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 .
November 19, 2019
This Weekly's Hot Topics  
  • Generic drugmakers file lawsuit challenging law barring brand-drug manufacturers from paying to delay releasing generic drugs California News
  • Proposed anti-kickback statute and Stark law regulations National News
  • Rules increase price transparency for both hospitals and insurers. CMS News

California News

A trade group for generic drugmakers has filed a lawsuit challenging California's recently-enacted law that bars manufacturers of brand name drugs from paying other companies to delay releasing generic drugs to resolve patent litigation. The Association for Accessible Medicines (AAM) in a lawsuit filed in federal court in Sacramento, California, on Tuesday argued that the nation's first-of-its-kind law to combat so-called "pay-for-delay" settlements is unconstitutional.
Sutter Health will pay more than $30 million to the federal government and a whistleblower to settle a lawsuit alleging the health system paid physicians to refer patients to their hospitals. The suit, filed by a whistleblower in 2014, was under seal until Thursday. The settled claims allege that between 2012 and 2014, Sutter issued nearly $2 million in illegal payments annually to the Sacramento Cardiovascular Surgeons Medical Group in exchange for physicians sending patients to Sutter for further procedures, rather than to other hospitals.
The California Medical Association (CMA) has prepared an updated guide for patients impacted by wildfires. As part of a new law enacted in 2018, health plans and insurers are required to act quickly to ensure patients in areas affected by wildfires and other disasters have continued access to care. CMA has published a guide to help patients navigate these services
 at .

California Pharmacists Association will be visiting cities statewide over the next few months hosting Town Halls to engage pharmacists on CPhA's strategic planning, execution, and advocacy on Pharmacy Benefit Manager (PBM) issues. For more details on certain locations, contact Nick Chiappe, Coalition Manager, at   or by phone at 916-978-3791. Heavy hors d'oeuvres and 1 CE credit will be available.
Southern California:
Monday, November 25 -  San Fernando Valley
Monday, December 2 -  Pomona Thursday, December 5 -  Orange County
Northern California:
Monday, December 9 -  Palo Alto

Noridian News 

Noridian/JEMAC has the following updates on their website 
MIPS: Virtual Group Election Period Open Through December 31
International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs)-April 2020 Update; October 2019 Update of the Hospital Outpatient Prospective Payment System (OPPS)-Revised; Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes-October 2019 Update-Revised
* HICN Claims Reject
* Open Enrollment Participation Program for 2020
* New Medicare Card: If an MBI Changes
* Drug Units in Excess of MUE: Comparative Billing Report in November
* Emergency Preparedness Resources
* Recognizing Lung Cancer Awareness Month and the Great American Smokeout
* Skilled Nursing Facility 3-Day Rule Billing
* MACRA Patient Relationship Categories and Codes: Reporting HCPCS Level II Modifiers
* Billing MSP via CMS-1500 Paper Form
* MPFSDB Update to Status Indicators CR11453
* Pre-Beneficiary Threshold Amounts-2020 Annual Update CR11532
* Therapy Cod eList-2020 Annual Update CR11501
* Medicare Telehealth Services Video
* 2020 Medicare Physician Fee Schedule Now Available
Forthcoming Noridian JEMAC meetings/webinars/workshops
* Noridian Medicare Portal Registration for Part A, B, and DME Users Webinar (November 19)
* 2020 Quality Payment Program: Final Rule Webinar (November 19)
* Using the Medicare Beneficiary Identifier (MBI) Webinar (December 3)
* New Provider Enrollment Rebuttal Process Webinar (December 4)
* Drug Units in Excess of MUE: Comparative Billing Report Webinar (December 4)
* Using the Medicare Beneficiary Identifier (MBI) Webinar (December 19)
For more information and to register visit:

MOASC News  

Thank you for joining us at the MOASC Educational Series Program. Presentations included:
USP 800 and Revisions to USP 797; Getting Ready for Medicare in 2020 and 2021; Billing & Coding Updates 2020; MACRA, MIPS, G-Codes; CMS Regulatory, Coding & Billing Updates and Southern California Benchmarks.
MOASC would like to hear from you, it will take you just one minute to complete the Survey: Administrators and Billers Survey (The deadline to respond is Friday, December 13, 2019).
If you would like copies of the presentations, please email the MOASC office at This program was sponsored, in part, by:Daiichi Sankyo, Inc.; Eisai, Inc.; Jazz Pharmaceuticals; Regeneron Healthcare Solutions and Tesaro. 
MOASC members can register for the 61st ASH Annual Meeting and Exposition in Orlando, December 7-10, 2019, using your ASH username  and password. If someone else is registering for you, please provide them with your credentials to avoid delays. If you have forgotten your credentials, you may reset them on the ASH website using the "Forgot your  Username  or  Password " links.
The MOASC Oncology Summit, Saturday, March 14, 2020 at the Hyatt Regency Huntington Beach. The MOASC Oncology Summit continues to highlight cutting-edge topics presented by world-renowned physicians. You will not want to miss our 2020 program!
- MOASC Member, City of Hope CME presents: Immunotherapy of Cancer: CAR T Cell to Checkpoint Inhibitors March 18, 2020 to March 21, 2020 @ Waldorf Astoria, Las Vegas, Nevada. For more information click here and to register go to:

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- ANCO's 4Q2019 Hematologic Malignancies Updates  took place in San Francisco on November 16. Download the meeting syllabus

- SAVE THE DATE for Best of SABCS Northern California is taking place in Berkeley on January 11. Best of SABCS is cosponsored by ANCO and Encore Medical Education.

- ANCO physician members, their practice staff, and representatives from ANCO's corporate members must register to access password-protected content (e.g., The ANCO Directory, ANCO meeting materials) on the ANCO website ( ) at .

Follow ANCO on Twitter at  @ANCO News .

National News
Proposed anti-kickback statute and Stark law regulations issued on October 9, 2019 signal potentially significant easing of compliance concerns throughout the healthcare community. The highly anticipated proposed regulations would create new anti-kickback safe harbors (for certain "value based" arrangements, and other activities) and ease compliance with existing ones, and would create similar new Stark law exceptions (there is also a new safe harbor under the civil monetary penalties law ("CMP")). Notably, the proposed Stark law regulations would also facilitate compliance with current regulations by adopting provider-friendly interpretations of terms such as "fair market value" and "commercially reasonable" that are used throughout the regulations, and have been a breeding ground of uncertainty. Read article here. 
A top aide to Speaker Nancy Pelosi (D-Calif.) said that he thinks the Trump administration will eventually support a sweeping Democratic bill to lower drug prices, despite recent criticism from the White House.
Achieving workplace efficiency is critical to overcoming barriers in value-based care adoption, but health care organizations must first address some fundamental elements to succeed in this setting, says Michael Cousins, chief analytics officer at Lumeris. Health care organizations must learn how to use technology to analyze value-based contracts with commercial payers so they can determine the quality measures on which they should focus, Cousins says. Healthcare Finance
- Despite laws requiring that health care providers hand over copies of patient records in a timely fashion, many people have trouble getting theirs. Ciitizen, a Palo Alto, Calif., company that helps cancer patients with the task, recently published a scorecard that rates hospitals, doctors and clinics on their compliance with records requests.
Reminder: Marketplace Open Enrollment started November 1 and lasts until December 15. Now is the time to visit to get ready for this year's Open Enrollment and review your 2020 health plan options. Communicate this with your patients to ensure they share their insurance changes with you.
TRICARE Open Season  runs from Nov. 11 through Dec 9, 2019.  Enrollment choices made during this period will take effect on Jan. 1, 2020.  On Jan. 1, some copayments for prescription drugs will increase. If prescriptions go through the TRICARE Pharmacy Home Delivery or at a retail network pharmacy, you will pay anywhere from $2 to $7 more starting Jan. 1. Congress made this change in the National Defense Authorization Act for Fiscal Year 2018. Read the  full article .

CMS News 
The Trump administration, last Friday, put forth two long-anticipated rules that increase price transparency for both hospitals and insurers. The CMS' hospital price transparency requirements finalize changes that require health systems to make their standard fees available on-demand and online. The "transparency in coverage" proposed rule would require health plans, including employer-based plans, and group and individual plans, to inform participants, beneficiaries and enrollees about price and cost-sharing information ahead of time. The agency hopes increased price transparency will boost competition among hospitals and insurers to drive down healthcare spending.
- Physician offices, ambulatory surgery centers and other health care sites will be subject to appropriate use criteria for advanced diagnostic imaging services beginning Jan. 1. Requirements include consulting an electronic clinical decision support tool before ordering advanced diagnostic imaging for patients covered by Medicare Part B, and the CMS will begin denying claims in 2021 if the CDS tool has not been consulted. Becker's ASC Review
- Read Bobbi Buell's analysis of the CMS's final rules for the CY2020  Medicare Physician Fee Schedule, Evaluation and Management Guideline Changes for 2021, Hospital Outpatient Final Rule for 2020, and HCPCS for Drugs in 2020 at .
Earlier, CMS had published updated open payments data reported in 2018 and physicians have until December 31 to review and dispute the 2018 data reported in their name. Learn more and review your data at

Affiliate Association News

Starting November 15, ASH will open applications for the ASH Congressional Fellowship Program, a yearlong opportunity available for one ASH member starting in September 2020 to work in a Congressional office and help shape health care and hematology policy. Learn more at .
Voting began November 1 and closes on December 2, for the ASCO Board Election. The Committee has selected 14 distinguished ASCO members as candidates for open leadership positions within the Society, including President-Elect, four seats on the Board, and two seats on the Nominating Committee. Eligible ASCO members can vote for their chosen leader beginning November 1. ANCO member Beverly S. Mitchell, MD, Stanford Cancer Center, is among the candidates for the Nominating Committee. Review the online candidate information at .
- ASCO's delegates to the American Medical Association's (AMA) House of Delegates (HOD) proposed several resolutions during the policy-making body's interim meeting taking place from November 16-19. ASCO's resolutions aim to improve the delivery of care and address Pharmacy Benefit Manager (PBM) Formulary Design; Step Therapy; and, Quality Payment Program (QPP) & Electronic Health Records (EHRs). Learn more at .

- Round 2 data submission runs through December 3 for ASCO Quality Oncology Practice Initiative (QOPI). The oncologist-led, practice-based, quality assessment program for outpatient oncology clinics, is free for practices with at least one active ASCO member. Practices can benchmark their quality of care against more than 150 quality measures. Register at .

- NCCN has published updated guidelines at --colon cancer and rectal cancer; non-small cell lung cancer; and, occult primary.

Industry News 
Celgene Corporation and Acceleron Pharma Inc. are pleased to announce that REBLOZYL has received FDA approval for anemia in adult patients with β-thalassemia requiring regular RBC transfusions. REBLOZYL is not indicated for use as a substitute for RBC transfusions in patients who require immediate correction of anemia.  View the announcement here.
BeiGene has announced that the FDA has approved Brukinsa for adult patients with mantle cell lymphoma (MCL) who have received at least one prior therapy.

In This Issue


Oncology Summit 
March 14, 2020

Spotlight On Hematology
February 1, 2020


Best of WCLC San Francisco
Early Bird ANCO member registration available; November 23) 

Best SABCS Northern California (Berkeley, January 11, 2020)

ASCO's Gastrointestinal Cancers Symposium
(San Francisco, January 23-25, 2020)

 ASH's Highlights of ASH (San Francisco, January 24-25, 2020) 

ASCO's Genitourinary Cancers Symposium
(San Francisco, February 13-15, 2020) 

Stanford's Review of the 61st Annual ASH Annual Meeting (Half Moon Bay, February 15, 2020)

(Stanford, April 2-3, 2020)
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  MOASC and ANCO 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|

ANCO: P.O. Box 2954, Alameda, CA 94501 |  P (415) 472-3960 |