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 .

J u n e 26 2 0 1 8
This Weekly's Hot Topics  
  • Aetna/CVS defends proposed merger before California Department of Insurance (California News)
  • Final resolution on the denials of 96402 from CMS (MOASC News)
  • American Medical Association House of Delegates approves several ASCO-led resolutions (National News)

California News 
CVS Health and Aetna executives defended their $69 billion proposed merger before the California insurance commissioner, as a panel of antitrust experts and healthcare providers chipped away at the companies' promise to lower U.S. healthcare costs and improve the quality of care without harming competition. The American Medical Association has urged regulators to block the proposed acquisition of health insurer Aetna by retail pharmacy and pharmacy benefit manager CVS Health. After conducting an exhaustive analysis, AMA found evidence of the merger's likely anticompetitive effects on Medicare Part D, pharmacy benefit management services, health insurance, retail pharmacy and specialty pharmacy. Medical oncologist and AMA President, Barbara L. McAneny, M.D., announced AMA's opposition to the CVS-Aetna deal at the hearing held Tuesday by the California Department of Insurance. Although California Insurance Commissioner Dave Jones doesn't have direct approval authority over the merger because Aetna isn't based in California, his opinion could influence how other state regulators view the deal.
When it comes to the availability of specialty palliative care, there is encouraging news in California. In 2014, CHCF assessed the supply of specialty palliative care programs compared to the estimated need for people in the final year of life. The research found these services could meet just one quarter to half of the estimated need, with uneven distribution across the state. An update to the mapping project finds dramatic increases in the number of palliative care programs and the number of patients served, and broader availability of programs statewide. Although there is at least some palliative care in all California counties, pronounced variation still exists. For example, inpatient palliative care is more available in urban areas compared to rural areas. But even in urban areas, the supply of services meets just half of the need. See the mapping project.
While the Aid-In-Dying law faces an uncertain future, state officials released numbers last Friday showing an increase in deaths from 16.5 per month in 2016 to 31.2 in 2017. According to data compiled by the California Department of Public Health, more than 90 percent of individuals were 60 or older and about 89 percent were white. Almost 55 percent had completed a college education. The patients were nearly evenly split between women (51 percent) and men (47 percent). Sacramento Bee: CA Assisted Death Law Used By Nearly 400 Patients In 2017

Noridian News  
Noridian/JEMAC has the following updates on their website
- MLN Connects Provider eNews:
Announcements: New Medicare Cards May Have QR Codes; Quality Payment Program Look-Up Tool Updated; Quality Payment Program Website Includes 2018 MIPS Measures and Activities
Publications : July Quarterly Update for 2019 DMEPOS Fee Schedule MLN Matters Article-New; Qualified Medicare Beneficiary Call: Audio Recording and Transcript-New ; DMEPOS Fee Schedule-July 2018 Update CR10807; MolDX: FDA Approved CLL Companion Diagnostic Test Billing and Coding Guidelines Coverage Article
Upcoming Noridian/JEMAC webinars include: 
Beneficiary Forms: When and Why Providers Issue Them Webinar (June 26)  5 p.m. Pacific Read the complete update
Part B, Home Health & Hospice Collaborative Webinar (June 27)
Noridian Part B Web Tour (July 12)
Visit for more information and to register.

MOASC News  
Thank you for your membership in MOASC, current membership expires June 30, 2018!  Together we are building and connecting the oncology community throughout California. With your support of, and membership in, MOASC we can continue to protect oncology interests in California and across the country. We are looking forward to an exciting year ahead with benefits to both enhance your career and strengthen your practice by ensuring your success through networking, education, shared knowledge and advocacy.
You can renew your membership in two ways:
1.  Print the application HERE mail it along with your check made payable to: Medical Oncology Association of Southern California, Inc P.O. Box 161, Upland, CA 91785
2.  ´╗┐Go to and pay via PayPal.
If you have any questions, please do not hesitate to contact the MOASC Office at or 909-985-9061 ext. 1.  
- MOASC has acquired a final resolution on the denials of 96402 from Neal E. Logue,  Health Insurance Specialist, Division of Financial Management and Fee for Service Operations, Centers for Medicare & Medicaid Services (CMS), CMS San Francisco Regional Office.  His June 4, 2018 response is as follows:
"We are writing in response to your inquiry regarding the Medicare program. You expressed concerns with Noridian denying Medicare claims submitted with procedure code 96402. You asked CMS to review specific claim examples as referenced in your inquiry.
We contacted Noridian Healthcare Solutions, which currently serves as the Medicare Administrative Contractor (MAC) in Jurisdiction E. The J-E MAC determined that the claims were denied in error. The J-E MAC's claims processing system has been updated, and Noridian will perform a mass adjustment later this week for the erroneously denied claims.
If you have further billing concerns, you may contact the J-E MAC's provider contact center at (855) 609-9960. We hope this is of assistance to you." 
Please contact the MOASC office at 909-985-9061 x-1 or email, if you have further questions.
MOASC and ANCO are jointly conducting a 2018 staff salary survey. The survey will be USPS mailed, e-mailed/FAXed to all MOASC members in mid-May and is available online at A $50 Visa gift card for respondents is included in this year's survey. Return your completed survey no later than September 30; results will be analyzed and reported in 4Q2018.
- Licensed Vocational Nurse, in the Inland Empire, with oncology experience is looking for work in the same field. Resume and cover letter linked here: Cover Letter   Resume 
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ANCO News  
ANCO and MOASC are jointly conducting a 2018 staff salary survey. The survey will be USPS mailed, e-mailed/FAXed to all ANCO members in mid-May and is available online at A $50 Visa gift card for respondents is included in this year's survey. Return your completed survey no later than September 30; results will be analyzed and reported in 4Q2018.
- ANCO members may register at a discounted rate for the 19th Annual International Lung Cancer Congress (Hyatt Regency Huntington Beach, July 26-29) at

SAVE THE DATE: ANCO'S ASCO Highlights 2018 will take place on August 25 at The Claremont Resort in Oakland. Watch for an announcement and registration form in late June.

ANCO is organizing a series of Hematologic Malignancies Updates in 2018. The first Update took place on June 16 at the Sacramento Hyatt Regency with Gabriel Mannis, M.D., University of California, San Francisco, Joseph Tuscano, M.D., University of California, Davis, Jeffrey Wolf, M.D., University of California, San Francisco, and Naseem Esteghamat, M.D., University of California, Davis. The latest research on novel treatment modalities for hematologic malignancies--leukemias, lymphomas and myeloma--along with case studies for these diagnoses were presented. These updates are supported by AMGEN, Janssen Oncology, Jazz Pharmaceuticals, Novartis Oncology, and Seattle Genetics. Download the presentations The next Update  takes place on September 15 in Palo Alto; watch for an announcement and registration form in August.

National News

- During the American Medical Association (AMA) House of Delegates (HOD) annual meeting, delegates approved several ASCO-led resolutions and incorporated them into the AMA's policy agenda, as follows:
* Pharmacy Benefit Managers--the resolution commits AMA to gather more data on pharmacy benefit managers (PBMs), their policies, and the patient-physician relationship.
* 340B Drug Discount Program--the resolution commits AMA to support reforms of the 340B program, including changes to make the program more transparent and make more practices eligible for participation.
* Inter-pharmacy Transfer of Opioid Prescriptions--the resolution commits AMA to backing policies that would make it easier to transfer electronic opioid prescriptions to ensure patients with bona fide need for opioids area able to access medications in a timely manner.
* Survivorship Care Plans--the AMA HOD reaffirmed existing AMA policy on the need to improve billing for survivorship plans.
* Alcohol Use and Cancer--the AMA HOD reaffirmed existing AMA policy that alcohol is a modifiable risk for cancer and physicians should provide support and counsel to their patients.
Here is the latest release of combined CDC and NCI surveillance data. The U.S. Cancer Statistics are the official federal cancer statistics, providing the latest cancer information on 100% of the U.S. population. This new data release allows researchers, public health professionals, and the public an opportunity to better understand cancer, inform coordinated efforts to prevent cancer, and evaluate progress in cancer control. The U.S. Cancer Statistics public use database includes cancer incidence and population data for all 50 states, the District of Columbia, and Puerto Rico. The de-identified data are available online, at no cost to researchers - CDC, NCI, and the central cancer registries cover the cost to collect and produce the database.
Dr. Atul Gawande is set to become the chief executive of a new health care company being formed by Amazon, Berkshire Hathaway, and JPMorgan Chase, to trim employee healthcare costs. The company, which has yet to be named, is being launched with lofty ambitions: to find innovative ways to improve health care for employees of the three companies. But its founders have hinted that company-wide solutions could help find solutions to problems across the entire U.S. health system. Dr. Atul Gawande, heading up the health care initiative, is geared toward starving the "tapeworm on the American economy." While many people's attention is focused on skyrocketing drug prices, Gawande says that is just 10 percent of total U.S. healthcare spending. Dr. Atul Gawande, a surgeon, last week cited surgery as the single biggest U.S. healthcare cost and said there are ways to both cut costs and improve patient care. Speaking in San Diego at the annual meeting of America's Health Insurance Plans, a health insurance trade association, Gawande also said that end-of-life care needs to take into account the wishes of patients, something which he said is now sorely lacking.
Beginning July 1st, 2018, scheduled minimum wage increases will take effect in several municipalities. The Federal minimum wage has been $7.25 since 2009, but many states and localities have passed their own minimum wage laws. Employers must pay non-exempt employees at least minimum wage and where rates differ between federal, state, and municipal laws, the highest rate must be paid. Please review the Minimum Wage Increase chart, using the link below, to determine if you will need to make any adjustments to your employee rates (wage rates changing July 1 will be highlighted). Unless noted, new rates went into effect January 1st, 2018. MINIMUM WAGE RATE CHANGES

CMS News 
- By THIS FRIDAY, June 29, submit your ideas to CMS!  CMS is accepting proposed measures for inclusion in the Medicare Promoting Interoperability program, formerly known as meaningful use. Stakeholders may that focus on the improvement of health data exchange and interoperability, advanced use of 2015 edition certified EHR technology, patient safety, outcomes measurement, and streamlined program effectiveness, efficiency and flexibility. EHR Intelligence.
Compliance with the adopted Administrative Simplification standards and operating rules can benefit organizations across the health care industry, including providers, health plans, and clearinghouses. CMS has created tools and resources to help you understand and reach compliance, which you can find below. CMS, under the Secretary's authority granted to HHS, also enforces Administrative Simplification requirements to ensure the health care community reaps the benefits of standardized transactions and reduced administrative costs. Informational Videos are a quick and easy way to learn about Administrative Simplification compliance and enforcement:
Enforcing HIPAA Administrative Simplification Requirements - Learn why and how CMS is enforcing Administrative Simplification requirements.
Reaching Compliance with ASETT - Learn how to use the Administrative Simplification Enforcement and Testing Tool (ASETT) to test transactions and file a complaint.
The Administrative Simplification Enforcement and Testing Tool, or ASETT, allows you to test transactionsfor HIPAA compliance. You can also use ASETT to file a complaint if you believe there are compliance violations in any of your trading partner transactions. You can use the Quick Start Guide and User Manual to help get started on ASETT.
CMS has published the draft 2019 CMS Quality Reporting Document Architecture (QRDA) Category III Schematron for Eligible Clinicians and Eligible Professionals for public comment. This is a draft document and the contents are subject to change. The public comment period started June 20, 2018,and ends on July 5, 2018. The 2019 CMS QRDA III Schematron is a companion to the 2019 CMS QRDA III Implementation Guide (IG) and allows for computerized validation of QRDA documents against the IG requirements. The Schematron helps eligible clinician and eligible professional submitters check QRDA III files for the calendar year 2019 reporting period in the Merit-based Incentive Payment System (MIPS), Comprehensive Primary Care Plus (CPC+) Program, and the Medicaid Promoting Interoperability (PI) Program. To Submit Comments on the draft Schematron: JIRA ticket number QRDA-700 . A JIRA account is required to comment. Comments will be accepted until 2:00 p.m. Pacific time, on July 5, 2018.
The final 2019 CMS QRDA III Schematron and sample file will be published in late July 2018 on the Electronic Clinical Quality Improvement (eCQI) Resource Center QRDA page
Additional QRDA-Related Resources , as well as current and past implementation guides, are found on the eCQI Resource Center QRDA page. For questions related to this guidance, the QRDA Implementation Guides or Schematrons, visit the ONC QRDA JIRA Issue Tracker
On July 24 and 26, the Centers for Medicare & Medicaid Services (CMS) will host two 60-minute Physician Compare webinars about public reporting on Physician Compare and information in the pipeline for potential inclusion on Physician Compare in late 2018, including Year 1 Quality Payment Program performance information. Specifically, the webinars will cover:
Overview of public reporting on Physician Compare
Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) on Physician Compare
Upcoming 30-day Preview Period
Two different times are offered to accommodate your busy schedule. Both webinars will present the same information. During each webinar, you will have an opportunity to ask questions.
Registration information coming soon.
To learn more about public reporting on Physician Compare, visit our Initiative page where you can find resources and documents, including information about the 2016 performance information currently available on Physician Compare.

Affiliate Association News 
- On July 10, ASH, along with the Lymphoma Research Foundation and the National Comprehensive Cancer Network, is co-hosting a briefing on Capitol Hill to educate Members of Congress and staff on chimeric antigen receptor (CAR) T-cell therapy. This innovative treatment, currently approved for certain patients with leukemia and lymphoma, is used to treat the sickest of the sick, typically individuals who have exhausted all other treatment options, including chemotherapy, radiation, or stem cell transplant.  The briefing will provide an opportunity for attendees to learn about the development of CAR T-cell therapy, the way in which CAR T-cell therapy treats blood cancer, and to hear directly from a patient about her own treatment experience. Confirmed speakers include MOASC member, Dr. Joseph Alvarnas, City of Hope, Duarte, CA, Chair, ASH Committee on Practice. Please reach out to Leslie Brady lbrady@hematology.orgfor more information.
- Help steer the meeting discussion by providing input today, for the   ASH Summit on Emerging Immunotherapies for Hematologic DiseasesJuly 12 & 13, 2018. The Summit will feature interactive breakout sessions aimed at addressing important topics relevant to the design and application of immunotherapies. These small-group sessions will create a unique opportunity for attendees to steer the conversation and help chart the course for the field. Please complete a short pre-meeting survey to help facilitate scientific discourse during the breakout sessions.
- The Medicare PROPOSED Regulations for 2018 will be out around the 1st of July . onPoint Oncology and Bobbi Buell are scheduling the following Lunch and Learn Webinars:
Proposed 2018 Medicare Regulations: Offices and Hospital Outpatient  on  7/20/2018 and 7/27/2018 at 9am PDT (12pm EDT, 11am CDT, 10am MDT)
- The best new scientific research in all areas of hematology will be presented at the 60th ASH Annual Meeting and Exposition in San Diego, California.  We encourage all hematology researchers to submit an abstract by August 1 at 11:59 p.m. Pacific time. More than 1,000 abstracts will be presented orally, with thousands more accepted for poster presentations. All accepted abstracts will be published in BloodDon't miss this great chance to showcase your research in front of the brightest minds and influencers in the field of hematology!
Visit the  ASH website for a full list of abstract review categories, policies, and eligibility requirements.
ASCO recently launched myConnection, a new online community platform that provides ASCO members with the opportunity to connect, collaborate, participate in in-depth discussions, and receive feedback and resources with the nearly 45,000 members in ASCO's global network. Get started at my
ASCO's PracticeNET is a collaborative network in which practices share and receive insights to enhance their business operations and quality of care. A new video overview of PracticeNET explains how the network gives practices a unique opportunity to see how they compare to others and learn from their peers. Watch the video at
- ASCO is requesting you to  submit an abstract for the Palliative and Supportive Care in Oncology Symposium,November 16-17, 2018 in San Diego, California. Innovative and cutting-edge research is growing across the field of palliative and supportive care, underpinned by continuing advances in symptom science. This symposium is the ideal venue to present your research to colleagues interested in the integration of palliative and supportive care across various cancer care settings. Abstract Submission Deadline: July 24 at 8:59 PM (PDT).
COA and their Pharmacist group, COPA, are needing your help to send to them ANY & ALL PBM delay stories, as well as any other stories where patient care is compromised.  
Several fronts, including legislative (federal and state levels) and legal are being tapped into!  The message MUST go out far and wide. Below are some quick links to a couple of projects that COPA board members have been working on. There are links to two articles and one podcast below that are very well done regarding the challenges that we all face surrounding PBMs and them restricting our ability to care for our patients. 
Please send your stories to Ricky Newton rnewton@coacancer.orgat COA. Thank you.
- ASCO invites all practices to participate in the 2018 ASCO Practice Census, an annual survey of the entire U.S. oncology practice community that aims to capture keep information on what is happening in oncology practice today and that is chronicled as part of ASCO's State of Cancer Care in America initiative. Complete the Census at
NCCN has published the following updates at
Anal carcinoma (V2.2018), antiemesis (V3.2018), head and neck cancers (V2.2018), lung cancer screening (V1.2019), primary cutaneous B-cell lymphomas (V2.2018).

Industry News 

Genentech BioOncology and Merck inform ANCO and MOASC that the United States Food and Drug Administration is restricting the use of Tecentriq and Keytruda for patients with locally advanced or metastatic urothelial cancer who are not eligible for cisplatin-containing therapy. This results from decreased survival associated with the use of Tecentriq or Keytruda as single therapy (monotherapy) compared to platinum-based chemotherapy in clinical trials to treat patients with metastatic urothelial cancer who have not received prior therapy and who have low expression of the protein programmed death ligand (PD-L1). The labels of both drugs have been revised to reflect the restricted limitations.
Merck Helps offers a full suite of support services that facilitate access to Merck's oncology drugs for eligible patients who are unable to afford their Merck medications. These services include help with insurance-related matters and copays, free Merck medications for qualified patients, and assistance with Keytruda copays for eligible patients who have private insurance. Merck Helps 800-727-5400 Visit Website and Merck Access Program 855-257-3932


In This Issue

LunchTime Series

ANCO's ASCO Highlights
(Oakland, August 25) 
ANCO Hematologic Malignancies Updates (Palo Alto,
September 15)
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 ANCO and MOASC 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 151109, San Rafael, CA 94915 |  P (415) 472-3960 | F (415) 472-3961 |