California Oncology Weekly Newsletter 10.25.2016

California’s Office of the Patient Advocate released its annual report cards on health plans and medical groups. These tools are meant to help guide consumers and employers as they shop for coverage during the upcoming open enrollment season. For more information click here.

CMA has published A Physician’s Guide to AB72: Questions and Answers to help clarify the new law and to address physician concerns and questions. AB72 changes the reimbursement of non-participating physicians providing non-emergency care at in-network hospitals, ambulatory surgery centers, and laboratories. For more information click here.

Part B providers can now use the Noridian/JEMAC Medicare Portal to conduct self-service clerical corrections to previously processed Part B claims to add/change a modifier or to add/change a diagnosis code. For more information click here.

In an effort to answer questions members may have regarding compliance with new Federal nondiscrimination notice posting requirements, the California Medical Association (CMA) has created an FAQ resource to help guide member. For more information click here.

The Centers for Medicare & Medicaid Services (CMS) invites you to join a webinar on October 26 at 11:00am-12:00pm Pacific Time, the webinar will provide an overview of the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Model (APM) incentive payment provisions under MACRA, collectively referred to as the Quality Payment Program. For more information click here.

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October 25, 2016

 

Physicians’ Advocacy Group Asks Court To Block Law On Surprise Medical Bills. The law “gives the insurance companies the power of government,” saying it empowers private insurance companies to set prices for physicians and other caregivers who are not in their network. A political advocacy group for physicians has filed a lawsuit against the new California law designed to protect consumers from unexpected out-of-network medical bills. For more information click here.

Forthcoming Noridian/JEMAC educational events: Getting Paid and Keeping it-In-Person Seminar in Union City (October 25); Evaluation and Management Modifiers (October 26); Ordered, Referred, and Prescribed Services (November 15). For more information click here.

The Department of Health Care Services (DHCS) will accept a second round of applications for Whole Person Care (WPC) pilot projects.  The second round of applications is due on March 1, 2017.  WPC pilots are part of the Medi-Cal 2020 Section 1115 demonstration waiver, approved in December 2015 by the federal Centers for Medicare & Medicaid Services. For more information click here.

There is great concern among the patient advocacy community about CMS’ proposed Part B Drug Payment Model changes that, if implemented, would severely disrupt care for vulnerable beneficiaries with cancer, macular degeneration, rheumatoid arthritis, neurological disorders, primary immunodeficiency diseases, rare diseases, and other serious medical conditions.  This proposed rule changes speaks to a larger issue. For more information click here.

MOASC is pleased to be a co-sponsor of the California Partnership for Access to Treatment, (CPAT) upcoming seminar titled From Molecule to Miracle – The Process of Drug Discovery and Development This seminar is an educational forum and complimentary luncheon which will take place on Wednesday, October 26, 2016 at the Comprehensive Blood & Cancer Center in Bakersfield, California. For more information click here.

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October 18, 2016

CMA’s Practice Resources (October 2016) is now available online, features articles entitled Blue Shield to update fee schedule effective December 1; Physicians encouraged to verify CHPI data by November 11; Physicians must post nondiscrimination statements by October 26; Know Your Rights: Managed care contractual problems; and, The Coding Corner: How to apply CPT modifier 79. For more information click here.

As California continues enrolling people under the Affordable Care Act and shifting the majority to Medi-Cal managed plans, the growing share of doctors refusing to accept low-income patients due to inadequate reimbursement rates from the state has thousands wondering where they can go for care. The state budget for low-income health programs has been running low since the 2007-09 recession. Gov. Jerry Brown has not restored the 10 percent cut made to Medi-Cal reimbursement in 2011, despite pushes from patient advocacy groups and organized medicine in California. For more information click here.

The American Medical Association (AMA) and ReachMD have produced a series of podcasts to provide physicians with an inside look at what’s to come and what they can do now to prepare for the transition to MACRA. For more information click here.

DHHS has finalized a rule that expands and clarifies what clinical-trial data legally needs to be made public. Entities that perform clinical trials will face new rules designed to make sure that valuable information from patients is widely available, not only to the patients themselves but to scientists trying to advance medical science. For more information click here.

2015 Supplemental QRUR Physician Feedback Program, “How to Interpret Your 2015 Supplemental Quality and Resource Use Report (SQRUR),”is scheduled for Thursday, October 20, 2016, 10:30 AM – 12:00 PM Pacific Time.  This MLN Connects® National Provider Call provides an overview of the 2015 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.

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October 11, 2016

California has the third largest number of community oncology practice closures (40) after New York with 41 and Michigan with 43 closures. The Community Oncology Alliance (COA) sixth Community Oncology Practice Impact Report , released today, covers activity for a nine-year period, from January 2008 through September 2016. It notes that the monthly rate of community oncology practice closures has increased 87% since the previous practice impact report.  Compiled from public and private data sources, the 2016 Practice Impact Report provides a unique look at community oncology trends at both the national and state level. For more information click here.

Forthcoming Noridian/JEMAC educational events; Getting Paid and Keeping it-In-Person Seminar in Union City (October 25); Evaluation and Management Modifiers (October 26); Ordered, Referred, and Prescribed Services (November 15). For more information click here.

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 released an updated palliative care policy document and data analysis on September 1, 2016, in response to stakeholder feedback on the draft policy paper released in 2015.  DHCS also held a stakeholder webinar on September 8 to discuss the policy. For more information click here.

The Community Oncology Alliance (COA) today released the 2016 Community Oncology Practice Impact Report which tracks the changing landscape of cancer care in the United States.  It documents a 121% increase in community cancer clinic closings and a 172% increase in consolidation into hospitals since 2008. In that period, 380 cancer treatment facilities have closed and 609 community cancer practices have been acquired by or become affiliated with hospitals. Another 390 practices report that they are struggling to stay open due to financial stresses. For more information click here.

2015 Physician Quality Reporting System (PQRS) Feedback Reports and 2015 Annual Quality and Resource Use Reports (QRURs) are available now. The reports were released on September 26, 2016. The PQRS Feedback Reports show your program year 2015 PQRS reporting results, including payment adjustment assessment for calendar year 2017. The 2015 Annual QRURs show how physician groups and physician solo practitioners performed in 2015 on the quality and cost measures used to calculate the 2017 Value Modifier as well as their 2017 Value Modifier payment adjustment. For more information click here.

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October 4, 2016