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!
~ Physician Fee Schedule Proposed Rule: CMS Listening Sessions ~ 'Dangerous Nightmare for Cancer Patients': Step Therapy Details >
Wednesday, August 29, 2018 at 12:00 pm ESTComment Period Ends September 10th, do not miss this update! Details >Wednesday, October 17, 2018Schoolcraft College - Livonia, MI
REGISTRATION NOW OPEN! Details >
SeattleGenetics~ Oncology-related products: Adcetris® (brentuximab vedotin) Details >~ Co-pay Accumulator Programs ~ Pan Foundation Provider Newsletter Details >
August 2018Including... ~ CMS Re-work of the National Coverage Determination for ESAs Still Pending - NO UPDATE ~ WPS LCD changes related to ESA Q-codes, HIFU in the treatment of Recurrent Prostate Cancer, MolDX changes, Added C9467 for Rituximab and hyaluronidase human, 10 mg (for outpatient hospital use only) 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.... ~ Webinar - 09/12/18 CERT Overview ~ Teleconference - 09/19/18 Waivers to Extend Timely Filing PLUS many more educational opportunities! Details >
Region 1 - Performant Recovery, Inc.August 2018 - New update regarding physician services during hospice period Details >This edition includes articles on......~ CMS Proposes 50 Percent Reduction in Claims Submitted with Modifier 25 ~ Analysis: Deep Thoughts on the 2019 Proposed E&M Changes Details >Recent Oncology Related Articles~ New Medicare Card: Order Handouts for Patients That Did Not Get Their New Cards ~ Quality Payment Program: Design Examples for CY 2019 Proposed Rule ~ Quality Payment Program: Participation Status Tool Includes 2018 Data Snapshot ~ Medicare Physician Fee Schedule Database: October 2018 Update MLN Matters Article ~ HCPCS Drug/Biological Code Changes: October 2018 Update MLN Matters Article ~ PECOS for Physicians and NPPs Booklet ~ Advance Care Planning Fact Sheet ~ Medicare Part D Vaccines and Vaccine Administration Fact Sheet ~ Comparative Billing Report on Licensed Clinical Social Workers Webinar — September 12 ~ Quality Payment Program Year 2 Overview Web-Based Training Course ~ Quality Payment Program: MIPS Promoting Interoperability Performance Category Year 2 Web-Based Training Course ~ Quality Payment Program MIPS Quality Performance Category Year 2 Web-Based Training Course ~ Physician Fee Schedule Proposed Rule: Understanding 3 Key Topics Listening Session – August 22 Details >
Recent Oncology Related News~ National drug code (NDC) unit or basis for measurement code (code qualifier) ~ Look up patient eligibility easier with the new web-DENIS Prior Authorization button ~ Commercial Medical Drug Prior Authorization Program adds 3 groups, as of Sept. 1 ~ Medicare Advantage compliance audits to begin Oct. 1 ~ Starting Oct. 1, additional specialty medications require authorization for BCN AdvantageSM members ~ Billing chart: Blues highlight medical, benefit policy changes ~ We’ve canceled the modifier 25 payment adjustment for evaluation and management services ~ New radiation oncology program benefits providers offering ‘gold standard’ of care ~ Register for a medical specialty drug prior-authorization web tool refresher course ~ Effective Oct. 1, Prolia® and Xgeva® are subject to a site-of-care requirement for BCN HMOSM members Details >
Last Updated 8/21/18Review the reported payer reimbursement issues MSHO is currently addressing... ~ RESOLVED - WPS Medicare Doing Take Backs on Treanda, J9033 Details >Recent Oncology Related Issues and NewsMedicaid Advantage Pending Issues; Meridian approving Neulasta! Also, in this update..... Public Comment on MDHHS Medicaid Health Plan Common Formulary, MSA Bulletins, Biller "B" Aware Notices Details >System Updates~ Many updates/corrections. Listed below is a sampling of what you will find...
****Voided claims are incorrectly denying as duplicates
****Claims are denying against the Medicare 72 hour rule ****Coinsurance and reimbursement are applying incorrect rates for rural health center claims ****Specialty versus primary care physician copayments, wrong copay applied
****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: Aetna/Cofinity~ Online Manual for Health Care Professionals ~ 180 Day Dispute Filing Standard ~ Drug Infusion Site of Care Policy Details >
~ Physicians to Expect Greater Competition for Bonuses in 2019 Details >
August 2018, Frequently Asked QuestionsTopics Include: ~ Office Visit Coding Changes for 2019 ~ Nurse Practitioner Education ~ Visit New Patient vs Established Patient ~ Free Transportation for Chemotherapy Appointments Details >
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