like us on facebook connect with us on linkedin follow us on twitter August 22, 2018

Welcome to the Reimbursement Bulletin

MSHO Confidentiality Statement

We recommend you view the Bulletin in your web browser. At the very top, it says, "To view this bulletin in a web browser, click here." 

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

~ Physician Fee Schedule Proposed Rule: CMS Listening Sessions
~ 'Dangerous Nightmare for Cancer Patients': Step Therapy

Details >
Section Header

MSHO Hosts Webinar on Proposed E & M Changes and the Impact to Medical Oncology

Wednesday, August 29, 2018 at 12:00 pm EST

Comment Period Ends September 10th, do not miss this update!

Details >

MSHO's Fall Reimbursement Meeting

Wednesday, October 17, 2018

Schoolcraft College - Livonia, MI
REGISTRATION NOW OPEN!

Details >
Section Header

MSHO Featured Corporate Sponsor Assistance Program

SeattleGenetics

~ Oncology-related products: Adcetris® (brentuximab vedotin)

Details >

PAN Foundation Updates

~ Co-pay Accumulator Programs
~ Pan Foundation Provider Newsletter

Details >
Section Header

WPS Oncology Related LCD Updates

August 2018

Including...
~ 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 >

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....
~ Webinar - 09/12/18 CERT Overview
~ Teleconference - 09/19/18 Waivers to Extend Timely Filing
PLUS many more educational opportunities!

Details >
Section Header

Michigan RAC Information

Region 1 - Performant Recovery, Inc.

August 2018 - New update regarding physician services during hospice period

Details >

Recent RAC Monitor Articles

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 >

CMS-Medicare

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 >
Section Header

BCBSM/BCN

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 >
Section Header

Payer Issue Tracking Page

Last Updated 8/21/18

Review the reported payer reimbursement issues MSHO is currently addressing...
~ RESOLVED - WPS Medicare Doing Take Backs on Treanda, J9033

Details >

Medicaid

Recent Oncology Related Issues and News

Medicaid 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 >

Medicare Plus Blue

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 >

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: Aetna/Cofinity

~ Online Manual for Health Care Professionals
~ 180 Day Dispute Filing Standard
~ Drug Infusion Site of Care Policy

Details >
Section Header Section Header

Recent Oncology Related News

~ Physicians to Expect Greater Competition for Bonuses in 2019

Details >
Section Header

ASK MSHO

August 2018, Frequently Asked Questions

Topics Include:
~ Office Visit Coding Changes for 2019
~ Nurse Practitioner Education
~ Visit New Patient vs Established Patient
~ Free Transportation for Chemotherapy Appointments

Details >