by ASCO's expertise and mission to support all cancer physicians-in every community and every setting-and powered by the SAP HANA platform, CancerLinQ equips oncologists with a vast network of information to improve the quality of patient care and maximize outcomes.
CancerLinQ will improve the care for all cancer patients and provide valuable tools to enhance practice efficiencies. We hope you can join this effort to empower oncologists everywhere to deliver high-quality care to their patients.
For more information and to set up an informational meeting, please contact:
Duane Heitkemper, BSc, CNMT, RT, (N)
External Relations Specialist
571.344.9499 (direct)
Jeff Szykowny
External Relations Specialist
571-242-9499 (direct)
American Society of Clinical Oncology
2318 Mill Road, Suite 700, Alexandria, VA 22314
 


Industry News
 
- Janssen Biotech, Inc. informs MOASC & ANCO that the U.S. Food and Drug Administration (FDA) has approved YONDELIS� (trabectedin) for the treatment of patients with unresectable (unable to be removed with surgery) or metastatic liposarcoma (LPS) or leiomyosarcoma (LMS) who received a prior anthracycline-containing regimen. Press Release- Yondelis

- AMGEN informs ANCO and MOASC that the United States Food and Drug Administration has approved Imlygic, a genetic modified enclitic viral therapy, for the local treatment of unresectable cutaneous, subcutaneous and nodal lesions in patients with melanoma recurrent after initial surgery.
 
- Boehringer Ingelheim Pharmaceuticals informs ANCO and MOASC that the United States Food and Drug Administration has approved Prdxbind for the treatment of patients treated with Pradaxa when reversal of the anticoagulant effects of Pradaxa is needed for emergency surgery/urgent procedures, or in life-threatening conditions or uncontrolled bleeding.
 
- Bristol-Myers Squibb Oncology informs ANCO and MOASC that the United States Food and Drug Administration has approved Yervoy for the additional indication of adjuvant treatment of patients with cuteness melanoma with pathetic involvement of regional lymph nodes of more than 1mm who have undergone complete resection, including total lymphadenectomy.

  
 
In This Issue
California News
Noridian News
DHCS/Medi-Cal News
MOASC News
ANCO News
National News
CMS News
Affiliate Association News
Industry News
  1.  

 

 MOASC CALENDAR

 

LunchTime Series
  November 18th

 




 

 

 

 

 

 

ANCO  
CALENDAR

   

(January 7-9; San Francisco) 

 

ASCO's 2016 Cancer Survivorship Symposium 

(January 15-16; San Francisco)

 

(January 21-23; San Francisco) 

 

(March 18-20; Napa) 

 

 

 

 

 

 

 

 

 

 

 
 
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