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.
MerckRecent FDA Approvals for Keytruda Details >~ 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 Details >
Immediate Past President, Jerome Seid, MD, FACP, is featured in The Detroit News Cancer patients aren’t alone in their fight.Details >Wednesday - December 5, 2018 12:00-1:00 PMRegistration is open! Details >
Eisai~ Oncology-related products: Aloxi® (palonosetron hydrochloride) injection, Halaven® (eribulin mesylate), Lenvima® (lenvatinib) capsules Details >
November 2018Includes multiple MolDX updates... Details >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. Details >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 Details >
Region 1 - Performant Recovery, Inc.Latest Issue Being Audited - Facility vs Non-facilty Reimbursement Details >This edition includes articles on......~ E&M Flat Rate Reimbursement Delayed to 2021 ~ CMS: Time to Modernize Medicare Advantage, Expand Telehealth Access Details >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 Details >
Special Webinar Series for Medical and Radiation OncologyTwo 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. Details >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 Details >
Last Updated 11/7/18Review the reported payer reimbursement issues MSHO is currently addressing... ~ WPS Medicare Issue with ESA J0881 and J0885 Denials - PARTIALLY RESOLVED Details >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 Details >Update on Injection and Infusion Services PolicyDetails >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... Details >~ Aetna OfficeLink Updates
~ BCN Provider News
~ Cigna
~ HAP/HealthPlus ProviderPlus
~ Humana YourPractice
~ UHC NetworkBulletin
~ UHC Medical Policy Update
Details >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 Details >
~ UnitedHealthcare Names 3 Biosimilars Preferred Treatments in 2019 MA Plans Details >
~ 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 Details >
November 2018, Frequently Asked QuestionsTopic: ~ 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 Details >
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