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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 12, 2016
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- Thank you to all those members who responded to ANCO and MOASC's request for feedback regarding experiences with Anthem Pathways. Responses were received from California, Ohio and Georgia, between November 16 and December 15, with a majority of respondents being in private practice, ranging in size from 1 to 25 physicians. In summary, 78% of respondents are aware of and/or participate in the Anthem Cancer Care Quality Program (i.e., Pathways); 33% feel that Anthem's cancer treatment pathways adequately represent today's standard of care across the various tumors; and, Two-thirds of the respondents are having issues with using the Anthem portal or with access to peer-to peer discussions on any variances in treatment, with respondents equally split as to whether the Pathway incentives are appropriately aligned, are not appropriately aligned or should be different.
Respondents recommended the following changes to the Pathways:
- Frequently receiving claim denials for S0353 and S0354. Have to appeal them. Appeals are sometimes being denied after receiving payment on prior codes on same patient. The system can not handle these codes.
- Incentives should be based on total cost of care and quality, not just drug costs.
- Anthem follows the standard of care except I wish they give special priority to clinical trials.
- NCCN, ASCO, or even Via should set the Pathways, not an individual insurance company.
Respondents listed the essential elements of a Pathways program:
- Practice-directed Pathways.
- Clinical trials should be the first preferred option, with incentives to do so.
- "I want to treat the patient, not their insurance company."
ANCO and MOASC are meeting with a California state legislator regarding insurer set pathways, and will share these survey results with the Assemblyperson's office.
- UnitedHealthcare's Network Bulletin(January 2016) is now available online at http://unitedhealthcareonline.com > Quick Links > Network Bulletin and highlights 2016 UnitedHealthcare Administrative Guide Available--Effective April 1, 2016; Prior Authorization Required for Select Musculoskeletal and Pain Management Procedures--Effective April 1, 2016; Radiology Program Procedure Code Changes--Effective January 1, 2016; and, Medical Policy, Drug Policy, Coverage Determination Guideline and Utilization Review Guideline Updates.
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- The Noridian Provider Outreach and Education (POE) staff is hosting a Reopening Workshop on January 20 at 12 p.m. Pacific Time. Read the complete update.
* MLN Connects Provider eNews
Announcements--EHR Incentive Programs: 2015 Program Year Attestation Begins January 4; PQRS: Submission Time Frames for 2015 Data; PQRS: Self-Nomination for 2016 Qualified Registries and QCDRs Open through January 31; January Quarterly Provider Update Available
Claims, Pricers, and Codes--Holding of 2016 Date-Of-Service Claims for Services Paid Under the 2016 MPFS
* Flow Cytometry LCD-R3
* Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment-2016 Annual Update CR9465
* Intensity Modulated Radiation Therapy (IMRT) LCD-R3
* Self-Administered Drug Exclusions List-R5
* 2016 CPT/HCPCS LCDs and Articles Revision-Effective January 1, 2016
* Prolonged Service in the Office or Other Outpatient Setting, 99354-Widespread Service Specific Probe Review Notification
* NCD for Screening for Colorectal Cancer Using Cologuard-A Multitarget Stool DNA Test-Revised CR9115
* Ask the Contractor Teleconference (January 20)
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- Although federal law requires that Medi-Cal (Medicaid) payment rates be sufficient to enlist enough providers so that patients have meaningful access to care, there hasn't been a process for states to demonstrate that they are meeting these requirements. Since 2011, CMS has been working on federal guidelines for states to demonstrate that they are in compliance with the federal access requirements. The result of this work is the recently published final rule, Medicaid Program; Methods for Assuring Access to Covered Medicaid Services,80 FR 67575 - A Rule by the Centers for Medicare & Medicaid Services published on 11/02/2015, which is currently open for public comment. This final rule with comment period provides for a transparent data-driven process for states to document whether Medicaid payments are sufficient to enlist providers to assure beneficiary access to covered care and services consistent with section 1902(a)(30)(A) of the Social Security Act (the Act) and to address issues raised by that process. The rule requires, among other things, that states perform an independent assessment of access before implementing a rate reduction. Over the years, when the state of California faced budget cuts, one of the first programs impacted was California's Medi-Cal program. The decrease in funding for the Medi-Cal program was a clear indication that rates are often subject to fluctuation and instability based on the ever-changing political and budgetary climate. Click here to read CMA's comments.
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- MOASC's first 2016 LunchTime Series presentation is scheduled for Wednesday, January 27th, 12:00pm Pacific Time. Elaine L. Towle, CMPE, Director, Analysis & Consulting Services, Clinical Affairs Department, American Society of Clinical Oncology, will present the changes in Medicare for 2016 and how to survive them. Please RSVP via phone 909-985-9061 ext. 1 or via email moasc@moasc.org.
- SAVE THE DATE! MOASC and University of California Irvine are proud to present the first "Spotlight on ASH." Speakers, who attended ASH in Orlando this week, will bring the premier topics and discussions to clinicians, Thursday, January 28, 2016, 5:30pm - 9pm, at the Fairmont Newport Beach. Please RSVP via phone 909-985-9061 ext. 1 or via email moasc@moasc.org.
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- ANCO's Medicare Reimbursement for Oncology 2016 and Beyond webcast with Roberta Buell, M.B.A.,
onPoint Oncology, is available as a recording at http://cc.readytalk.com/play?id=dx50jb; or download
- ANCO's SABCS Highlights 2015 will take place on January 13, 2016 at The Claremont Resort in Oakland. Faculty from Stanford (Carol Marquez, MD), UC Davis (Helen K. Chew, MD), and UC San Francisco (Michael Alvarado, MD) will present and review the clinically most relevant results presented at December 2015's San Antonio Breast Cancer Symposium.
- 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. Early registration rates end January 31. For more information, visit http://cme.stanford.edu/multicancers.
- ANCO members elected Dimitrios Colevas, M.D. (Stanford), David Gandara, M.D. (Sacramento), Raymond Liu, M.D. (San Francisco), and Daniel Mirda, M.D. (Napa) to the Board of Directors for terms ending in 2018.
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- The Commission on Cancer (CoC) has issued Cancer Program Standards: Ensuring Patient-Centered Care (2016 Edition); these requirements are effective January 1, 2016 (with the exception of the 2017 phase-in standards) and determine compliance with CoC standards. CoC's 2016 standards are at https://www.facs.org/quality-programs/cancer/coc/standards. - USP Compounding Committee has announced its intention to publish the Proposed Handling Hazardous Drugs. The official implementation will not be until July 1, 2018. You can read about it on USP.org at: - January 15 is deadline to enroll in a health insurance plan, to start February 1. 8 out of 10 people who enrolled through HealthCare.govqualified for financial help, most people received an average of $294 per month in financial help. |
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New chronic conditions - chronic viral hepatitis (B & C), HIV/AIDS;
New Interactive Atlas of Chronic Conditions - a GIS tool to examine geographic variability in chronic conditions;
Updated geographic data for the years 2007-2014 summarized to national, state, county, and hospital referral regions levels;
Updated interactive dashboards with 2014 data.
These public data resources provide researchers and policymakers a better understanding of the burden of chronic conditions among beneficiaries and the implications for our health care system. Information on prevalence, utilization, and Medicare spending for specific chronic conditions and multiple chronic conditions demonstrates the overall burden and complexity of chronic conditions among Medicare beneficiaries and can be used to inform policymakers, local health leaders, providers, and health systems about resource utilization of patients with chronic diseases. This information can be used to improve care coordination and health outcomes for Medicare beneficiaries living with chronic conditions.
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Affiliate Association News
- Capitol Hill Day 2016 will serve as the kick-off for the Association of Community Cancer Centers (ACCC) 42nd Annual Meeting, CANCERSCAPE, March 2-4, 2016, in Washington D.C., where the policy conversation will continue. Capitol Hill Day 2015 mobilized ACCC members from 23 states to advocate for a permanent fix to the sustainable growth rate (SGR), oral chemotherapy parity legislation, and elimination of the prompt pay discount. More than 80 congressional meetings helped to pass legislation and positively influence the future of community oncology. Capitol Hill Day 2016 is Wednesday, March 2.
- Registration is open for the Community Oncology Alliance's (COA) 2016 Community Oncology Conference. The most comprehensive community oncology conference is back, bringing together clinicians, practice administrators, payers, and industry leaders for two days of learning and networking. April 14-15, 2016 | The Lowes Royal Pacific Resort, Orlando.
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Industry News
- Lilly PatientOne strives to offer reliable and individualized treatment support for eligible patients prescribed a Lilly Oncology product whether they are insured, underinsured, or simply uninsured. For those who qualify, we can help in the following ways: Connect patients with our Patient Assistance Program to determine eligibility and funding options Evaluate financial assistance options including co-pay programs and co-pay assistance foundations Provide reimbursement assistance (benefits investigation, prior authorization, evaluation of other funding options) Assist with denied claim appeals Call 1-866-4PatOne (1-866-472-8663) Monday-Friday, 6AM-4PM Pacific Time or visit www.lillypatientone.com.
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MOASC CALENDAR
Spotlight on ASH
January 28th
LunchTime Series Teleconference/Webinar
April 27th June 29th August 31st October 26th Oncology Roundtable Teleconference March 2nd May 25th July 27th September 28th November 30th
ASH Highlights in
San Diego, CA
January 29th - 30th
NCCN in Florida
April 1st - 2nd
ASCO National Meeting
in Chicago, II
June 3rd - June 6th ASCO State Affiliate
Meeting in Virginia, VAOctober 26th - 28th MOASC Billers Program November 30th
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(January 13; Oakland)
(January 15-16; San Francisco)
(January 21-23; San Francisco)
(March 18-20; Napa)
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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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