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Welcome to the Reimbursement Bulletin!

In order to more easily view the new format of this Bulletin, we recommend you view it in your web browser. At the very top it says, "To view this bulletin in a web browser, click here." By viewing it this way, you eliminate the need to go back and forth between your email and web browser, making it much easier to navigate. We hope this helps you enjoy our updated Bulletin!

This Bulletin will be published semi-monthly.  As always, any comments, suggestions, stories or questions can be sent to billing@msho.org. We hope you enjoy this issue!

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A Message From Your E-bulletin Sponsor

Lilly's Verzenio Now Approved in Three Indications

The only CDK4 & 6 Inhibitor approved across HER+, HER2- MBC in combination with an AI or Fulvestrant and as a single agent.

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Important Oncology Related News

~ WPS GHA is Increasing the High Dollar Review Threshold Amount from $7,500 to $10,000!
- MSHO and ASCO Hold Call to Address the Negative Impact of the Pump Policy Change to G0498

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MSHO's Spring Reimbursement Meeting

Wednesday, April 25, 2018, 8:00 am - 3:30 pm

Lansing Community College - West Campus
~ LAST CALL TO REGISTER!
- (online registration closes this Thursday, April 19th.)

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BAYER

REACH - Nexavar (sorafenib) tablets

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WPS Oncology Related LCD Updates

April 2018

Including...
~April 2, 2018 MSHO Update on the National Coverage Determination for ESAs
-WPS LCD changes related to biosimilars (within "Drugs and Biologics (Non-Chemotherapy and Human Granulocyte/Macrophage Colony Stimulating Factor), and more...

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WPS Recent Oncology Related News

Part A, Part B and Part A/B News

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Join WPS for a Teleconference, Webinar or Seminar!

Check out these upcoming training events....

Including....
~ Teleconferences on 5/1 and 6/1 on MSP Overview and Appeals, In-person Seminar on 5/15 in Saginaw, "Medicare Day of Learning"

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Michigan RAC Information

Region 1 - Performant Recovery, Inc.

April 2018

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Recent RAC Monitor Articles

This edition includes articles on......

~ Advice for Coding Medical Necessity on Outpatient Claims

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CMS-Medicare

Recent Oncology Related Articles

~ CMS Transmittal 191 on OCM Bundling Edits
~ 2018 MIPS Eligibility Tool
~ Provider Compliance Tips for Oral Anticancer Drugs and Antiemetic Drugs Used in Conjunction
~ New Waived Tests MLN Matters Article
~ Claims Processing Actions to Implement Certain Provisions of the Bipartisan Budget Act of 2018 MLN Matters Article
~ April 2018 MLN Catalog
~ New Medicare Card Project
~ HCPCS Code Set Modifications
~ Institutional Billing for No Cost Items MLN Matters Article
~ 2018 Medicare Part C and Part D Reporting Requirements and Data Validation Web-Based Training Course
~ E/M Services Listening Session: Audio Recording and Transcript
~ Billing Requirements for OPPS Providers with Multiple Service Locations MLN Matters Article
~ Medicare Parts A and B Appeals Process Booklet

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BCBSM/BCN

Recent Oncology Related News

~ Reminder from MSHO - Z51.11 in first diagnosis position on BCBSM claims
~ Medicare Outpatient Observation Notice requirements clarified
~ Update on the two-midnight rule, provider audits
~ UPDATE: Professional claims – front-end edits on NPI
~ Effective July 1, no authorization is required for multiple sclerosis medications for Blue Cross, BCN commercial members
~ Clarification about hospital outpatient infusions
~ MOQC expands to include gynecologic cancers – targets improvement in quality of ovarian cancer care delivery
~ April 26, 2018 ICT Webinar: You’ve submitted a few claims; now what?
~ Blue Cross to update ClaimsXten with additional professional and outpatient facility edits in June

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Payer Issue Tracking Page

Last Updated 04/17/18

Review the reported payer reimbursement issues MSHO is currently addressing...
~ BCBSM is denying some drugs when the Z51.11 ICD10 code is in the first position.
~ BCBSM PPO is denying CPT 96366, therapeutic infusion additional hour when billed with 96413

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Medicaid

Recent Oncology Related Issues and News

Medicaid Advantage Pending Issues; stay tuned, MSA Bulletins, Biller "B" Aware Notices

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Priority Health

Update on Erythropoiesis Stimulating Agents (ESA) NCD/LCD

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Newsletters of Interest

~ Aetna OfficeLink Updates
~ BCN Provider News
~ Cigna
~ HAP/HealthPlus ProviderPlus
~ Humana YourPractice
~ UHC NetworkBulletin
~ UHC Medical Policy Update

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Managed Care Committee Reimbursement "TIDBITS"

Featuring this month: Priority Health

Update on Priority Health Advantage and coverage of ESA's!

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Recent Oncology Related News

~ Procedure code 99495 is payable
~ COA Practice Impact Report Details Consolidation, Shift of U.S. Cancer Care System Into More Expensive Hospital Setting
~ ASCO Volunteers Will Help Shape CMS Development of Episode-Based Cost Measures
~ Payment Bundles That Include Drug Costs May Destabilize Cancer Care Delivery Environment

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"Ask MSHO"

April 2018, Frequently Asked Questions

Topics Include: Modifiers for Biosimilar Products, New Medicare Card Release, New Medicare Card Required Timing of Use, the new TPE program by CMS, Office Visit and Injection Same Day, E & M Guidelines

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