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 20, 2019

This Weekly's Hot Topics

  • MOASC mourns the passing of Fredrick Rundall II, M.D. MOASC News
  • DMHC now required to review unfair billing patterns complaints. California News
  • The Virtual Research and Development Center to accelerate research into new cancer treatments. National News

California News

- Anthem Blue Cross has notified physicians that it will begin conducting pre-payment reviews for claims with certain modifiers for dates of service on or after October 1, 2019. The pre-payment modifier review will focus on claims with modifiers 25, 59, 57, LT/RG, and other anatomical modifiers to determine whether it is appropriate for the modifier to bypass the edit. Learn more 
A s a result of bill,   AB 315   (Wood) as well as another legislative bill last year  ( AB 2674 ), the  Dept. of Managed Health Care is now required to review "patterns of provider complaints for unfair billing patterns," once you go through the provider dispute resolution process. You may have recently received a message from one of your health plans regarding this matter. If you have complaints about billing patterns from your PBM or a health plan, provders need to submit a complaint through this process. The DMHC will only act on "patterns" of complaints, so multiple providers need to submit complaints to establish a record of problems in order for DMHC to act. This is standard procedure for claims filed by providers and consumers alike. To utilize this, MOASC solicits your claims of unfair billing practices to compile from various practices to communicate with DMHC.
The Fresno Bee goes in-depth about the effects that PBMs have on a patient's health and access to life-saving medicine. This article outlines the different practices that delay processes for patients to receive urgent medicine for cancer patients particularly a resident of Fresno. You can read the article by clicking here.

Noridian News 

- Noridian/JEMAC has the following updates on their website
New Medicare Card: Transition Period Ends in Less than 5 Months; CAR T-Cell Cancer Therapy Available to Medicare Beneficiaries Nationwide; 
MACRA Patient Relationship Categories and Codes: Learn More
Radiation Oncology Model Listening Session-August 22
International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs)-January 2020 Update; Chronic Care Management Services-Revised; ICD-10-CM, ICD-10-PCS, CPT, and HCPCS Code Sets-Revised
* Billing and Coding Guidelines: Truxima (rituximab-abbs)
* Additional Information Required for Coverage and Pricing for Category III CPT Codes-R10
* ICD-10 and Other Coding Revisions to NCDs-January 2020 Update CR11392
Forthcoming Noridian JEMAC meetings/webinars/workshops
* 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)
* Guidance for Date of Service Billing on Professional Claims-30 Minute Webinar (August 28)
* Claim Submission: Paper and Electronic Webinar (September 4)
* Drugs and Biologics-Outpatient Billing Webinar (September 10)
* Reopenings Webinar (September 12)
* Recovery Auditor Program Webinar (September 12)
* Submitting Your Enrollment Online-Part 2 (PECOS) Webinar (September 18)
* Modifier 59, NCCI and MUEs Webinar (September 18)
* Eligibility Claim Denials and Rejections Webinar (October 3)
* 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  

MOASC mourns the passing of Fredrick Rundall II, M.D., yesterday, August 19, 2019.
Dr. Rundall served selflessly as a member of the Board in various capacities, predominantly as the Medi-Cal Liaison, from 1990 to 2014. MOASC extends condolences to Dr. Rundall's family.
ATTENTION PHYSICIANS, NURSES, PHARMACISTS AND ALL CLINICAL STAFF! Save the date for the MOASC LunchTime Series webinar, "The Venetoclax CLL Scientific Story," Wednesday, August 28th at 12:00pm Pacific time. The webinar will include:
1.     A review of the indications and important safety information for Venetoclax.
2.      Examining Chronic Lymphocytic Leukemia Disease Landscape.
3.      Evaluating the efficacy results of Venetoclax in CLL patients.
4.      Understanding the adverse reactions and important safety considerations of Venetoclax.
Please register at Thank you.
- 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. This year's 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!

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ANCO News  
- Congratulations to ANCO member Yasmin Karimi, MD, Stanford University, for receiving an ASCO CancerLinQ Discovery Research Support Grant. Dr. Karimi will examine the real-world utilization and efficacy of osteoclast inhibitors on skeletal related events and mortality in patients with metastatic breast cancer and known bone metastasis.

- 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 CancerĀ®, 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 .
- ANCO's 3Q2019 Hematologic Malignancies Updates: Leukemias, Lymphomas, & Myeloma is taking place at the Sacramento Hyatt Regency on September 14. Register at

- SAVE THE DATE FOR ANCO's  Annual Professional Education Meeting 2019 at The Claremont Resort in Berkeley on October 17 . Watch for a meeting announcement in late August.

- SAVE THE DATE for the   ANCO-UCSF Precision Oncology Symposium  at the Marine's Memorial Club in San Francisco on Saturday, November 9 . Watch for a meeting announcement in late August. Learn more 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

- The Virtual Research and Development Center launched by MD Anderson Cancer Center and Boehringer Ingelheim aims to accelerate research into new cancer treatments. The center will enable data sharing and analysis for researchers from both organizations, and current targets include treatments for mutations in the KRAS gene, which is associated with some lung and gastrointestinal cancers and development of an antibody with the ability to induce apoptosis.  Becker's Health IT & CIO Report .
A study funded by the Agency for Healthcare Research & Quality found that accountable care organizations, based on care management and coordination activities, were not associated with improved outcomes among patients who were frail or had multiple chronic conditions, ACOs give health organizations and providers financial incentives to improve care coordination. Researchers who reviewed survey responses found patients in the best-performing ACOs for care management and coordination activities did not have different outcomes compared with patients in lower-performing ACOs. Study findings suggest that health organizations should consider the effectiveness of investing heavily in care coordination activities that are difficult to implement. The study is published in JAMA Network Open. Access the abstract to the study.
Agile principles, from the software industry, may help health care organizations innovate in areas such as patient experience, clinical workflows and digital technology, write three physicians who have used it at their facilities. They say Agile helps users move from a system focused on meticulous planning to one that acknowledges, plans for and embraces change.  Health Affairs
Telehealth utilization between patients and health care providers not based at hospitals grew from 0.007% of all medical claim lines in 2014 to 0.104% in 2018, according to a FAIR Health analysis of data from more than 29 billion private health care claims. The usage increase was more pronounced in urban than in rural areas, and 31- to 40-year-olds accounted for 21% of all telehealth claim lines. Physician's Briefing/HealthDay News
CMS News 

The provisions of the SUPPORT Act that impact the Open Payments program and the additional proposed CMS changes appear as a rider to the 2020 Physician Fee Schedule. The CY 2020 Medicare Physician Fee Schedule Proposed Rule with comment period was placed on display at the Federal Register on July 29, 2019. CMS will accept comments on the proposed rule until September 27, 2019 and will respond to comments in the final rule. The proposed rule can be downloaded from the Federal Register at:
For further information, please visit theOpen Payments Law and Policy Page.
The American Hospital Association said the CMS should proactively identify billing codes for complex new technologies, rescind the JW modifier, align billing requirements with Current Procedural Terminology codes, minimize or rescind temporary Healthcare Procedure Coding System level II codes and revise recovery audit contractor incentives that cause improperly denied claims. The Healthcare Business Management Association, the American Academy of Ophthalmology and others said the CMS should reform the prior authorization process, particularly in Medicare Advantage, and America's Health Insurance Plans acknowledged that automating the process would make it less burdensome. RevCycle Intelligence
Use of generic versions of older drugs instead of updated brand-name medications could have saved Medicare Part D an estimated $17.7 billion from 2011 to 2017, according to a study in the Annals of Internal Medicine. Studies have shown that the updated drugs provide little or no therapeutic advantage. Becker's Hospital Review .


Affiliate Association News

2 weeks remain to get your representative and senator to your office and sit in your patient's chair! During the August congressional recess (August 1 - September 9) get your representative and senator to your practice, NOW! 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.
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.
- Oncology Nursing Certification-TWO-DAY COURSE
This two-day course will review key components of the oncology nursing certification  test blue print in an effort to assist oncology nurses to prepare for the exam. Target  audience for this course are: Oncology nurses who are planning to take the OCN exam; Nurses who are new to oncology and are seeking oncology specific CEU's; Oncology nurses who are already certified and seek to obtain oncology specific CEU's. This review course is structured to highlight the key areas of testing and to provide a collaborative working environment. For more information, call 562.698.0811 Ext. 12896 or click here .
- Register to secure your place at the 61st ASH Annual Meeting and Exposition in Orlando, December 7-10, 2019. The meeting will provide invaluable education, science, and networking opportunities. To register, you will need to sign in 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. Please note that SPARGO, Inc. is the only official housing and registration provider for the 61st ASH Annual Meeting and Exposition. For more information on housing and registration fees, please visit the ASH websiteView the preliminary program online.
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 to:
- Watch the Best of ASCO Meetings 2019 from the convenience of your home or office by accessing the cutting-edge science presented during the sessions. Purchase the captured sessions and high-resolutions slides presented at all three BOA meetings on any computer, tablet or mobile device.

- Submit your application for the 2020-2021 cycle of ASCO's Health Policy Leadership Development Program. This one-year program gives ASCO members the opportunity to develop expertise in health policy, advocacy, and grassroots activity while learning valuable leadership skills. Learn more 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 

Industry News

-  Genentech BioOncology informs ANCO and MOASC that the
United States Food and Drug Administration has approved Rozlytrek for the treatment of adults patients with ROS1-positive, metastatic non-small cell lung cancer (NSCLC), and for the treatment of adult and pediatric patients 12 years of age and older with solid tumors that have a neurotrophic tyrosine receptor kinase (NTRK) gene fusion without a known acquired resistance mutation, and are metastatic and have either progressed following prior therapies or as initial therapy when there are no acceptable standard therapies.

In This Issue


LunchTime Series
August 28, 2019

Educational Series 
November 14, 2019

Oncology Summit 
March 14, 2020

 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)

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