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 .
August 6, 2019

This Weekly's Hot Topics

  • PBMs have the authority to trump a doctor's medical judgment. Protect your patients' access to YOUR cancer care. California News
  • This Sunday, August 12th, send YOUR ideas to reduce unnecessary administrative burdens! National News
  • NOW is the time to get your representative and senator to Sit in My ChairAffiliate Association News

California News

- MOASC member, Dr. Ravi Rao, M.D, an oncologist with cCare Fresno, is highlighted in an article just published in the Fresno Bee As mentioned in the article, "pharmacy benefit managers have the authority to trump a doctor's medical judgment without seeing patients or knowing their full medical history, and without accountability for the consequences of what happens to sick people," MOASC encourages all California hematology, oncology, urology, rheumatology & affected specialties to share with MOASC, your PBM experiences. Earlier, NPR Marketplace presented a segment on the PBM experiences of an oncology practice in Tennessee: Please contribute your PBM experiences and put the spotlight on how PBM's are hurting real cancer patients, to now! Thank you.
The California Medical Association asks all California practices to schedule appointments with their Members of Congress during the month-long August Congressional Recess, August 1 - September 9, to discuss CMA's Congressional priorities which include the surprise medical billing legislation moving swiftly through Congress. Please let Elizabeth McNeil know as soon as you have your appointments scheduled.  If you are having trouble, please let Elizabeth know and CMA will help you. CMA may also add some CMA and specialty society leaders to your meetings.  It is extremely important that California physicians and practice leaders meet with every California Member of Congress during August if organized medicine is to prevail on the surprise billing legislation. CMA has organized three conference calls to educate the MEC and physician leaders about these issues, review the talking points, and answer any of your questions. Please feel free to join any of the following call TODAY, Tuesday, August 6, 2019: 6:30-7:30 pm; 1 866 906 7447; passcode 8025862#.
The following documents should be given to your Representatives:
1. CMA Talking Points "Congressional Legislative Priorities: August 2019" CMA FedTalking Points. August Recess 
2. PAI California vs. New York  Surprise Billing CA vs NY (PAI) 
3. Op Ed CMA CEO Dustin Corcoran and MSSNY CEO Phil Schuh  Surprise Billing CA NY Op Ed Morning Consult 
4. Independent Dispute Resolution: The Facts. Surprise Billing IDR the Facts. CMA 
- Anthem Blue Cross's Provider News (August 2019) is now available online at  and features articles entitled: Clinical Criteria and Prior Authorization Update for Specialty Pharmacy are Available; Help with Claim Issue Resolution; Contracted Provider Claim Escalation Process; Provider Education Seminars, Webinars, Workshop and More!; Anthem Blue Cross Provider Directory and Provider Data Updates.

Noridian News 
- Noridian/JEMAC has the following updates on their website
SNF: FY2020 Payment and Policy Changes; Protect Your Patients' Identities: Use the New MBI Now; Reducing Administrative Burden: Comment by August 12; Open Payments Program Expansion; July-September Quarterly Provider Update; Disaster Preparedness Resources
Physician Fee Schedule Proposed Rule: Understanding 3 Key Topics Listening Session-August 12; OPPS and ASC Proposed Rule Listening Session-August 14; 
New Waived Tests; Skilled Nursing Facility 3-Day Rule Billing; Quality Payment Program Merit-based Incentive Payment System (MIPS): Cost Performance Category in 2019 Web-Based Training Course-Revised; Quality Payment Program 2019 Overview Web-Based Training Course-Revised.
* Coverage of Intravenous Immune Globulin for Treatment of Primary Immune Deficiency Diseases in the Home-Medicare Benefit Policy Manual, Chapter 15, 50.6-R2.
* Additional Information Required for Coverage and Pricing for Category III CPT Codes-R9
* Immune Globulin Intravenous (IVIg) LCD-R9
* NMP: Upload Appeals Documentation to a Submitted Request
* AUC for Advanced Diagnostic Imaging-Educational and Operations Testing Period-Claims Processing Requirements CR11268
* Documentation of Medical Necessary of Home Visit; and Physician Management Associated with Superficial Radiation Treatment-Revised CR11273
Forthcoming Noridian JEMAC meetings/webinars/workshops
* Revocation, Caps and Appeals Webinar (August 7)
* Using the Medicare Beneficiary Identifier (MBI) Webinar (August 8)
* Submitting Your Enrollment Online-Part 1 (I&A) Webinar (August 21)
* MSP Employer Based Plans Webinar (August 21)
* Understanding National and Local Coverage Determinations Webinar (August 22)
* Basic Non Covered Services Webinar (August 27)
* Drugs and Biologics-Outpatient Billing Webinar (September 10)
* Submitting Your Enrollment Online-Part 2 (PECOS) Webinar (September 18)
* Common Errors on all Application Types Webinar (October 9)

For more information and to register, visit: http://med.noridianmedicarecom/web/jeb/education/training-events.

MOASC News  

-  Thank you for your participation in the MOASC LunchTime Series teleconference, "Everything You Need To Know About USP Chapters 797/800." Listen to the recording by dialing 1-888-203-1112 and enter the pass code 709971126#. This recording will be available for the next 30 days. Click HERE for the slides. 
In a continuing effort to improve the information, presentations, and content of future events, it is extremely important to us to obtain your feedback on the meeting you attended. Please take a few moments to answer these questions.
1.      What was your overall opinion of this LunchTime Series Presentation? 
2.      Was the information presented helpful?
3.      Any suggestions for future topics? 
Please respond to the MOASC Office at Thank you for your comments!
- SAVE-THE-DATE for the MOASC Spotlight On Oncology, August 17, 2019 in Huntington Beach. MOASC awarded restricted grants to selected oncology fellows and faculty from the University of California, Irvine (UCI), to present the premier topics as a result of their attendance at the 2019 Annual ASCO Meeting. The presentations not only promote collegial discourse among colleagues along with networking in an informal setting but valuable clinical information.  Contact the MOASC Office for more information at .
- Renew your MOASC Membership TODAY to continue your investment in your state association! MOASC continues to advance oncology in California with your support and membership in MOASC. In 2018, MOASC successfully worked to create the California Cancer Caucus in Sacramento. YOU, the California oncologist, are the reason for MOASC's existence. MOASC advocates diligently insuring your ability to serve the California oncology community. 
You can renew your membership in two ways:
Print the application  HERE . With your check made payable to: Medical Oncology Association of Southern California, Inc., mail the completed application to: P.O. Box 161, Upland, CA  91785.
Go to  and pay via PayPal.
We are looking forward to an exciting year ahead with benefits you will not want to miss.
If you have any questions, please contact the MOASC Office at 909-985-9061 ext.1 or at .
Mark your calendars for the "MOASC Educational Series Program," administrator track & billing track, on Thursday, November 14, 2019. The program will highlight administrator issues as: Protecting Data in the Healthcare Industry; Secrets of successful provider contracting; Creating a custom website to drive patient growth and make your practice stand out. The current billing & collection issues and strategies to be addressed: billing & coding updates for 2020; MACRA Quality Measures guide; MIPS; G-Codes; Claims Review; Reporting and Returning Overpayments; Medicare Fraud and Abuse Penalties; Claim Denials - Understand why the claim was denied; Medicare Appeals Processes.
Mark your calendars NOW for the 7th Annual MOASC Oncology Summit, March 14, 2020 at the Hyatt Regency Huntington Beach. From 2014 through 2019, the MOASC Oncology Summit has highlighted cutting-edge topics presented by world-renowned physicians. From topics like: Decoding Molecular Medicine's "nibs" and "mabs" to Personalizing Cancer Care in the Era of Multiple Therapies and Diagnostic Tools to Harnessing the Power of Immunotherapy, and this year's Advancing Cancer Care in the Elderly; unlike any other, MOASC has brought to southern California physicians the most contemporary topics for presentation and discussion among colleagues. You will not want to miss our 2020 program!

    Like us on Facebook    Follow us on Twitter    View our profile on LinkedIn     

ANCO News  
- ANCO Institutional Member UC San Francisco invites ANCO and MOASC members to the 5th International Controversies in Breast Cancer Care Conference--When is Less More? on September 4-6 in San Francisco. According to Laura Esserman, MD, MBA-- "The program is really provocative. It is designed to make people question long held beliefs!  International speakers talking about all topics that are pertinent to breast cancer.  This has fun and exciting topics from imaging and genetics to issues for survivors.  We have a particularly great program around imaging this year as there are many new developments to discuss. We have tried to identify the most controversial topics across early and late stage cancer, and the debate style format will be very stimulating and fun!  We even have a session on why people are not swayed by data, and the FDA will come to speak about why they are interested in Real World Evidence.  I would really encourage  those who are interested to attend! We have a low registration price for advocates ($200) and students. " Download the meeting flyer!

ANCO annually funds one  Young Investigator Award  (YIA) for a qualified Northern California early-career cancer researcher through Conquer Cancer®, the ASCO Foundation. We encourage all eligible Northern California Fellows and Trainees to apply. The YIA is a one-year, $50,000 grant that provides research funding to promising physicians to support their transition from final years of subspecialty training to faculty appointment and to encourage and promote quality research in clinical oncology. In addition, ANCO funds two  Merit Awards  for the 2020 ASCO Annual Meeting and an award to attend the 6th Annual Scientific and Career Development Retreat in October 2020, which is by invitation only. Learn more at . For questions about eligibility and the application, please contact Conquer Cancer at .
- REGISTRATION NOW AVAILABLE ONLINE: ANCO's ASCO Highlights 2019 will take place on Saturday, August 17 at The Claremont Resort in Berkeley. Download the meeting announcement at .
- SAVE THE DATE for the ANCO Annual Professional Education Meeting 2019 in Berkeley, Saturday, October 17. Watch for a meeting announcement in late July.

- SAVE THE NEW DATE for the ANCO-UCSF Precision Oncology Symposium in San Francisco on Saturday, November 9. Watch for a meeting announcement in mid-July. Learn more at
- Employment opportunities are now announced on the new ANCO website at .
- ANCO physician members, their practice staff, and representatives from ANCO's corporate members must register to access password protected content on the ANCO website ( ) at .
- Follow ANCO on Twitter at  @ANCO News .

National News

THIS SUNDAY, August 12th comments are due for YOUR ideas to reduce unnecessary administrative burdens for regulatory, sub-regulatory, policy, practice and procedural changes for clinicians, providers, patients and their families! COA has been asked to participate in an RFI project as part of the "Reducing Administrative Burden to put Patients over Paperwork" that was initiated by the Administration through an Executive Order in 2017. Please provide specific areas of concern that might be included in the COA comments including any specific solutions that you may like to offer. There are many issues that make practice difficult. COA hopes to get a few concrete examples that can serve as the basis for COA's comments given the breadth of issues. If you can offer some help on issues that make life difficult for you as you provide cancer care day to day, and how you would like to see it changed, COA's comments may be more useful. A physician has already offered that the redundancy of documentation for things like smoking cessation and opioid prescribing where documentation is required in multiple places including notes and EHR rather than once, is a representative example. Thank you, in advance, for any thoughts you have that should be included in this somewhat global request for ideas that could improve cancer care by reducing the administrative burdens of giving that care. Knowing that you are busy, COA appreciates your time and expertise. Send to: Mark E. Thompson, M.D., Medical Director for Public Policy, Community Oncology Alliance
COA attorneys have filed their appeals brief last week on the sequester injunction.  It clearly lays out COA's position, and reason for appeal. COA Filed Appellate Brief 7.29
- Join ASCO in supporting the Improving Seniors' Timely Access to Care Act (HR3107), bipartisan legislation that would protect patients from unnecessary delays in care by streamlining and standardizing prior authorization in Medicare Advantage, providing much-needed oversight and transparency of health insurance for America's seniors. Learn more at
-  The Associated Press (AP) reports that physicians "say they worry about the growing influence insurers have over patient care," as can occur when coverage denials postpone access to medical tests or treatments. Meanwhile, "insurers say advances in medical care are prompting them to review more cases before deciding on coverage," and that such checks are "a way to talk to doctors about the best approach and to guard against unnecessary treatment." ASCO leaders--Barbara McAneny, MD, and Ray Page, DO, are quoted in the story at 
- UnitedHealthcare Network Bulletin (August 2019) is now available online (at Featured articles: medical policy updates; updates to requirements for specialty medical injectable drugs; pharmacy update: notice of changes to prior authorization requirements and coverage criteria; use their online tools to submit medical prior authorization; changes in advance notification and prior authorization requirements; new controlled substance e-prescription requirements.

CMS News 

CMS has released proposed rules for the 2020 Medicare Physician Fee Schedule (MPFS) and other changes to Medicare Part B payment policies, including proposals related to the Quality Payment Program (QPP). Cursorily, the conversion factor increased a bit, so depending on E&M billing practices physicians may see a slight bump. CMS estimates a 0% overall impact for both the hematology/oncology and radiation oncology specialties in 2020. Depending on how CMS implements the collapsing of 1-4 level codes, while retaining level 5, and paying for more involved cases, oncology could see Medicare payment increases of 8-12%. There is concern about the impact on drug administration codes. Targeted cuts to oncology were limited to two drug administration codes--96360 and 96372-- identified as miscalled in the 2019 final rule. The CPT changes would also revise the times and medical decision-making process for all codes and requires performing a history and exam only as medically appropriate. The proposed changes would also allow clinicians to choose the E&M visit level based on either medical decision-making or time. CMS is proposing to adopt the American Medical Association's (AMA) Specialty Society Relative Value Scale (RVS) Update Committee's (RUC) recommended values for the office/outpatient E&M visit codes for calendar year 2021 and the new add-on CPT code for prolonged service time. AMA RUC-recommended values would increase payment for office/outpatient E&M visits. At the same time, CMS related the Hospital Outpatient Prospective Payment System (HOPPS) proposed rule for 2020. CMS is proposing to continue to pay 340B hospitals at ASP - 22.5% in 2020 pending their appeal of the judge's ruling, the cut exceeds CMS' authority.  CMS is also soliciting comment of a payment rate of ASP +3% if the appeal is lost.  Regardless, it appears that CMS will not be unwinding the cut if it loses the appeal until the 2021 proposed rule. It is clear this administration is after 340B. Hospitals will be required to make public all their price data, not just from the chargemaster.
As proposed, the CMS is increasing Medicare's "new technology add-on payments" for 18 technologies including CAR T-cell therapies for cancer. The rule hikes this payment from 50% to 65%. However, the agency said it is not ready to make any major structural change to the way Medicare approaches CAR-T, despite some stakeholder pressure.

Affiliate Association News

The time is NOW, during the August congressional recess (August 1 - September 9) to get your representative and senator to Sit in My Chair! COA continues to make organizing a policymaker visit easy with the new and improved Sit in My Chair toolkit. It offers everything your practice needs to curate a moving and memorable experience, from checking policymakers into your waiting room, walking them through diagnosis, having them sit in a chemotherapy chair for treatment, and more. It is important to put a human face on tough issues. That is what helps policymakers appreciate the important role of community oncology in patients' lives and our cancer care system. 
COA is reaching out for any new PBM horror stories you want to share. Please submit them!COA is on a roll this year with pitching these, including national Marketplace NPR (14 million listeners), The Atlantic (33.7 average monthly readers), not to mention stories in the Times Picayune, and fantastic series from the Columbus Dispatch. There is a LOT of interest in PBM atrocities affecting patients' access to cancer care. This is where you come in. COA needs more stories, preferably fresh and active. They might be "old news" to you or the same old problem, but to reporters they are a big deal. Send your PBM experiences to Nicolas Ferreyros,
Director of Communications, Community Oncology Alliance (COA
Check out the COA PBM Abuses campaign website at and share it with your networks. The stories you submit are also there in videos, advertising, and more. They really help COA put a patient face on these issues. Thanks and please send any PBM horror stories you have
- Submit your application for the 2020-2021 cycle of ASCO's Health Policy Leadership Development Program. This is a one-year program that gives ASCO members the opportunity to develop expertise in health policy, advocacy, and grassroots activity while learning valuable leadership skills. Learn more at .
- The ASCO Oncology Practice Conference, September 5, in San Diego will focus on the business of cancer care addressing the needs of practice administration and operations, with timely and practice strategies for the challenges faced by all those involved in the business of cancer care. Learn more and register at .
The ASCO Quality Care Symposium, September 6-7 in San Diego, encompasses the latest strategies and methods for quantification of patient experience, provider efficiency, clinical outcomes, and quality and safety in the cancer care field. The Symposium will include a variety of sessions that will cover the latest science in precision and personalized medicine. This meeting will bring leaders in quality improvement science together to participate in stimulating conversation with opportunities for networking among physicians, nurse practitioners, physician assistants, and others. ASCO Quality Care Symposium .
Join ASH on September 6-7, 2019, for the 2019 ASH Meeting on Hematologic Malignancies, at the Fairmont Chicago, Millennium Park, to gain knowledge that can help you make an immediate impact in your practice. Top experts in the field, will present comprehensive clinical content, the latest clinical research, and opportunities to interact with colleagues in an intimate, small group setting with no competing sessions. The program content will be structured as "How I Treat" presentations, which will highlight each speaker's evidence-based treatment approaches, present cutting-edge scientific data that can be translated into new strategies for diagnosis and treatment, and address what to do in cases where there is no data. For more details, or to register, please visit the  ASH Website .
Wherever your career path leads, ONS offers the resources and opportunities to help you grow professionally. To join or renew click here . As a reminder, Students are free.
Conquer Cancer®, the ASCO Foundation, has awarded more than $126 million through nearly 2,100 grants and awards to medical students, trainees, young scientists, and oncologists at all stages of their careers. Many of ASCO's funding opportunities are currently accepting applications. While eligibility criteria differ for each award, all grants require that applicants be a member of ASCO to apply. Join ASCO and submit your grant application today! Highlighted funding opportunities include: Young Investigators Award; Global Oncology Young Investigators Award; Career Development Award; Gateway Discovery Grant in Immunotherapy Research. For detailed information regarding eligibility criteria for each funding opportunity and its application process, please select the name of the grant above, or view all available funding opportunities through Conquer Cancer®.
- Learn more about an alternative to the traditional 10-year ABIM MOC exam by watching the ASCO Annual Meeting session about the new ABIM/ASCO Medical Oncology Learning & Assessment program, available in 2020, at .

- Round 2 registration is now open, and data submission will run from July 1 to December 3, 2019, for ASCO's Quality Oncology Practice Initiative. QOPI is an oncologist-led, practice-based quality assessment program for outpatient oncology clinics.Register for QOPI at .
- ASCO and the Multinational Association for Supportive Care in Cancer/International Society of Oral Oncology have published an updated clinical practice guideline in the Journal of Clinical Oncology on medication-related osteonecrosis of the jaw. Read the updated guideline at .
- ASCO invites members to join the Practice Guidelines Implementation Network (PGIN), founded by and for physicians and advance practice providers who are passionate about promoting the use of high-quality guidelines for cancer care. As a PGIN member, ASCO will keep you up-to-date on new and updated guidelines and resources, as well as opportunities to get involved and participate in guidelines-related initiatives. Learn more at 

Industry News

- Daiichi Sankyo informs ANCO and MOASC that the United States Food and Drug Administrationhas approved Turalio capsules for adult patients with symptomatic tenosynovial giant cell tumor (TGCT) associated with severe morbidity or functional limitations and not amenable to improvement with surgery. 
- Merck informs ANCO and MOASC that the United States Food and Drug Administration has approved Keytruda for patients with recurrent, locals advance or metastatic, squamous cell carcinoma of the esophagus (ESCC) whose tumors express PD-L1 (combined positive score-CPS-greater than or equal to 10), as determined ny an FDA-approved test (PD-L1 IHC 22C3 pharmDx kit), with disease progression after one or more prior lines of systemic therapy.

In This Issue


Spotlight On Oncology
August 17, 2019


ANCO's ASCO Highlights 2019
(The Claremont Hotel, Berkeley, August 17, 2019) 
 5th World Congress on Controversies in Breast Cancer (CoBrCa): When is Less More? 
(Use code cobrca10 for ANCO Member Discount;
San Francisco, September 4-6) 

(NCCN, San Francisco, September 27-28) 
ANCO Annual Professional Education Meeting 2019 (Berkeley, October 17)

8th International Cancer Metastatis Congress
(San Francisco, October 25-27) 
Supportive Care in Oncology
(ASCO, San Francisco, October 25-26) 

Kaiser Permanente National Oncology Symposium (Los Angeles, November 8-9)
  ANCO-UCSF Precision Oncology Symposium (San Francisco, November 9),
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 |