Welcome to the Reimbursement Bulletin
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.
~ The Financial Impact of the Sequester Cut to Medicare Part B Drug Reimbursement in Community Oncology
~ Physician Fee Schedule Year 3 Proposed Rule: Comments due September 10
~ House and Senate leaders push HRSA to finalize 340B regulations on drug pricing, penalties
~ Trump administration moves to give Medicare drug plans more control over their offerings
~ COA Position on Step Therapy in Medicare Advantage Plans
~ Medicare overpaid millions for radiation therapy planning services, OIG says Details >
The handouts and recording are available on the MSHO website!Included within this article is...
~ MSHO Proposed Rule E & M Fee Schedule Changes Analyzer Tool
~ Step by Step Instructions To Submit Your Comments!
*****Deadline is September 10th! Details >Wednesday, October 17, 2018Schoolcraft College - Livonia, MI
Agenda now available and the registration is open! Details >
Teva~ Oncology-related therapeutic products: Bendeka® (bendamustine hydrochloride) for injection, Synribo® (omacetaxine mepesuccinate) for injection, Treanda® (bendamustine HCl) for injection, Trisenox® (arsenic trioxide) for injection
~ Oncology-related supportive care products: Actiq® (oral transmucosal fentanyl citrate) [C-II], Fentora® (fentanyl buccal tablet) [C-II], Granix® (tbo- lgrastim) injection Details >~ PAN Establishes Amyloidosis Assistance Program
~ PAN Foundation Provider Newsletter Details >
September 2018Including...
~ WPS LCD changes related to MolDX changes 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.Latest Update August 2018 - Update regarding physician services during hospice period Details >This edition includes articles on......~ OMHA: New Changes Designed to Improve Medicare Appeals Process
~ CMS Appears Willing to Change Method of Selecting E&M Code
~ Impact on Work RVUs Expected to be Far-Reaching – Including the Revenue Cycle Details >Recent Oncology Related Articles~ Patients Over Paperwork: Medicare Physician Fee Schedule Proposed Rule Presentation
~ Quality Payment Program: Design Examples for CY 2019 Proposed Rule
~ CMS Proposes 50 Percent Reduction in Claims Submitted with Modifier 25
~ MIPS Targeted Review Request: Deadline October 1
~ 2019 eCQM Flows for EPs
~ 2016 PQRS and 2018 Value Modifier Experience Reports
~ Provider Minute: Laboratory and Diagnostic Services Billing Video
~ Claims for Biosimilar Drug Code Q5108
~ Next Generation ACO Model 2019 Benefit Enhancement MLN Matters Article
~ Diagnosis Coding: Using the ICD-10-CM Web-Based Training Course
~ Medicare Enrollment for Physicians, NPPs, and Other Part B Suppliers Booklet
~ CMS provides new flexibility to increase prescription drug choices and strengthen negotiation for Medicare enrollees Details >
Regarding Outpatient Hospital Site of Service Drugs~ And an additional IMPORTANT message from MSHO to all outpatient hospital providers Details >Recent Oncology Related News~ Reminder: Follow these guidelines when billing medical drugs that haven’t been purchased
~ Register for the September PGIP Quarterly Meeting Today
~ Medicare Plus BlueSM PPO manual update coming in October
~ Renflexis® requires authorization for BCN AdvantageSM starting Oct. 1
~ Change to Provider Taxonomy Code field – New name, same information
~ Phone numbers change for BCN Case Management and Care Transition programs
~ We're working on a system update to allow new patient evaluations, management services
~ National drug code (NDC) unit or basis for measurement code (code qualifier)
~ Medicare Advantage compliance audits to begin Oct. 1
~ Starting Oct. 1, additional specialty medications require authorization for BCN AdvantageSM members
~ We’ve canceled the modifier 25 payment adjustment for evaluation and management services
~ 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 9/4/18Review the reported payer reimbursement issues MSHO is currently addressing...
~ Medicare Plus Blue Xgeva Prior Authorization Issue Details >Recent Oncology Related Issues and NewsMedicaid Advantage Pending Issues;
**** Total Healthcare approving Aloxi!
**** Meridian approving Neulasta!
Also, in this update.....
**** Proposed Medicaid Policy on Claims for Medicaid Beneficiaries Eligible for Medicare
**** MSA Bulletin Updates
**** 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 >~ Changes to Prior Authorization Management
~ Update to UHC Reimbursement Policy Details >~ Aetna OfficeLink Updates
~ BCN Provider News
~ Cigna
~ HAP/HealthPlus ProviderPlus
~ Humana YourPractice
~ UHC NetworkBulletin
~ UHC Medical Policy Update
Details >Featuring this month: HAP Midwest Health Plan~ Who They Are
~ Benefit Requirements
~ Newsletter and Recent Changes Details >
~ FDA Grants Keytruda Priority Review to Treat Rare Form of Skin Cancer
~ Some Pharmacy Benefit Manager Practices May Erode Patient Access to Cancer Care, ASCO Analysis Finds
~ CMS Advisers Back Patient Reporting Tools for CAR-T Drugs Details >
~ Medical Economics September Issue
~ Avoiding a compliance and coding tug-of-war at your practice Details >
September 2018, Frequently Asked QuestionsTopics Include:
~ Multiple questions related to Medicare Proposed Changes to E & M Coding and Reimbursement Details > |
