Welcome to the Reimbursement Bulletin
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.
~ WPS Medicare High Dollar Reviews ~ MIPS 2019 Payment Adjustment Confusion ~ CMS proposes Coverage with Evidence Development for Chimeric Antigen Receptor (CAR) T-cell Therapy Details >AstraZeneca~ AZ Oncology ID is your resource for biomarker testing to help patients receive the most appropriate, personalized treatment. Details >
March 13, 2019 12:00 - 1:00 PMREGISTER TODAY!!! ~
Submit any questions you would like answered during this program before 3/1/19 Details >March 21 - 22, 2019ATTENTION ONCOLOGY BILLERS ~ Do not miss this amazing opportunity to become a Certified Hematology Oncology Coder!! ~LAST CALL to Register! Details >Wednesday, April 17thSan Marino Club - Troy ~
View the amazing agenda! ~ Registration is Open! 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.... ** Teleconference: 3/5/19 - New to Medicare, Getting Started with Provider Enrollment & 4/25/19 - Working with Not Otherwise Classified (NOC) Procedure Codes ** 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......~ Lawsuit by Policyholders Targets Anthem Details >Recent Oncology Related Articles~ New Medicare Card: 0 not O ~ Open Payments: Transparency and You Call — March 13 ~ CLIA Program and Medicare Laboratory Services Fact Sheet— Revised ~ Medicare Advance Written Notices of Noncoverage Booklet— Revised ~ Medicare Parts A & B Appeals Process Booklet— Revised ~ Quality Payment Program: Overview of APMs for Year 3 Webinar — February 21 ~ QPP Videos: MIPS Data Submission ~ Quality Payment Program 2019 Resources and Webinar Library ~ Recent LearnResource & MedLearn Matters Articles Details >
Recent Oncology Related News~ Processing delay for professional medical drug claims ~ Start transitioning adult HMO members using infliximab products to Inflectrata ~ Prior-authorization changes coming to AIM authorization program ~ Reminder: Check for authorization requirements, not all Blue Cross patients require AIM authorization ~ The Record Details >
Last Updated 2/19/19Review 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..... ~ Issue in Bridges System in December Giving Resident Aliens Full Medicaid in Error ~ Michigan Medicaid Drug Carve-out Update ~ 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~ Modifier required for 340b payable drugs, recoupment upcoming for 2018 claims ~ 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 >
~ Americans have the right to know their health care and hospital costs ~ 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 >
|