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.
~ Medicare Advantage Appeal Outcomes and Audit Findings Raise Concerns About Service and Payment Denials
~ ATTENTION ALL MSHO MEMBERS - Managed Medicare Audits on Waste!
~ CMS Admits Errors In MIPS Payment Calculations After 'Target Review' Of Payment Factors Details >
DON'T MISS THIS OPPORTUNITY TO MEET WITH PAYERS Wednesday, October 17, 2018Schoolcraft College - Livonia, MI
Agenda updated and the registration is still open!
Approved for 7.0 CEUs by both AAPC and PMI! Details >SAVE THE DATE!
Registration will open November 1, 2018Webinar
December 5, 2018
12:00-1:00 PM
Details >
Astellas~ Oncology-related products: Tarceva® (erlotinib) tablets (co-marketed with Genentech, Inc.), Xtandi® (enzalutamide) capsules Details >
October 2018Including...
~ MolDX, ICD-10 Change to Chemotherapy Agents for Non-Oncologic Conditions, ICD-10 Change to Erythropoiesis Stimulating Agents, ICD-10 Change to Human Granulocyte/Macrophage Colony Stimulating Factor, and more... 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....
~ New On Demand E & M Training Opportunities
~ Webinars
**** CERT Part B Results - 10/17/2018
**** Medicare Beneficiary Identifier (MBI) Ask-the-Contractor Teleconference (ACT)
10/30/2018
**** PLUS many more educational opportunities! Details >
Region 1 - Performant Recovery, Inc.Latest Issue Being Audited - Facility vs Non-facilty Reimbursement Details >This edition includes articles on......~ Medicare Payment Perspective: Is Healthcare Really a Business? Details >Recent Oncology Related Articles~ QRURs and PQRS Feedback Reports: Access Ends December 31
~ MIPS Targeted Review Request: Deadline Extended to October 15
~ Quality Payment Program: MIPS Resources
~ Improper Payment for Intensity-Modulated Radiation Therapy Planning Services
~ Medicare Appeals Council: New Decision Format
~ ASP Pricing Files and Coverage for Drugs
~ ICD-10 and Other Coding Revisions to NCDs MLN Matters Article — Revised
~ Open Payments: Key Thresholds for Program Year 2019 Reporting
~ Open Payments: Program Year 2019 Teaching Hospital List
~ Physician Compare: Public Reporting Webinar Materials
~ Annual Clotting Factor Furnishing Fee: 2019 Update MLN Matters Article
~ Influenza Vaccine Payment Allowances: Annual Update MLN Matters Article
~ Influenza Virus Vaccine Code: January 2019 Update MLN Matters Article
~ Complying with Documentation Requirements for Lab Services Fact Sheet
~ 2016 PQRS and 2018 Value Modifier Experience Reports
~ Claims for Biosimilar Drug Code Q5108
~ Diagnosis Coding: Using the ICD-10-CM Web-Based Training Course
~ Medicare Enrollment for Physicians, NPPs, and Other Part B Suppliers Booklet Details >
Recent Oncology Related News~ October 18, 2018 ICT Webinar: You've submitted a few claims; now what?
~ Medical records requests will begin for commercial initiatives, Oct. 2018
~ Update: Magellan claims receiving edit error for invalid payer ID 01260
~ Updates to PPO professional, outpatient claim editing process coming in December
~ Reminder: Follow these guidelines when billing medical drugs that haven’t been purchased
~ Phone numbers change for BCN Case Management and Care Transition programs
~ National drug code (NDC) unit or basis for measurement code (code qualifier)
~ Register for a medical specialty drug prior-authorization web tool refresher course
~ BCBSM October RECORD Details >
Last Updated 10/2/18Review the reported payer reimbursement issues MSHO is currently addressing...
~ Medicare Plus Blue Xgeva Prior Authorization Issue- RESOLVED! Details >Recent Oncology Related Issues and News~ Medicaid 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 >~ Check out the Newest Programs available Details >~ HCCP Dual Eligible Plan
~ Changes to Prior Authorization Management
~ Update to UHC Reimbursement Policy 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: McLaren Health Plan/CareSource Michigan~ Updated prior authorization list with not many changes
~ McLaren Health Plan now offers a Medicare supplement policy
~ Visit their website Details >
~ How to Increase Access Cancer Drugs Discussed at NCCN Meeting
~ ASCO Comments on U.S. Food and Drug Administration Biosimilars Approval Process Details >
~ Medical Economics Magazine
~ Michigan legislature adopts minimum wage increase and paid sick leave ballot proposals.
~ The Growing Role for Nurse Practitioners & Physician Assistants in Oncology Details >
October 2018, Frequently Asked QuestionsTopic:
~ ATTENTION FINANCIAL NAVIGATORS - Medicare Advantage Plans have been approved to begin to allow "step edits" on Part B administered drugs beginning in 2019! Read these Q & As for more information! Details > |
