Welcome to the Reimbursement Bulletin!
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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!
Lilly's Verzenio Now Approved in Three IndicationsThe only CDK4 & 6 Inhibitor approved across HER+, HER2- MBC in combination with an AI or Fulvestrant and as a single agent. Details >~ 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 Details >
Wednesday, April 25, 2018, 8:00 am - 3:30 pmLansing Community College - West Campus
~ LAST CALL TO REGISTER! - (online registration closes this Thursday, April 19th.) Details >
April 2018Including... ~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... Details >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" Details >
Region 1 - Performant Recovery, Inc.April 2018 Details >This edition includes articles on......~ Advice for Coding Medical Necessity on Outpatient Claims Details >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 Details >
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 Details >
Last Updated 04/17/18Review 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 Details >Recent Oncology Related Issues and NewsMedicaid Advantage Pending Issues; stay tuned, MSA Bulletins, Biller "B" Aware Notices Details >Update on Erythropoiesis Stimulating Agents (ESA) NCD/LCDDetails >~ Aetna OfficeLink Updates
~ BCN Provider News
~ Cigna
~ HAP/HealthPlus ProviderPlus
~ Humana YourPractice
~ UHC NetworkBulletin
~ UHC Medical Policy Update
Details >Featuring this month: Priority HealthUpdate on Priority Health Advantage and coverage of ESA's! Details >
~ U.S. Medicare Sets Outpatient Rate For Yescarta Reimbursement Details >
~ 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 Details >
April 2018, Frequently Asked QuestionsTopics 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 Details >
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