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!
AMGEN ASSIST 360~ Help your patients find co-pay and reimbursement resources Details >~ 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 Details >
Wednesday, July 25, 2018Registration is Open! Details >Wednesday, October 17, 2018Schoolcraft College - Livonia, MI
SAVE THE DATE! Details >
June 2018Including... ~ 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... 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.... ~ 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! Details >
Region 1 - Performant Recovery, Inc.June 2018 Details >This edition includes articles on......~ How Coding Errors Lead to Overpayment Recoveries Details >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 Details >
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 Details >
Last Updated 6/5/18Review 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 Details >Recent Oncology Related Issues and NewsMedicaid Advantage Pending Issues; stay tuned, MSA Bulletins, Biller "B" Aware Notices Details >Important Updates~ Addition to National Drug Code Requirement Policy ~ Specialty Medication Administration - Site of Care Review Guidelines Details >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 Details >~ Aetna OfficeLink Updates
~ BCN Provider News
~ Cigna
~ HAP/HealthPlus ProviderPlus
~ Humana YourPractice
~ UHC NetworkBulletin
~ UHC Medical Policy Update
Details >Featuring this month: Physicians Health Plan-Mid Michigan~ Timely Filing Limit ~ New Provider Portal ~ Medical Policies Online ~ Credentialing Rules for Physician Extenders Details >
~ 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 Details >
~ ASCO Policy Issue Brief: Oncology Clinical Pathways ~ Recent Medical Economics Articles ~ Auditing Issues Uncovered in Physician Documentation: Part III Details >
June 2018, Frequently Asked QuestionsTopics 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 Details >
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