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.
~ MIPS 2019 Payment Adjustment Confusion
~ Trump Administration Proposes Big Changes In How Prescription Drugs Are Priced
~ COA Applauds HHS for Taking Strong Step Towards Ending Secretive Rebate System
~ More than 60 Leading Health Care Organizations Call on CMS to Maintain Coverage for Medically Necessary Cancer Testing
~ CMS proposes Medicare Advantage and Part D payment and policy updates to maximize competition and coverage Details >AMGEN ASSIST 360~ Help your patients find co-pay and reimbursement resources Details >
March 13, 2019 12:00 - 1:00 PMREGISTER TODAY!!! Details >March 21 - 22, 2019ATTENTION ONCOLOGY BILLERS - Do not miss this amazing opportunity to become a Certified Hematology Oncology Coder!!
~Registration is OPEN! Details >The handouts and recording are available on the MSHO website Details >
Janssen Biotech, Inc.~ Oncology-related products include: Darzalex® (daratumumab), Doxil® (doxorubicin HCl liposome injection), Erleada™ (apalutamide), Procrit® (epoetin alfa), Sylvant® (siltuximab), Yondelis® (trabectedin), Zytiga® (abiraterone acetate) Details >
February 2019Including...
~ Human Granulocyte/Macrophage Colony Stimulating Factors Billing and Coding Guidelines
~ 2019 MolDX Updates
~ Drug Administration Coding - Effective February 1, 2019 Details >Part A, Part B and Part A/B NewsIncludes articles that may be of interest to oncology released in the past 2 weeks
~ Also, Medicare Hot Links to Fee Schedules and Final Rules Details >Check out these upcoming training events....Including....
**** Webinar: 2/12/19 - New to Medicare, Exploring Resources
**** Teleconference: 2/20/19 Provider Enrollment Revalidation
**** PLUS many more educational opportunities including On-Demand E & M training opportunities! Details >
Region 1 - Performant Recovery, Inc.Nothing new specific to Medical Oncology - Latest Issue Being Audited: Facility vs Non-facilty Reimbursement posted on 9/18/18 Details >This edition includes an articles on......~ Medicare Advantage Plans Are Supposed to Follow The Two-Midnight Rule
~ Compliance Issues on the Horizon: Closer Than You Think
~ Provider-Based Clinics: Keeping Up with All the Changes Details >Recent Oncology Related Articles~ Coding and Billing Date of Service on Professional Claims MLN Matters Article — Reissued
~QPP Videos: Create an Account in HARP
~QPP Videos: MIPS Data Submission
~Open Payments Data Update
~ New System for PRRB Appeals MLN Matters Article
~ICD-10-CM, ICD-10-PCS, CPT, and HCPCS Code Sets Educational Tool — Reminder
~ ICD-10 and Other Coding Revisions to NCDs MLN Matters Article 2019
~ GAO Report on Episode-Based Payment Models including the Oncology Care Model
~ Hospice Election Statement Lack Required Information
~ NCCI PTP Edits: Quarterly Update MLN Matters Article
~ Local Coverage Determinations MLN Matters Article
~ Proper Use of the KX Modifier for Part B Immunosuppressive Drug Claims
~ Hospital OPPS: January 2019 Update MLN Matters Article
~ Medicare Billing: Form CMS-1500 and the 837 Professional Web-Based Training Course
~ Quality Payment Program: 2019 Resources
~ Quality Payment Program: Webinar Library
~ Recent LearnResource & MedLearn Matters Articles Details >
Recent Oncology Related News~ Prior-authorization changes coming to AIM authorization program
~ Reminder: Check for authorization requirements, not all Blue Cross patients require AIM authorization
~ 2019 Medicare Plus BlueSM claims processed with 2018 rates
~ Additional fee schedules added to web-DENIS
~ February 11, 2019 ICT Webinar: You've submitted a few claims; now what?
~ NASCO conducting payment recovery for General Motors
~ Payment recovery, rebilling advice for incorrect 340B modifier drug claims
~ Medicare Plus Blue PPO drug administration coding
~ The Record Details >
Last Updated 2/5/19Review the reported payer reimbursement issues MSHO is currently addressing including ESA denials by WPS and incorrect Rituxan MUE with BCBSM 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.....
~ Medicaid Enrollees Must Have Access to High-quality Cancer Care, ASCO Writes in Comments to CMS
~ Public Comment on MDHHS Medicaid Health Plan Common Formulary IS OPEN
~ MSA Bulletin Updates
~ Biller "B" Aware Notices Details >February Monthly Status ReportMany updates/corrections. Listed below is a sampling of what you will find...
~ 835 Recoupment Isn't Reflected on the Voucher
~ Voided Claims Incorrectly Denying as Duplicates
~ Claims denying against the Medicare 72 hour rule
~ Facility Claims in Paid Status but No Paid Amount for Out of State Claims
~ Coinsurance and Reimbursement are Applying Incorrect Rates for Rural Health Center Claims
~ and many more... Details >News Updates~ Reminder: No longer accepting fax submissions for record requests and appeals starting March 4
~ Provider website pages moving outside of login
~ Reminder: Effective Jan. 1, step therapy added for Medicare Part B drugs
~ System updates associated with CMS releases Details >~ Aetna OfficeLink Updates
~ BCN Provider News
~ Cigna
~ HAP
~ Humana YourPractice
~ UHC Network Bulletin
~ UHC Medical Policy Update
Details >Featuring this month: Cigna~ Cigna patient required to meed with independent genetic counselor prior to undergoing certain genetic tests
~ Updated website
~ Outreach program for patient's pharmaceutical treatment patterns and options Details >
~ ASCO - Safe Handling of Hazardous Drugs Webinar: Friday, February 15 Details >
~ Understanding CMS Advanced Practitioner Professional Billing
****ATTENTION MSHO MEMBERS - READ THIS ARTICLE!
Also....
~ ACCC Patient Assistance & Reimbursement Guide Now Available
~ Latest Issue of Medical Economics Details >
February 2019, Frequently Asked QuestionsTopic:
~ New/Updated bortezomib codes
~ Documentation requirements for drugs billed by NDC
~ MIPS adjustments on drugs
~ Billing a long push as an infusion
~ Requirements for documentation of waste
~ Procrit MUE and denials
~ Billing Medicare for packaged drugs Details > |
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