California Oncology Weekly Newsletter 4.26.2016

On July 1, 2016, a new California law will take effect that requires plans to ensure that physician directories are accurate and up-to-date. Payor are required to contact providers in writing, electronically, and by telephone to verify directory entries. CMA will host a webinar on April 27 on the new law. For more information click here.

Providers are now able to quickly access important Medicare coverage guidelines by visiting the Policies section of Noridian’s website and choosing Local Coverage Determination/Active LCDs. As of March 23, 2016, the LCDs are published in Portable Document Format (PDF) as a single policy for all states in our Jurisdiction. For more information click here.

Providers who see 30% or more Medi-Cal patients may be eligible for incentive payments that can range up to $63,750 over six years. The California Department of Health Care Services, Medi-Cal Electronic Health Record (EHR) Incentive Program’s mission is to encourage the adoption, implementation, and meaningful use of EHR technology certified by the Federal Government. For more information click here.

In April 2015, Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA), which represents the most sweeping set of changes to Medicare’s physician payment methodology since the current system was put in place 25 years ago. Although many of the changes outlined in MACRA will not take effect until 2019. For more information click here.

TODAY, Tuesday, April 26, 2016, from 2:00 pm until 3:00 pm Pacific Time, CMS Region IX Division of Financial Management & Fee For Service Operations will be hosting a conference call for Region IX.  The purpose of the call will be to provide an update on CMS’ initiatives. For more information click here.

 

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April 26, 2016

 

 

Most Doctors Unsure How to Discuss End-of-Life Care, Survey Says. They recognize the responsibility, but some may need training. California’s End of Life Option Act becomes law on June 9. For more information click here.

MOASC is proud to be a coalition member sponsoring “The California Children’s Education and Health Care Protection Act of 2016” (CEHCP). This initiative, which will be on California’s November 2016 ballot, will provide much needed funds for education and, expand access to health care.  For more information click here.

Noridian/JEMAC has posted the following updates to its website: * MLN Connects Provider eNews: Announcements; Claims, Pricers and Codes; Events; Publications and Videos * MolDX: Genetic Testing for Lynch Syndrome Final LCD-Effective June 1, 2016;* Part B Ask the Contractor Teleconference (April 20); * DME Documentation (April 27); * In-Person Seminars (San Diego, May 2); * In-Person Seminars (Glendale, May 5); *In-Person Seminars (Sacramento, May 7); * Open Public Meeting (June 2). For more information click here.

If UnitedHealth Group pulls out of the Affordable Care Act exchanges; it could have a significant impact on health care marketplace competition in some states and counties, according to a new study by the Kaiser Family Foundation. While a withdrawal from all marketplaces could have significant consequences in local areas, it would only cause a slight rise in the national premium average, the study said. For more information click here.

Grassroots Advocacy is the Key to Stopping CMS’s Part B Drug Reimbursement Experiment

The proposed Medicare Part B Payment Model would allow government to interfere in decisions that should be left between patients and doctors. Congress must prevent this misguided change, which would increase barriers to care and limit doctor’s ability to employ the most effective treatments. This is ultimately a battle between The White House and Congress, therefore tell your members of Congress to stop The White House, before your ability to practice medical oncology is decided for you. For more information click here.

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April 19, 2016.

California Medical Association’s Practice Resources (CPR) for April 2016 is now available online,  features articles entitled: Health plan group pilots program to improve physician directories; UnitedHealthcare to post patient satisfaction ratings in provider directory; Last chance to appeal payments under ACA primary care physician rate increase. For more information click here.

Noridian/JEMAC has posted the following updates to its website: Changes to Laboratory NCD Edit Software-July 2016 CR9584; CCI Edits, Version 22.2, Effective July 1, 2016-Quarterly Update CR9516;Modifier 59 Workshop (April 14); Part B Ask the Contractor Teleconference (April 20); DME Documentation (April 27); In-Person Seminars (San Diego, May 2); In-Person Seminars (Glendale, May 5); In-Person Seminars (Sacramento, May 7); Open Public Meeting (June 2).  For more information click  here.

“There are very few tools in our toolbox” to control pharmaceutical spending, said Diana Dooley, secretary of California’s Health and Human Services Department. Despite recent cost-cutting measures, such as putting tighter controls on which patients get coverage for which drugs and when, California’s spending on pharmaceuticals has gone up, and so has the number of pricey drugs it is covering. It’s not clear state agencies have the means to balance drug cost pressures in a way that serves the best interests of patients, taxpayers and public health. For more information click  here

Grassroots advocacy will be the key to stopping CMS from implementing their plans in 2016!

Part I: Drug Reimbursement: CMS has proposed a Part B drug reimbursement experiment. Under the CMS proposed experiment, half of all oncology practices will be placed in a control group and continue to receive ASP+6% (less the Federal sequester) as drug reimbursement for physician-administered drugs. For more information click here

PART II: MACRA will change the way oncologists are paid for the care they provide to people with cancer. Attend the MOASC General Membership Meeting on Saturday, April 30th to learn more about MACRA’s impact on your ability to practice medicine, no matter in what setting you practice. For more information click here

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April 12, 2016.

California’s End of Life Options Act becomes law on June 9. State lawmakers adjourned the special session that passed the Act on March 9 starting the 90-day countdown to making physician-assisted suicide legal. The California Medical Association has released guidelines for physicians regarding the Act. For more information click here.

Noridian/JEMAC has posted the following updates to its website * MLN Connects Provider eNews; Announcements–* Advance Care Planning: New FAQs,  Claims, Pricers, and Codes; Events–* 2016 PQRS Reporting: Avoiding 2018 Negative Payment Adjustments, Call-Registration Now Open; Publications & Videos— *Basics of Medicare Series of Web-Based Training Courses-New, * Clinical Laboratory Fee Schedule Fact Sheet-Revised. For more information click here.

April 1 is the effective date of the final rule for covered outpatient drugs, with a compliance date of April 1, 2017.  On January 21, CMS issued a final rule for covered outpatient drugs that addresses key areas of Medicaid drug reimbursement and changes made to the Medicaid Drug Rebate Program by the ACA.  For more information click here.

A new Milliman study shows that over the last decade the total costs of treating patients with cancer in the United States have risen no faster than overall costs for Medicare and commercially insured populations. Contrary to a commonly held misbelief that cancer care costs have rapidly outpaced other health care spending trends, the study actually found that total costs of treating patients with cancer have increased at essentially the same rate as all health care spending since 2004. For more information click here.

URGENT GRASSROOTS ADVOCACY ACTION REQUIRED! CMS has proposed a Part B drug reimbursement experiment. Under the CMS proposed experiment, half of all oncology practices will be placed in a control group and continue to receive ASP+6% (less the Federal sequester) as drug reimbursement for physician-administered drugs. The other half of the oncology practices will be placed in an experimental group and received ASP+2.5%+$16.80/drug/patient/day (less the Federal sequester; effectively, ASP+.86%+$16.53/drug/patient/day) as reimbursement for physician-administered drugs. For more information click here.

 

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April 4, 2016.