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!
Merck-KEYTRUDA®~ April 2018 New England Journal of Medicine publication that discusses KEYTRUDA® (pembrolizumab) Injection 100 mg. Details >~ White House Proposes Cuts to CMMI in New Rescission Proposal
~ Administration Releases Drug Pricing and Cost Containment Plan
~ COA Statement on President’s Blueprint to Lower Drug Prices
~ ASH Policy Statement in Support of Patient Access to Safe and Effective Drugs Details >
Wednesday, July 25, 2018SAVE THE DATE! Details >Wednesday, October 17, 2018Schoolcraft College - Livonia, MI
SAVE THE DATE! Details >
May 2018Including...
~ May 2, 2018 CMS Re-work of the National Coverage Determination for ESAs Still Pending
~ WPS LCD changes related to MolDx... Details >Part A, Part B and Part A/B NewsArticles that may be of interest to oncology which were released in the past 2 weeks. Details >Check out these upcoming training events....Including....
~ Teleconference on 6/5 on New to Medicare- Appeals Overview, and many more! Details >
Region 1 - Performant Recovery, Inc.May 2018 Details >This edition includes articles on......~ Auditors Going from Targeting Just Physicians to Targeting Physicians and NPPs
~ Exclusive: Medicaid: The State of the Union Details >Recent Oncology Related Articles~ Oncology Care Model Update—Stakeholders’ Perspectives
~ First CMS Rural Health Strategy
~ Hospital Compare Preview Reports Available through June 2
~ eCQM Annual Update
~ New Medicare Cards: You Can Use MBIs Right Away
~ Administrative Simplification: Transactions
~ Can’t Find An Answer To Your Question?
~ Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes – July 2018 Update
~ Quarterly Update to the NCCI PTP Edits, Version 24.2 MLN Matters Article
~ Guidelines for Teaching Physicians, Interns, and Residents Booklet
~ ICD-10-CM/PCS: The Next Generation of Coding Booklet
~ General Equivalence Mappings FAQs Booklet Details >
Recent Oncology Related News~ Reminder from MSHO - Z51.11 in first diagnosis position on BCBSM claims
~ Reminder: EDI Professional Commercial Payer List - Updated payer IDs effective April 23, 2018
~ Medicare Plus BlueSM PPO weekly claims-reprocessing report: May 19 (Oncology Related)
~ Status update on observation care claims we're reprocessing
~ Medicare Plus BlueSM PPO weekly claims-reprocessing report: May 12 (Oncology Related)
~ Payment recovery for discarded drug claims starting immediately
~ Provider manual Utilization Management changes coming June 28; Specialty Medication Prior-Authorization Program adding outpatient facility sites of care
~ Effective July 1, BCN won’t accept late claims
~ Clinical Quality Corner tip sheets updated for 2018
~ More medical drugs added to site of care infusion requirement, beginning July 1
~ We’ve modified provider appeal time frames, effective June 1 Details >
Last Updated 5/15/18Review 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 >HAP Reduces Authorization RequirementsDetails >System Updates~ System fix for Procrit J0885 and Aranesp J0881
~ System problem for Specialty vs Primary Care Physician Co-payments, wrong copay applied Details >System Updates~ Priority Health and Cigna Form Alliance
~ Update on Erythropoiesis Stimulating Agents (ESA) NCD/LCD Details >~ Aetna OfficeLink Updates
~ BCN Provider News
~ Cigna
~ HAP/HealthPlus ProviderPlus
~ Humana YourPractice
~ UHC NetworkBulletin
~ UHC Medical Policy Update
Details >Featuring this month: Priority Health~ Biosimilars preferred over Remicade® effective July 1
~ Practitioner Medicare billing edits change effective June 1
~ New process: Unlisted codes on facility claims Details >
~ LONSURF Pivotal Phase 3 Trial Results
~ FDA approval of Akynzeo IV Details >
~ Auditing Issues Uncovered in Physician Documentation: Part I
~ LARA: New opioid laws FAQs Details >
May 2018, Frequently Asked QuestionsTopics Include: WPS High Dollar Review, "Incident To" and Midlevel Providers, Concurrent Infusion and Discharging a Patient Details > |
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