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.
Warm Holiday wishes from our family to yoursThe MSHO office will be closed Dec. 19, 2018 - Jan. 1, 2019 Details >~ CMS Proposal Effectively Unprotects Six Protected Classes ~ HHS implements long-awaited 340B drug price transparency rule ~ COA Statement: CMS Proposal Effectively Unprotects Six Protected Classes ~ New CMS Proposal Includes Prior Authorization and Step Therapy for Part D Drugs ~ Compromising Patient Protections to Lower Drug Costs Could Harm People with Cancer ~ CMS Proposes Drug Reimbursement Changes Under Medicare Part C and D Details >
Do You Know the Impact of the 2019 Reimbursement Changes on your E/M and Administration Codes?Made exclusively for MSHO, we have created a tool to make the analysis easier! Details >List of Oncology Related New/Revised/Deleted HCPCS CodesWATCH OUT! Among other changes; J9310 Rituximab 100 mg DELETED and replaced with J9312 Rituximab 10 mg! Details >The handouts and recording are available on the MSHO website!Details >
Genentech/OSI~ Oncology-related products include: Alecensa® (alectinib) capsules, Avastin® (bevacizumab), Cotellic® (cobimetinib) tablets, Erivedge® (vismodegib), Gazyva® (obinutuzumab), Hemlibra® (emicizumab-kxwh), Herceptin® (trastuzumab), Kadcyla® (ado-trastuzumab emtansine), Perjeta® (pertuzumab) for injection, Rituxan® (rituximab), Rituxan
HycelaTM (rituximab and hyaluronidase human), Tarceva® (erlotinib), Tecentriq® (atezolizumab), VenclextaTM (venetoclax), Zelboraf® (vemurafenib) tablets Details >
December 2018There are no new Oncology related policies/articles this month Details >Part A, Part B and Part A/B News~ 11/28/18 WPS Update to the ESA Rejections ~ WPS Articles that may be of interest to oncology were released in the past 2 weeks. ~ Medicare Hot Links to Fee Schedules and Final Rules 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......~ A Stitch in Time: An Indictment of the CMS Appeals Process Details >Recent Oncology Related Articles~ RARC, CARC, MREP and PC Print Update ~ Quality Payment Program Year 1 Performance Results ~ QRURs and PQRS Feedback Reports: Access Ends December 31 ~ Quality Payment Program: Visit the Resource Library Website ~ Medicare Deductible, Coinsurance and Premium Rates: 2019 Update MLN Matters Article ~ Medicare Billing: CMS Form CMS-1500 and the 837 Professional Booklet 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~ AllianceRx Walgreens Prime specialty pharmacy program starts Jan. 1 ~ Medicare Plus BlueSM PPO manual update coming in January ~ AIM provider portal experiencing system issues ~ Blue Cross Complete lab services update ~ eviCore to manage two radiopharmaceutical drugs, starting Feb. 1 ~ Tips to differentiate home health care from home infusion services ~ December 13, 2018 ICT Webinar: You’ve submitted a few claims; now what? ~ Correction: List of medical drugs in commercial Medical Drug Prior Authorization Program ~ Enhancements to the 835 ~ Continuity of Care in place for URMBT members in the medical or radiation oncology programs ~ 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 ~ BCBSM grants MOC exceptions ~ 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 ~ The Record December 2018 Details >
Last Updated 12/4/18Review the reported payer reimbursement issues MSHO is currently addressing... ~ WPS Medicare Issue with ESA J0881 and J0885 Denials - PARTIALLY RESOLVED - New Update from WPS 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 ~ MSA Bulletin Updates ~ Biller "B" Aware Notices Details >Priority Health Fee Schedule UpdateThey Have Re-posted the 4th Quarter Immunization and Injections Fee Schedule Due To An Error Details >System UpdatesMany 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: UnitedHealthcare Community Plan~ Medical Benefit Drug Policy had Diagnosis Code Requirements for IVIG ~ Site of Care Policy ~ Outpatient Prior Authorization through Optum Details >
~ A Prescribers Guide to the New Medicare Part D Opioid Policies for 2019 ~ Access to Care & Drug Pricing: 2018 ~ UnitedHealthcare Names 3 Biosimilars Preferred Treatments in 2019 MA Plans Details >
~ ASCO and Friends of Cancer Research Applaud NCI’s Expansion of Clinical Trial Eligibility Criteria ~ Latest Issue of Medical Economics Details >
December 2018, Frequently Asked QuestionsTopic: ~ New code for billing a phone call ~ Virtual Check-In coding questions ~ New code for remove evaluation of video or image ~ Modifier 25 ~ What happened with the E & M codes for 2019 Details >
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