California Oncology Weekly Newsletter 10.27.15

As a reminder, CAPP (Californians Allied for Patient Protection defenders of MICRA) is hosting a reception in honor of Assembly Member Freddie Rodriguez on Wednesday, November 4 from 4:30 p.m. – 6:00 p.m. The event is being held at the offices of NAMM California/PrimeCare Medical Network located at 3990 Concours, Suite 500, Ontario, CA 91764. For more information click here.

Noridian/JEMAC has posted the following updates to its website.
* MLN Connects Provider eNews
ICD-10–Learn How to Assign an ICD-10-CM Diagnosis Code with MLN Connects Videos; 5 Ways to Check Your Claim Status; Contact List for ICD-10 Questions
Announcements–MACRA Request for Information: Comments Accepted through November 17
* ICD-10 News: Checking Your Medicare FFS Claim Status
* CCI and MUE Workshop (November 20). For more information click here.

According to Modern Healthcare, all hospitals — except for public safety-net facilities — are required under federal law to obtain pre-authorization from Medi-Cal before admitting fee-for-service beneficiaries. The majority of Medi-Cal beneficiaries have been moved to managed care in recent years, but up to three million individuals still are in fee-for-service coverage, including beneficiaries who are: Dually eligible for Medicare and Medi-Cal; Enrolled in home- and community-based programs; andResidents in long-term care facilities. For more information click here.

Democrat lawmakers say they are struggling to get Republican lawmakers on board to prevent a 52% spike in Medicare Part B premiums. Senate Democrats, led by Sen. Ron Wyden of Oregon, have introduced legislation that would freeze Medicare’s Part B premium and deductible for 2016, but its prospects are uncertain. For more information click here.

CMS has opened a preview period for the 2014 quality measures that will be reported on the Physician Compare website later this year. Physicians can access the preview site now through November 6 via the PQRS portal-Provider Quality Information Portal. For more information click here.

To view the complete California Oncology Weekly Newsletter, click on the date below.

10-27-2015

Governor Brown has signed AB374 into law. AB374 permits prescribing physicians to request a step therapy override determination from a health plan or insurer on behalf of a patient if doing so in the best interest of the patient. For more information click here.

Noridian/JEMAC has posted the following updates to its website
* MLN Connects Provider eNews
ICD-10–Use ICD-10 Now; ICD-10 Ombudsman and ICD-10 Coordination Center Support Your Transition; Qualifiers for ICD-10 Diagnosis Codes on Electronic Claims
* Self-Administered Drug Exclusions List-R3
* Use ICD-10 Now–Here is How
* Outpatient Therapy Services (October 20)
* ICD-10 (October 22)
* The ABCs of the CERT Program (October 28). For more information click here.

DHCS/Medi-Cal now accepts the CPT code 81519 for Oncotype DX. While Medicare and most commercial plans implemented the code in January 2015, DHCS/MediCal has just updated their system. Effective October 1, DHCS/MediCal will no longer accept its code S3854 for Oncotype DX. In addition, Medi-Cal has expanded coverage to include both node negative and node positive (1-3 involved nodes) disease. For more information click here.

This Friday, the House of Representatives is expected to vote on a reconciliation package that would roll back parts of the Affordable Care Act. Some conservative lawmakers say the bill doesn’t go far enough because it wouldn’t repeal Medicaid expansion or subsidies for state-based exchanges. For more information click here.

CMS has a created a new webpage onto EHR Incentive Programs website that contains all the program requirements and resources for previous years of the EHR Incentive Program. For more information click here.

To view the complete California Oncology Weekly Newsletter, click on the link below.

October 20, 2015

Dear MOASC Members:

Genomic Health announces that Medi-Cal has updated their system and a new CPT code has been implemented for the Oncotype DX Breast Cancer Assay effective October 1, 2015.  The new code is 81519 , is exclusive to Oncotype DX,  and is the only gene expression profiling test covered by Medi-Cal – other tests are not benefits of the Medi –Cal program.  Medi- Cal has expanded coverage to include both node negative and node positive (1-3 involved nodes) disease.

Congress passed legislation to avert the government shutdown and keep the government running until December 11, 2015.   Health Care Issues in the Presidential Campaign. On October 7, the LA Times ran an excellent article by Noam Levy framing the health care issues in the 2016 Presidential Election. For more information click here.

Following, please find links to the various MolDX policies to be discussed at the Noridian CAC meeting, next week, October 21st. Please take a look at them. Is this acceptable to oncology? Oncology has an opportunity to comment and make change, if necessary. Please send you comments to the MOASC Office [email protected] by THIS FRIDAY, October 16th, so we can get our comments to Noridian prior to the meeting.  Thank you for your attention to this request. For more information click here.

The next DHCS Stakeholder Advisory Committee (SAC) meeting will be held on Wednesday, October 14, 2015, from 9:30 a.m. to 3:30 p.m. at the Sacramento Convention Center. There is also a listen-only conference line to hear the meeting:  888-968-3517, passcode 8245294. The agenda for the October 14, 2015, SAC meeting and the summary of the July 22, 2015, meeting can be found at the link below.  Additional materials will be available on the DHCS website by October 9. All meeting materials can be found on the SAC website. For more information click here.

Before departing for a week long recess, on October 9th the House Budget Committee marked up a reconciliation package that repeals five key portions of the Affordable Care Act. The package, which repeals the individual and employer mandates, several Affordable Care Act taxes that are unpopular with industry groups, and the Independent Payment Advisory Board, is expected to receive a floor vote in the House this month. For more information click here.

On Thursday, October 15; 10:30-12pm Pacific Time, MLN Connects National Provider Call will provide an overview of the 2014 Supplemental Quality and Resource Use Reports (QRURs); confidential feedback reports for medical group practices and solo practices on resource utilization for Fee-For-Service episodes of care. For more information click here.

To view the full California Oncology Weekly Newsletter, simply click on the link below.

October 13, 2015

For more than 15 years MOASC & ANCO worked tirelessly to keep the onerous legislation at bay, fraught with liability to the physician with no protection, California Gov. Jerry Brown (D) signed ABX2-15 Assemblymember Susan Talamantes Eggman (D-Stockton) End of Life. This bill allows terminally ill patients to be prescribed life-ending drugs.  For more information click here.

Join Noridian at the upcoming Ask the Contractor Teleconference (ACT), Thursday, October 15, 2015, 1:00-2:00 p.m. Pacific Time. Call 866-243-8959. Noridian representatives from various departments including Appeals, Claims Processing, Electronic Data Interchange Support Services (EDISS), Medical Review (MR), Provider Contact Center (PCC), Provider Enrollment, Provider Outreach and Education (POE), and System Support will be available to address your questions. For more information click here.

There has been erroneous information regarding Medi-Cal’s ICD-10 preparedness and the states that are using a crosswalk solution. DHCS has made it clear that California is ready and is fully compliant with the CMS ICD-10 mandate. Medi-Cal will be accepting ICD-10 codes, adjudicating them, and returning 835’s to the submitters. Therefore, you must submit ICD-10 codes on claims with dates of services on or after October 1, 2015. For more information click here.

The Community Oncology Alliance (COA) President, Bruce Gould, M. D. testified, last Thursday, on Capitol Hill.  Asking for COA’s attendance, the Energy & Commerce Committee held a legislative hearing on 3 Medicare bills, with one being the CMR/Israel bill (HR 1934) addressing oncology payment reform.  This hearing signifies that the bill is moving.  Dr. Gould answered questions on the bill and related areas in a thorough, professional manner.  For more information click here.

The Centers for Medicare and Medicaid Services (CMS) has opened the 30-day preview period for the 2014 quality measures that will be reported on Physician Compare later this year. You can access the secured measures preview site now through the PQRS portal-Provider Quality Information Portal (PQIP). For more information click here.

To view the complete California Oncology Weekly Newsletter, simply clink on the link below.

October 6, 2015