like us on facebook connect with us on linkedin follow us on twitter November 07, 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

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A Message From Your Bulletin Sponsor

Merck

Recent FDA Approvals for Keytruda

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Important Oncology Related News

~ CMS Finalizes Changes to Physician Fee Schedule and Quality Payment Program  Nov 01, 2018
~ CMS Finalizes Rule that Encourages More Choices and Lower Costs for Seniors (OPPS Final Rule Released)
~ 2019 Physician Fee Schedule and Quality Payment Program Final Rule Released
~ CMS Finalizes 2019 Cuts to Hospital Outpatient Payments and 340B
~ COA Largely Commends CMS on Final Physician Fee Schedule Rule
~ Trump Administration Drug Pricing Plan Would Tie Medicare Part B Reimbursement to International Prices
~ Community Oncology Alliance Statement on Trump Administration’s Part B Payment Model Proposal
~ Site Neutral Payment, 340B Payment Cuts Raise Hospitals’ Hackles

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MSHO is Working Hard to Get Oral Parity Legislation Passed

Immediate Past President, Jerome Seid, MD, FACP, is featured in The Detroit News Cancer patients aren’t alone in their fight.

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MSHO Legislative Update Webinar
Key Changes for 2019

Wednesday - December 5, 2018 12:00-1:00 PM

Registration is open!

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MSHO Featured Corporate Sponsor Assistance Program

Eisai

~ Oncology-related products: Aloxi® (palonosetron hydrochloride) injection, Halaven® (eribulin mesylate), Lenvima® (lenvatinib) capsules

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WPS Oncology Related LCD Updates

November 2018

Includes multiple MolDX updates...

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WPS Recent Oncology Related News

Part A, Part B and Part A/B News

~ ESA Rejections Addressed and Partially Resolved
~ Articles that may be of interest to oncology which were released in the past 2 weeks.

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Join WPS for a Teleconference, Webinar or Seminar!

Check out these upcoming training events....

Including....
~ Teleconference:
**** 01/08/19 New to Medicare National and Local Coverage Determinations
**** 01/16/19 Provider Enrollment Ask-the-Contractor
**** PLUS many more educational opportunities!
~ New On Demand E & M Training Opportunities

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Michigan RAC Information

Region 1 - Performant Recovery, Inc.

Latest Issue Being Audited - Facility vs Non-facilty Reimbursement

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Recent RAC Monitor Articles

This edition includes articles on......

~ E&M Flat Rate Reimbursement Delayed to 2021
~ CMS: Time to Modernize Medicare Advantage, Expand Telehealth Access

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CMS-Medicare

Recent Oncology Related Articles

~ Groups to Sue CMS Over Site-Neutral Payments
~ Final Rules from CMS Offer Something for Everyone
~ Physician Fee Schedule Final Rule: Understanding 3 Key Topics Call — Monday, November 19 from 2 to 3:30 pm ET
~ MRI MLN Matters Article
~ Patient Relationship Categories and Codes Webcast: Audio Recording and Transcript
~ Medicare and Medicaid Basics Booklet
~ Quality Payment Program 2018 MIPS Cost Performance Category Web-Based Training Course
~ Quality Payment Program 2018 MIPS Improvement Activities Performance Category Web-Based Training Course
~ Quality Payment Program 2018 MIPS APMs Web-Based Training Course
~ Quality Payment Program 2018 Advanced APMs Web-Based Training Course
~ CMS announces 2019 Medicare Parts A & B premiums and deductibles
~ LCDs MLN Matters Article
~ Updates to the OCM Quality Measures and Lessons Learned Moving Forward

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BCBSM/BCN Launching AIM Specialty Health Initiative

Special Webinar Series for Medical and Radiation Oncology

Two new utilization management programs launching January 1, 2019. Multiple webinar opportunities available for Medical and Radiation oncology, as well as clinical and non-clinical staff.

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BCBSM/BCN

Recent Oncology Related News

~ Continuity of Care in place for URMBT members in the medical or radiation oncology programs
~ REMINDER: EDI Professional Commercial Payer List – Updates
~ Attention CT, MRI specialists: Sign up for OptiNet® webinar, opt in for patient referrals
~ Cinqair, Nucala, Xolair added to site of care infusion requirement, beginning Jan. 1
~ Reminder - New Institutional Blue Care Network edit: NDC DRUG QUANTITY MUST BE GREATER THAN ZERO
~ Medicare Part B medical specialty drug prior authorization lists changing in 2019
~ AllianceRx Walgreens Prime specialty pharmacy program starts Jan. 1
~ We're telling BCN Advantage members they don't need referrals
~ BCBSM grants MOC exceptions
~ Onpattro, Poteligeo, Signifor LAR added to medical benefit specialty drug prior authorization program for commercial members
~ Some medical benefit drugs for Medicare Advantage members need step therapy,  starting January 1
~ Reminder: Follow these guidelines when billing medical drugs that haven’t been purchased
~ BCBSM November RECORD

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Payer Issue Tracking Page

Last Updated 11/7/18

Review the reported payer reimbursement issues MSHO is currently addressing...
~ WPS Medicare Issue with ESA J0881 and J0885 Denials - PARTIALLY RESOLVED

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Medicaid

Recent Oncology Related Issues and News

~ Medicaid Advantage Pending Issues;
MSHO Addressing Managed Medicaid Plans with Medical Drug Benefit Restrictions

Also, in this update.....
~ Public Comment on MDHHS Medicaid Health Plan Common Formulary - Comments Due by November 23rd
~ Michigan Second State To Pursue Outcomes-Based Contracts For Medicaid Rx Pricing
~ Proposed Medicaid Policy on Claims for Medicaid Beneficiaries Eligible for Medicare
~ MSA Bulletin Updates
~ Biller "B" Aware Notices

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United Healthcare Update

Update on Injection and Infusion Services Policy

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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
****Facility claims are in paid status but there's no paid amount for out of state claims
****Coinsurance and reimbursement are applying incorrect rates for rural health center claims
****and more...

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Newsletters of Interest

~ Aetna OfficeLink Updates
~ BCN Provider News
~ Cigna
~ HAP/HealthPlus ProviderPlus
~ Humana YourPractice
~ UHC NetworkBulletin
~ UHC Medical Policy Update

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Managed Care Committee Reimbursement TIDBITS

Featuring this month: United Healthcare

~ UHC is retiring fax numbers used for Medical Prior Auth
~ Optum will begin managing the prior authorization requests for outpatient injectable chemotherapy and related cancer therapies
~ Billing issue for intravenous and subcutaneous immune globulin and Remicade

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Recent Oncology Related Drug News

~ UnitedHealthcare Names 3 Biosimilars Preferred Treatments in 2019 MA Plans

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Recent Oncology Related News

~ Surprise Deal: Cardinal Health Sells Its Specialty Pharmacy (Again)
~ PAN Foundation Updates
~ ASCO Submits Two Comment Letters to the FDA on Modernizing Clinical Trials
~ Physicians' EHR work-arounds

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ASK MSHO

November 2018, Frequently Asked Questions

Topic:
~ Michigan Rules for Medical Assistants
~ Treating a patient from Inpatient Rehab
~ Drug Waste for Imfinzi
~ Definition of "Step Edit"
~ Electronic Signatures on Orders
~ Medicare CERT Program
~ Billing for 2 Pushes

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