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.
~ Oncology Reimbursement Reform Leaves Stakeholders With More Questions Than Answers
~ Court Again Rules That HHS’s Medicare 340B Drug Price Cuts Are Illegal, But Gives The Agency A Chance To “Unscramble The Egg”
~ COA News: New PBM Abuses Campaign, Step Therapy in MA Plans, Hill Day Update
~ ASCO Town Hall Brings Tense Conversation About Drug Pricing
~ White House Wants Patients to Know Health-Care Prices Up Front
~ Judge Rips Insurance Company for ‘Immoral, Barbaric’ Cancer Denials Details >AstraZeneca~ Access 360 - Helping Patients Access The Care They Need! Details >
Held on Wednesday, May 22ndIf you missed this webinar; the recording and handouts are available on the MSHO website! Details >Wednesday, October 23, 2019SAVE THE DATE! Details >
Teva~ Oncology-related therapeutic products: Bendeka® (bendamustine hydrochloride) for injection, Synribo® (omacetaxine mepesuccinate) for injection, Treanda® (bendamustine HCl) for injection, Trisenox® (arsenic trioxide) for injection
~ Oncology-related supportive care products: Actiq® (oral transmucosal fentanyl citrate) [C-II], Fentora® (fentanyl buccal tablet) [C-II], Granix® (tbo-filgrastim) injection Details >
June 2019Including... Billing and Coding: Human Granulocyte/Macrophage Colony Stimulating Factors & MolDX! 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....
In-Person Event: "Medicare Day of Learning" in Kalamazoo on 8/20
Webinar: Qualified Medicare Beneficiary (QMB) Program 7/23
Also On-Demand: Provider Enrollment - Eligible Non-physician Practitioners (NPPs)
** PLUS many more educational opportunities including E & M training opportunities! Details >
Region 1 - Performant Recovery, Inc.Latest Issues Under Review That May be Significant to Oncology - Complex Coding Validation and Subsequent Hospital and Discharge Day Posted in April, 2019! Details >This edition includes an article on......~ New Guidance Expected for Shared Space Details >Recent Oncology Related Articles~ More than Half of All OCM Providers Could Owe CMS Money if Required to Join in 2-Sided Risk Model
~ CMS Takes Action to Lower Prescription Drug Prices and Increase Transparency
~ April – June Quarterly Provider Update
~ Improper Payment for Intensity-Modulated Radiation Therapy Planning Services
~ Medicare Shared Savings Program: Submit Notice of Intent to Apply Beginning June 11
~ Laboratory Blood Counts: Provider Compliance Tips
~ Recent LearnResource & MedLearn Matters Articles Details >
Recent Oncology Related News~ Register for the June PGIP Quarterly Meeting Today
~ HCPCS update: New codes added
~ Billing chart: Blues highlight medical, benefit policy changes
~ Providers receiving ineligible for inquiries error will need group NPI to access Medicaid information
~ Medication reconciliation reimbursement increases to $35
~ 2019 InterQual criteria to be implemented Aug. 1
~ NaviNet replacing Blue Exchange for online eligibility and claims inquiries; register for access now
~ June 13 ICT Webinar: You've submitted a few claims; now what?
~ Medicare Part B medical specialty drug prior authorization list changing July 22
~ NASCO conducting payment recovery for URMBT retiree groups
~ Blue Care Network updates professional fees July 1
~ Medicare Plus Blue PPO claim reimbursement policy changes effective July 1
~ Effective July 1, Khapzory and Fusilev® will be added the prior authorization program for PPO commercial members effective July 1
~ The Record Details >Publications~ The Record
~ BCN Provider News
~ Blues Brief for Oncology Providers Details >June 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
~ 835 CARC 210 sanction amount incorrect
~ J0881 and J0884 claims are denying incorrectly (New Issue but corrected on May 10)
~ Providers are getting false eligibility information for processing eviCore claims (New Issue)
~ Radiation oncology claims are taking longer to process because of an internal MPB problem (New Issue)
~ Problems with rural health center claims processing deductibles
~ and more... Details >AIM Specialty Health to manage medical oncology medications for BCN Starting August 1Details >
Last Updated 6/4/19Review the reported payer reimbursement issues MSHO is currently addressing including Medicare Plus Blue update on wrongful denials for Imfinzi, J9173. Details >Recent Oncology Related Issues and NewsMedicaid Advantage Pending Issues;
***Issue Resolved - Molina Medicaid not processing J9999 for Imfinzi
***Issue Resolved - UHC Community Plan and Velcade Denials
Also,
~ MSA Bulletin Updates
~ Biller "B" Aware Notices Details >Meridian Releases HealthHelp for Prior Authorization RequestsDetails >Important Update from MSHO Managed Care Committee Member Robin FreyDetails >~ Aetna OfficeLink Updates
~ Cigna
~ HAP
~ Humana YourPractice
~ UHC Network Bulletin
~ UHC Medical Policy Update
Details >Featuring this month: Managed Medicaid~ Tidbits on Healthy Michigan, Harbor Health Plan and Managed Medicaid Provider Assistance Details >
~ What Pharmacists Should Know About the Pitfalls of Step Therapy
~ Questions raised over cancer drugs in FDA's accelerated approval program Details >
~ PAN Foundation Announces a new Treatment Transport Program!
~ FDA Officials Call for Patient-Friendly Terminology in Oncology
~ Latest Issue of Medical Economics Details >
June 2019, Frequently Asked QuestionsTopic:
~ CPT Code for Concurrent Chemotherapy Infusion
~ Coding CBC without Differential
~ Where to find information on billing for biosimilars
~ Where to find drug pricing for outpatient hospital facilities
~ Rectroactive payments for drugs
~ Definition of an ACO Details > |
