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!
~ 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 >
Outpatient Hospital Denials for ESAsDetails >Wednesday, July 25, 2018Recording and handouts will be available the day after the program Details >Wednesday, October 17, 2018Schoolcraft College - Livonia, MI
SAVE THE DATE! Details >
SANDOZ~ Oncology-related product: Zarxio® (filgrastim-sndz) Details >Sign up for PAN’s Financial Assistance Webinar for Hem/Onc ProvidersDetails >
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; **7/31 - 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......~ CMS Proposed E&M Changes: Reimbursement and Documentation Changes: Part I Details >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 >
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 >
Last Updated 7/25/18Review 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 >Recent Oncology Related Issues and NewsMedicaid Advantage Pending Issues; still pending, Public Comment on MDHHS Medicaid Health Plan Common Formulary, 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 >News Updates~ Medicare chart reviews starting soon ~ Request elective retrospective authorizations through Clear Coverage starting Aug. 15 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 >
~ Administrator Verma Statement on FDA’s Biosimilars Action Plan 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 >
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