California Oncology Weekly Newsletter 8.30.2016

A battle in California could influence bills pending in states across the country, including Pennsylvania, New Jersey, Georgia, Hawaii and Missouri.  A measure to protect California consumers from surprise medical bills — among the longest-debated issues to be considered by state lawmakers — moved closer than it’s ever been to becoming law when the Senate approved it yesterday with a 35-1 vote.For more information click here.

A California judge has rejected a request by physicians to immediately suspend the new state law allowing terminally ill people to end their lives. Judge Daniel A. Ottolia of Riverside County Superior Court ruled on Friday that the law would remain in effect for now. But he agreed to allow the physicians to pursue their lawsuit claiming that the law lacks safeguards against abuse.  For more information click here.

Noridian/JEMAC has posted the following updates to its website. MLN Connects Provider eNews
Announcements–ICD-10: Updated Questions and Answers; Claims, Pricers, and Codes; Events–SNF Quality Reporting Program Webcast-September 14; Publications–Medicare and Medicaid Basics Booklet-New; PQRS Call: Audio Recording and Transcript. For more information click here.

The Department of Managed Health Care has updated its website to reflect a new posting under “Open Pending Regulations.”  Pursuant to Government Code section 11346.4, the DMHC is giving notice of a proposed regulation, Prescription Drug Prior Authorization or Step Therapy Exception Request Form Process, amending section 1300.67.241 of Title 28 of the California Code of Regulations. For more information click here.

The MOASC Office is in receipt of questions regarding the Anthem/WellPoint Pathways Program.  Below is a brief survey regarding participation. Please reply to [email protected] with your answers by close of business on Friday, September 2nd. For more information click here.

The Food and Drug Administration (FDA) has announced efforts to help mitigate the shortage of Bleomycin. The agency will be coordinating with Anneal Bioscience to import its Bleomycin which contains the same active ingredients as the FDA-approved Bleomycin. For more information click here.

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August 30, 2016

THANK YOU to all MOASC & ANCO Members for your response to our “Call To Action!” After being approved by a key committee last week, SB1010 was pulled by its author on Wednesday. The bill would have required drug companies to justify treatment costs and price hikes. California state Sen. Ed Hernandez (D-West Covina) said that he introduced the bill “with the intention of shedding light on the reasons precipitating skyrocketing drug prices.” But amendments by an Assembly committee last week make it difficult to accomplish this goal, he said in a statement. For more information click here.

Friday, August 19, 2016 was the final day for bills to be amended, and MOASC, with a coalition of other specialty groups in California, has signed onto a letter remaining OPPOSED to AB 72 as Amended August 19, 2016. AB 72 attempts to “protect” patients from “surprise billing.” For more information click here.

Noridian/JEMAC will soon be deactivating billing privileges for physicians who received re-validation notices from Noridian but have not submitted completed applications to CMS. Noridian/JEMAC reports that only 19% of physicians have responded to the most recent re-validation process. For more information click here.

Last fall, the Centers for Medicare & Medicaid Services (CMS) issued a final rule related to access for covered services in FFS Medicaid programs. Under the final rule, states are required to design and develop an access monitoring plan, and establish procedures to monitor beneficiary access when proposing to reduce or restructure Medicaid FFS payments. For more information click here.

CMS recently provided additional clarification to MACs and providers regarding reimbursement for prolonged drug and biological infusions that are started in the office and that are associated with care that is billed incident to a physician service using an external pump. For more information click here.

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August 23, 2016

 

Your ACTION is needed NOW! SB1010 is heading to the Assembly Floor for a vote in the next week or two. As we have been placing in this publication throughout this legislative season, Senate Bill 1010, by Senator Ed Hernandez, could threaten your ability to prescribe to your patients the desired treatments needed to help them. For more information click here.

The California Medical Association (CMA) has published a MACRA preparation checklist. For more information click here.

Noridian/JEMAC will soon be deactivating billing privileges for physicians who received revalidation notices from Noridian but have not submitted completed applications to CMS. To prevent deactivation, CMA recommends that practices look up their revalidation dates through the CMS look-up tool. For more information click here.

DHCS is surveying physicians for feedback on the effectiveness on Medi-Cal’s fee-for-service provider relations activities, including the telephone service center; cash control unit, regional reps, publications and provider seminars/trainings. DHCS has not asked for this level of feedback in quite some time and it’s critical that physicians that participate in the Medi-Cal fee-for-service program and their staff take the time to participate. For more information click here.

The next CMS Physicians, Nurses & Allied Health Professionals Open Door Forum scheduled for tomorrow, Wednesday August 17, 2016 at 11:00 PM Pacific Time (PT); Please dial-in at least 15 minutes before call start time. Conference Leaders: Marge Watchorn (Center for Medicare) & Dr. William Rogers (Director, PRIT, Office of Communications). Some of the topics to be addressed are: Medicare Care Choices Model, Preparing for EIDM. For more information click here.

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August 16, 2016

CMA’s Practice Resources (August 2016) is now available online, features articles entitled: HealthNet Federal Services awarded Tricare contract beginning in late 2017; Blue Shield implements system fix to correctly pay HPV9 claims; Covered California announces plan offerings for 2017; Anthem Blue Cross announces changes to reimbursement policies and claims software; Last chance for some providers to prevent deactivation by Medicare; UHC to require prior authorization for select outpatient surgical procedures; CMA publishes MACRA resource center and preparation checklist; CMS releases proposed 2017 Medicare physician fee schedule; DOJ files lawsuit to block two health insurance mega-mergers; New online Medi-Cal provider enrollment portal launch planned for October 2016; The Coding Corner: The essential facts about CPT modifier 33. For more information click here.

Noridian/JEMAC has posted the following updates to its website. MLN Connects Provider eNews; Announcements–Physician Fee Schedule: Proposed CY2017 Changes; Hospital and ASCO: at Claims, Pricers, and Codes–July 2016 OPPS Pricer File Update; Events–PQRS Feedback Reports and Informal Review Process for Program Year 2015 Results Call-August 10; SNF Quality Reporting Program Provider Training-August 24; Publications–Medicare Billing Certificate Programs for Part A and Part B Providers WBT-Revised; Complying with Medicare Signature Requirements Fact Sheet-Revised. For more information click here.

The California Department of Health Care Services (DHCS) Affordable Care Act (ACA) Ordering Referring and Prescribing (ORP) provider transition management project is inviting interested healthcare providers to participate as a Stakeholder Council member. The project is directed to help all providers, who order, refer, or prescribe Medi-Cal related services and providers who bill Medi-Cal, become compliant with the requirements mandated by the Affordable Care Act. The introductory-kickoff meeting will be on 8/22/2016 at 2:00 PM Pacific time. For more information click here.

S3211, the Cancer Care Payment Reform Act of 2016, has been introduced in the Senate and would establish a national Oncology Medical Home demonstration project for payment reform under the Medicare program. The purpose of the bill is to change the way Medicare pays for cancer treatment in order to provide well-coordinated, high-quality care that results in lower overall costs to cancer patients and the health care system. For more information click here.

In late 2016, a sub-set of the individual and group practice-level 2015 Physician Quality Reporting System (PQRS) measures and Consumer Assessment of Healthcare Providers and Systems (CAHPS) for PQRS measures will be publicly reported on Physician Compare. All measures available for public reporting are decided via rulemaking. For more information click here.

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August 9, 2016

The campaign against Proposition 61, a ballot measure that would limit how much pharmaceutical companies can charge state agencies for prescription drugs, had nearly $66 million on hand in June. For more information click here.

Noridian/JEMAC has posted the following updates to its website. MLN Connects Provider eNews; Announcements–Physician Fee Schedule: Proposed CY2017 Changes; Hospital and ASCO: at Claims, Pricers, and Codes–July 2016 OPPS Pricer File Update; Events–PQRS Feedback Reports and Informal Review Process for Program Year 2015 Results Call-August 10; SNF Quality Reporting Program Provider Training-August 24; Publications–Medicare Billing Certificate Programs for Part A and Part B Providers WBT-Revised; Complying with Medicare Signature Requirements Fact Sheet-Revised. For more information click here.

Beta testing of the Provider Application & Validation for Enrollment (PAVE) secure web-based provider portal is expected to begin in late August.  PAVE will transform provider enrollment activities from a manual process to a web-based portal that providers can use to complete and submit their application and verification, and report changes. For more information click here.

The National Quality Forum “Cancer Project 2015-2017” has opened the public and member public comment period through August 8, 2016 (3 pm PST), on their draft report on 18 cancer care measures that were evaluated by the Cancer Project steering committee on May 18-19, 2016 in Washington, D.C. For more information click here.

CMS released the proposed CY2017 Medicare Physician Fee Schedule (MPFS). It estimates that in CY2017 reimbursement for the hematology/oncology specialty is set to increase by 2%, though the impact on individual practices will depend on the mix of services provided. For more information click here.

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August 3, 2016