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!
~ UPDATED Opioid Laws FAQ's
~ Medicare Payment Advisory Commission Releases Report on Medicare and the Health Care Delivery System
~ Azar Blasts Proposal for Medicare to Negotiate Drug Prices Details >
Webinar - Understanding Michigan Opioid LawsThursday, June 28, 2018, 12:00-1:00PM, Register Now! 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......~ Aetna Whistleblower Sues CVS’s Pharmacy Benefit Management Division for Spread Pricing Details >Recent Oncology Related Articles~ Billing for Stem Cell Transplants
~ FY 2019 ICD-10-CM Diagnosis Codes
~ Update of the Hospital OPPS: July 2018 MLN Matters Article
~ I/OCE Specification Version 19.2: July 2018 MLN Matters Article
~ Transition to New Medicare Numbers and Cards Fact Sheet
~ CMS Web Wheel Educational Tool
~ Avoiding Medicare Fraud & Abuse: A Roadmap for Physicians Web-based Training
~ Remittance Advice Resources and FAQs Booklet
~ View Your MIPS Preliminary Performance Feedback Data
~ Physician Compare Downloadable Database: 2016 Performance Scores Details >
Recent Oncology Related News~ Effective Oct. 1, Prolia® and Xgeva® are subject to a site-of-care requirement for BCN HMOSM members
~ 2018 InterQual® criteria to be implemented starting Aug. 1
~ We're reprocessing some observation care claims
~ Effective June 22, submit appeals of eviCore decisions on BCN Advantage requests to BCN, not to eviCore
~ June 27, 2018 ICT Webinar: You've submitted a few claims; now what?
~ Medicare Advantage PPO adding outpatient facilities to specialty medical medications prior authorization program beginning June 28, 2018
~ 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 Details >
Last Updated 6/19/18Review the reported payer reimbursement issues MSHO is currently addressing...
~Priority Health Split Claims Causing Rejections
~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 >
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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