like us on facebook connect with us on linkedin follow us on twitter July 25, 2018

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!

Section Header

Important Oncology Related News

~ 2019 Physician Fee Schedule Proposed Rule Released
~ Community Oncology Alliance Finds Proposals in 2019 Medicare Physician Fee Schedule Puzzling
~ 340B Drug Rebate Lawsuit Dismissed
~ Seems Verma, CMS Administrator Pledges to Reduce Provider Burden in Documenting Visits

Details >
Section Header

MSHO Reimbursement Alert

Outpatient Hospital Denials for ESAs

Details >

MSHO's Medical Oncology Reimbursement 101 Webinar

Wednesday, July 25, 2018

Recording and handouts will be available the day after the program

Details >

MSHO's Fall Reimbursement Meeting

Wednesday, October 17, 2018

Schoolcraft College - Livonia, MI
SAVE THE DATE!

Details >
Section Header

MSHO Featured Corporate Sponsor Assistance Program

SANDOZ

~ Oncology-related product: Zarxio® (filgrastim-sndz)

Details >

PAN Foundation Updates

Sign up for PAN’s Financial Assistance Webinar for Hem/Onc Providers

Details >
Section Header

WPS Oncology Related LCD Updates

July 2018

Including...
~ CMS Re-work of the National Coverage Determination for ESAs Still Pending
~ WPS LCD changes related to MolDx's and ESA Biiosimilar additions...

Details >

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.

Details >

Join WPS for a Teleconference, Webinar or Seminar!

Check out these upcoming training events....

Including....
~ Evaluation and Management Webinars;
**7/31 - on Things to Think About
**8/14 - on Documentation
PLUS many more educational opportunities!

Details >
Section Header

Michigan RAC Information

Region 1 - Performant Recovery, Inc.

July 2018 - No New Updates

Details >

Recent RAC Monitor Articles

This edition includes articles on......

~ CMS Proposed E&M Changes: Reimbursement and Documentation Changes: Part I

Details >

CMS-Medicare

Recent Oncology Related Articles

~ MIPS 2017 Performance Feedback User Guide
~ MIPS Payment Adjustment Targeted Review: Request by October 1
~ MIPS 2019 Payment Adjustment Fact Sheet
~ New MBI: Get It, Use It MLN Matters® Article
~ Chronic Care Management Services: Changes for 2017 Fact Sheet
~ Chronic Care Management Services Fact Sheet
~ Qualified Medicare Beneficiary: Learn about State Medicaid Agency Requirements
~ Proper Use of the KX Modifier for Part B Immunosuppressive Drug Claims

Details >
Section Header

BCBSM/BCN

Recent Oncology Related News

~ New radiation oncology program benefits providers offering ‘gold standard’ of care
~ Register for a medical specialty drug prior-authorization web tool refresher course
~ 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 >
Section Header

Payer Issue Tracking Page

Last Updated 7/25/18

Review the reported payer reimbursement issues MSHO is currently addressing...
~Priority Health Split Claims Causing Rejections **RESOLVED - Priority Has Agreed To Remove The Edit Effective Immediately!!!
~ WPS Medicare Doing Take Backs on Treanda, J9033

Details >

Medicaid

Recent Oncology Related Issues and News

Medicaid Advantage Pending Issues; still pending, Public Comment on MDHHS Medicaid Health Plan Common Formulary, MSA Bulletins, Biller "B" Aware Notices

Details >

United Healthcare

Important Updates

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

Details >

Priority Health

News Updates

~ Medicare chart reviews starting soon
~ Request elective retrospective authorizations through Clear Coverage starting Aug. 15

Details >

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 fixed for Procrit J0885 and Aranesp J0881, all claims paid, issue closed
****and more...

Details >

Newsletters of Interest

~ Aetna OfficeLink Updates
~ BCN Provider News
~ Cigna
~ HAP/HealthPlus ProviderPlus
~ Humana YourPractice
~ UHC NetworkBulletin
~ UHC Medical Policy Update

Details >

Managed Care Committee Reimbursement TIDBITS

Featuring this month: Total Health Care, Inc

~ Timely Filing Requirements
~ Medicaid Billing Guidelines
~ Prior Authorization Issues Being Addressed By MSHO

Details >
Section Header

Recent Oncology Related Drug News

~ Administrator Verma Statement on FDA’s Biosimilars Action Plan

Details >
Section Header Section Header

ASK MSHO

July 2018, Frequently Asked Questions

Topics 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 >