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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

AMGEN ASSIST 360

~ Help your patients find co-pay and reimbursement resources

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Important Oncology Related News

~ COA Files Lawsuit Against Federal Government to Stop Sequester Cut to Cancer Drug Reimbursement
~ Where the 340B Program Currently Stands
~ COA Physician Survey: Medicare Part B Proposals Will Harm Patients, Increase Costs and Bureaucracy
~ 'Eliminating the Middlemen': Trump Takes Aim at PBMs in Drug Pricing Speech

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MSHO's Medical Oncology Reimbursement 101 Webinar

Wednesday, July 25, 2018

Registration is Open!

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MSHO's Fall Reimbursement Meeting

Wednesday, October 17, 2018

Schoolcraft College - Livonia, MI
SAVE THE DATE!

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WPS Oncology Related LCD Updates

June 2018

Including...
~ CMS Re-work of the National Coverage Determination for ESAs Still Pending
~ WPS LCD changes related to the addition of Not Otherwise Classified J9999/C9467 Rituxan Hycela and LCD changes to MolDx...

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WPS Recent Oncology Related News

Part A, Part B and Part A/B News

Articles that may be of interest to oncology which were released in the past 2 weeks.

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Join WPS for a Teleconference, Webinar or Seminar!

Check out these upcoming training events....

Including....
~ Evaluation and Management Webinars;
**6/26 - on History,
**7/10 - on Exam,
**7/24 - on Medical Decision Making,
**7/31 - on Things to Think About
**8/14 - on Documentation
PLUS many more educational opportunities!

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Michigan RAC Information

Region 1 - Performant Recovery, Inc.

June 2018

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Recent RAC Monitor Articles

This edition includes articles on......

~ How Coding Errors Lead to Overpayment Recoveries

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CMS-Medicare

Recent Oncology Related Articles

~ ASCO Policy Brief: Quality Payment Program
~ 2016 Physician and Other Supplier PUF
~ Provider Minute Video: The Importance of Proper Documentation
~ New Medicare Beneficiary Identifier: Get It, Use It MLN Matters Article
~ Quality Payment Program Call: Audio Recording and Transcript
~ MIPS Promoting Interoperability Performance Category
~ Targeted Probe and Educate Video
~ CQM Annual Update
~ RARC, CARC, MREP, and PC Print Update MLN Matters Article
~ Enhanced “Drug Dashboards” to Increase Transparency on Drug Prices
~ Hospital Outpatient Quality Reporting Spring 2018 Newsletter
~ Coding for CAR-T
~ National Coverage Analysis on CAR-T
~ ICD-10 and Other Coding Revisions to National Coverage Determinations MLN Matters Article
~ 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

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BCBSM/BCN

Recent Oncology Related News

~ Blue Cross won’t cover 4 more infusion drugs at outpatient hospital sites without approval, starting July 1
~ BCBSM New Payable Procedures
~ IMPORTANT - Medicare Advantage PPO adding outpatient facilities to specialty medical medications prior authorization program beginning June 28, 2018
~ Sign up for a webinar on the Medicare Plus Blue PPO outpatient facility authorization requirements for specialty medical drugs
~ Cancellation of modifier 25 payment adjustment for evaluation and management services
~ Medicare Plus BlueSM PPO weekly claims-reprocessing report: June 2
~ Updated clinical practice guidelines now available at MQIC.org
~ Status update on observation care claims we're reprocessing
~ Payment recovery for discarded drug claims starting immediately
~ We’ve modified provider appeal time frames, effective June 1

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Payer Issue Tracking Page

Last Updated 6/5/18

Review the reported payer reimbursement issues MSHO is currently addressing...
~RESLOVED - BCBSM PPO is denying CPT 96366, therapeutic infusion additional hour when billed with 96413
~RESOLVED - Medicare Plus Blue no longer denying ESAs

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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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United Healthcare

Important Updates

~ Addition to National Drug Code Requirement Policy
~ Specialty Medication Administration - Site of Care Review Guidelines

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Medicare Plus Blue

System Updates

~ Many updates/corrections. Listed below is a sampling of what you will find...
**Claims Denying for Not Requesting Authorization
**Claims Denying Against the Medicare 72 Hour Rule
**System fix for Procrit J0885 and Aranesp J0881 Updated
**Claims Denying After Clinical Review
**System problem for Specialty vs Primary Care Physician Co-payments, wrong copay applied

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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: Physicians Health Plan-Mid Michigan

~ Timely Filing Limit
~ New Provider Portal
~ Medical Policies Online
~ Credentialing Rules for Physician Extenders

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Recent Oncology Related Drug News

~ URGENT: Important Safety Information - Notice of New Special Handling Instructions due to Potential for Cracked Needle Hubsand Particulate in Multiple  Carpuject Luer Lock Glass Syringe Products
~ June 1 deadline for new prescribing requirements: 5 readiness tips
~ ACTION REQUIRED: Survey on legislation mandating ePrescribing
~ Unexpected Costs at Pharmacy Counter
~ BLINCYTO® REMS Safety Update
~ FDA Chief Outlines New Ways To Speed Cancer Drug Approvals

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Recent Oncology Related News

~ ASCO Policy Issue Brief: Oncology Clinical Pathways
~ Recent Medical Economics Articles
~ Auditing Issues Uncovered in Physician Documentation: Part III

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ASK MSHO

June 2018, Frequently Asked Questions

Topics Include: ~CMS Guidance on Billing Administration for a No-cost Drug
~ Submitting Review Requests to NCCN
~ Status of CMS NCD for ESAs
~ Information on Advanced Care Planning
~ Unspecified Diagnosis Coding

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