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!
~ COA Supports 340B Drug Discount Accountability Act
~ 3 Takeaways From Azars Speech at 340B Conference
~ Radiation Oncologists Urge Congress To Protect Patient Access To Cancer Care
~ CMS to test Medicare Advantage as alternative payment model under MACRA Details >
Understanding Michigan Opioid LawsMSHO partnered with LARA and DHHS. The recording and handouts are available! Details >Wednesday, July 25, 2018Register Today! Details >Wednesday, October 17, 2018Schoolcraft College - Livonia, MI
SAVE THE DATE! Details >
SANDOZ~ Oncology-related product: Zarxio® (filgrastim-sndz) Details >
July 2018Including...
~ CMS Re-work of the National Coverage Determination for ESAs Still Pending
~ WPS LCD changes related to MolDx's and ESA Biiosimilar additions... 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;
**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.July 2018 - No New Updates Details >This edition includes articles on......~ How Many Hours Are in a Day?
~ Whistleblowers Often Face Retaliation for Exposing Healthcare Fraud Details >Recent Oncology Related Articles~ CMS Proposes Rule Change to Protect Medicaid Provider Payments
~ MIPS: Understanding and addressing topped-out measures
~ MIPS Payment Adjustment Targeted Review: Request by September 30
~ Qualified Medicare Beneficiary Information on RAs and MSNs
~ Public Reporting on Physician Compare Webinar — July 24 or 26
~ IMPACT Act Call: Audio Recording and Transcript
~ New Medicare Card: Use MBI Like HICN Details >
Recent Oncology Related News~ Erroneous WPS 277CA reports and transactions
~ E-referral system is pending outpatient authorization requests for patients with the Blue Cross Blue Shield of Michigan plans
~ Monthly status report for Medicare Plus BlueSM professional, facility claims
~ 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
~ Don't miss this months RECORD to review policy changes/updates on:
****Cinvanti™ (aprepitant)
****FDA approves Lutathera
****Positron emission tomography for oncologic conditions
****Genetic testing – analysis of MGMT promoter methylation in malignant gliomas
****Genetic testing — Human platelet antigen genotyping
****Miscellaneous genetic and molecular diagnostic tests Details >
Last Updated 7/10/18Review the reported payer reimbursement issues MSHO is currently addressing...
~Priority Health Split Claims Causing Rejections Details >Recent Oncology Related Issues and NewsMedicaid Advantage Pending Issues; stay tuned, MSA Bulletins, Biller "B" Aware Notices Details >Important News Updates~ Update to allow 30-day supplies of short-acting opioids
~ Medicare chart reviews starting soon
~ Requesst elective retrospective authorizations through Clear Coverage starting Aug. 15 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 fixed for Procrit J0885 and Aranesp J0881, all claims paid, issue closed
****and more... Details >~ Aetna OfficeLink Updates
~ BCN Provider News
~ Cigna
~ HAP/HealthPlus ProviderPlus
~ Humana YourPractice
~ UHC NetworkBulletin
~ UHC Medical Policy Update
Details >Featuring this month: Total Health Care, Inc~ Timely Filing Requirements
~ Medicaid Billing Guidelines
~ Prior Authorization Issues Being Addressed By MSHO Details >
~ FDA limits the use of Tecentriq and Keytruda for some urothelial cancer patients
~ Drug Discount Program: Federal Oversight of Compliance at 340B Contract Pharmacies Needs Improvement Details >
~ The Controversy Continues: Medical Necessity versus MDM
~ More Cash-Pay Patients Means Docs Need Billing Strategies
~ Physicians Voice frustration over Payer Interference Details >
July 2018, Frequently Asked QuestionsTopics Include:
~ Two Sites SBRT
~ Opdivo MUE
~ Vial Size and Drug Waste
~ Push or Infusion Code
~ Use of New Medicare Card
~ JW and Fraction of Dose Administered Details > |
