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 27, 2019

This Weekly's Hot Topics  
  • DHCS releases its finalized telehealth policy for Medi-Cal FFS. California News
  • Control of workload, work-life balance and office atmosphere are factors that contribute to physician burnout and should be addressed along with EHR concern. National News
  • Significant changes to MOC standards. Affiliate Association 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 at .
In mid-August, the California Department of Health Care Services (DHCS) released its finalized telehealth policy update for the following:
Medi-Cal (California's Medicaid Program) fee-for-service program; An All Plan Letter (APL) for Managed Care; Indian Health Services, Memorandum of Agreement (IHS-MOAs); Family Plan, Access, Care and Treatment (Family PACT); Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). The policies were effective as of July 1, 2019 though only just released in their final form this month.  For more information regarding how the new fee-for-service policy differs from the previous policy as well as the proposed policy, see CCHP's comparison cross walk chart.

As 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.
As published in previous California Oncology Weekly's regarding PBM's, The Fresno Bee goes in-depth about the effects that California 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 Scroll down to Affiliate Association News  and read further on COA's action plan for anyone who is experiencing slow rolling on their CVS application to get into network. COA is reaching out for any new PBM horror stories you can share for their COA PBM Abuses campaign .
Scam artists posing as U.S. Drug Enforcement Administration (DEA) agents are calling California physicians and consumers as part of an international extortion scheme. While the scam is not new, a number of California physicians have reported recent extortion attempts.

Noridian News 

- Noridian/JEMAC has the following updates on their website
Overall Hospital Quality Star Ratings: Upcoming Enhancement; SNF Provider Preview Reports: Review Your Data by September 16; SNF PPS Patient Driven Payment Model: Get Ready for Implementation on October 1; Promoting Interoperability: 2019 Program Requirements for Hospitals; Quality Payment Program Exception Applications; Hospice Compare Refresh; MACRA Patient Relationship Categories and Codes: Reporting HCPCS Level II Modifiers
New Medicare Beneficiary Identifier (MBI) Get It, Use It-Reissued; Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB)-October 2019 Update; Quarterly Healthcare Common Procedural Coding System (HCPCS) Drug/Biological Code Changes-October 2019 Update; QPP: New Resources; 
* Telehealth Education on Demand
* MPFS Database-October 2019 Update CR11402
* HCPCS Drug/Biological Code Changes-October 2019 Update MM11422
* Open Public Meeting Announcement-September 9, 2019
* ACT Questions and Answers-July 24, 2019
* Medicare Coverable Services for Integrative and Non-pharmacological Chronic Pain Management SE19008
* New Medicare Beneficiary Identifier (MBI) Get It, Use It-Reissued SE18006
 Forthcoming Noridian JEMAC meetings/webinars/workshops
* 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  
- 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  
- Presentations from ANCO's ASCO Highlights 2019 are now available for download at

- 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 members will receive a complimentary registration when they register as an "Early Bird ANCO Member" for the Best of WCLC 2019-San Francisco. Learn more at; register at

ANCO annually funds one  Youn g 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

- ANCO's  Annual Professional Education Meeting 2019 is taking place at The Claremont Resort in Berkeley on October 17 . Register at

- 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

Control of workload, work-life balance and office atmosphere are factors that contribute to physician burnout and should be addressed along with EHR concerns, according to a study published in JAMA Network Open. Forty-five percent of the 282 providers surveyed reported burnout symptoms. EHR Intelligence
UnitedHealthcare now allows the update of approved prior authorizations. The change, effective immediately for its commercial lines of business, addresses the situation where a physician determines at the time of service a different or additional medically necessary procedure needs to be performed beyond that what was originally approved

CMS News 

- CMS has issued the FY2020 Hospice Payment Rate Update final rule and ASH has commented on the final rule's provisions related to coverage for palliative blood transfusions, the topic of ASH's recently released statement in support of palliative blood transfusions in hospice setting at
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 the Open Payments Law and Policy Page .

Affiliate Association News

- Tuesday, September 3, ACCC will host a webinar entitled CMS Proposed CY2020 Outpatient Prospective Payment System (OPPS) & Physician Fee Schedule (PFS) Rules: What You Need to Know on at 10:30AM PDT. Register 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 .
Community Oncology Alliance (COA) continues to contract with the law firm Frier Levitt to assist oncology practices with the cumbersome interaction with PBM's. Frier Levitt has provided the following action plan for anyone that is experiencing slow rolling on their CVS application on getting into network below. It can also be found on the COPA website under "Member Tools" and then select "PBM - Take Action" Jon and Jesse's contact info is located on that page as well for directly speaking to them on any matter. Please let Ricky Newton know if COA can do anything else to help in this matter. The more who participate in getting Frier Levitt to fight on your behalf on this issue the better since CVS may then back off on their current tactics and actually get everyone's applications approved. CLICK HERE for the Frier Levitt action plan.
- ASH applauds ABIM's announcement to make significant changes to maintenance of certification (MOC) standards. ABIM announced that it will provide diplomates with a new "self-paced pathway for physicians to acquire and demonstrate ongoing knowledge" in place of the high-stakes examination every 10 years and the two-year Knowledge Check-In. For more information on ABIM's changes, visit .
ASH signed on to a letter, led by the American Medical Association, expressing concern about recent guidance from the US Food and Drug Administration (FDA). The concern is that the guidance, Insanitary Conditions at Compounding Facilities, may place onerous restrictions on physician practices, threatening patient access to necessary and timely treatments. As the FDA works to finalize the draft guidance, the signees urge the agency to work closely with the physician community to determine the most appropriate path forward that ensures sterility of drug products prepared in office settings and maintains access to critical treatments for patients. To read the full letter, click here.
- 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 website View the preliminary program online .

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: .
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
- 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 .

- The QOPI Reporting Registry, a QCDR brought to you by ASCO and ASTRO, allows practices to report on CMS-approved quality measures as well as attest to participation in Improvement Activities and Promoting Interoperability. The registry supports continuous quality improvement and directly submits your data to MIPS. Sign up for electronic reporting by October 1 at .
Round 2 registration is now open, and data submission will run through 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

- Celgene informs ANCO and MOASC that the United States Food and Drug Administration has approved Inrebic capsules for the treatment of adult patients with intermediate-2 or high-risk primary or secondary (post-polycythemia vera or post-essential thrombocythemia) myelofibrosis (MF). For more information click HERE. 

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) 

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)

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

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 |