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.
~ Patients, Doctors, Providers say Health Can't Wait!!
Prior authorization red tape and step therapy delays care and treatment for Michigan patients!
~ Trump Issues Executive Order Increasing Transparency In Hospital Prices, Doctor Fees
~ Get to Know COA's OCM 2.0 Model Webinar - Friday July 12 Details >
Wednesday, October 23, 2019SAVE THE DATE!
~ Registration will open in August! Details >
Genentech~ Oncology-related products: Alecensa® (alectinib) capsules, Avastin® (bevacizumab), Cotellic® (cobimetinib) tablets, Erivedge® (vismodegib), Gazyva® (obinutuzumab), Herceptin® (trastuzumab), Kadcyla® (ado-trastuzumab emtansine), Perjeta® (pertuzumab) for injection, Rituxan® (rituximab), Rituxan Hycela® (rituximab and hyaluronidase human), Tarceva® (erlotinib), Tecentriq® (atezolizumab), Venclexta® (venetoclax), Zelboraf® (vemurafenib) tablets Details >
July 2019Including multiple MolDX Updates 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 articles on......~ RAC Audits: Alternatives to Litigation
~ Can You Challenge a Contractor’s Decision to Reopen a Claim?
~ Don’t Blame the Billing Company – They Are Your Bills Details >Recent Oncology Related Articles~ CMS Proposes New Electronic Prior Authorization Process to Speed Access to Care
~ Two HCPCS replacement codes take effect July 1
~ Two-Sided Risk in the Oncology Care Model
~ MIPS Data Validation and Audit for Performance Years 2017 and 2018
~ FY 2020 ICD-10-CM Diagnosis Code Updates
~ CMS Proposes to Update e-Prescribing Standards
~ NEW - Quality Payment Program: 2019 Resources
~ Recent LearnResource & MedLearn Matters Articles Details >
Recent Oncology Related News~ NovoLogix® user interface enhancements coming soon
~ Register now for an AIM Specialty Health® oncology management program webinar
~ Providers receiving ineligible for inquiries error will need group NPI to access Medicaid information
~ Comprehensive lists of requirements for medical specialty drugs and pharmacy benefit drugs available
~ HCPCS, CPT updates and early release codes
~ MIPS Data Validation and Audit for Performance Years 2017 and 2018
~ 2019 InterQual criteria to be implemented Aug. 1
~ Medicare Part B medical specialty drug prior authorization list changing July 22, 2019 Details >Publications~ The Record
~ BCN Provider News
~ Blues Brief for Oncology Providers Details >July Monthly Status ReportMany updates/corrections. Listed below is a sampling of what you will find...
~ 835 Recoupment Isn't Reflected on the Voucher
~ HCPCS V2788 is applying an incorrect denial claim adjustment reason code
~ 835 CARC 210 sanction amount incorrect
~ J0881 and J0885 claims are denying incorrectly (Newer Issue but corrected on May 10)
~ NEW ISSUE - Providers are getting false eligibility information for processing eviCore claims
~ Radiation oncology claims are taking longer to process because of an internal MPB problem (New Issue)
~ Problems with rural health center claims processing deductibles
~ Voided claims are incorrectly denying as duplicates
~ and more... Details >AIM Specialty Health to manage medical oncology medications for BCN Starting August 1Be sure to attend one of the Webinars available in June, July, August and September!! Details >
Last Updated 7/3/19Review the reported payer reimbursement issues MSHO is currently addressing including a LCD update request to the ESA Policy at WPS, and Medicare Plus Blue "claims re-processed" update related to the wrongful denials for Imfinzi, J9173. Details >Recent Oncology Related Issues and News~ Pending Issues being Addressed by MSHO; NEW - Meridian Medicaid Crossover Claims Not Being Processed and Problems with their Website
Additional Updates:
~ IMPORTANT NOTICE: Medicaid Third-Party Liability Information is reported incorrectly in CHAMPS!
~ MSA Bulletin Updates
~ Biller "B" Aware Notices Details >~ Aetna OfficeLink Updates
~ Cigna
~ HAP
~ Humana YourPractice
~ UHC Network Bulletin
~ UHC Medical Policy Update
Details >Featuring this month: Meridian Health Plan of MichiganTidbits regarding;
~ REMINDER - Use HealthHelp for prior auth for Medical and Radiation Oncology
~ Meridian Plan Types
~ Contact outside of Meridian Medicaid for Claims Assistance Details >
~ Coherus BioSciences Production Exceeds Four-Hundred Thousand UDENYCA® (pegfilgrastim-cbqv) Pre-Filled Syringes
~ What Pharmacists Should Know About the Pitfalls of Step Therapy Details >
~ One Simple Change Cut Unnecessary Imaging for Cancer Patients in Half
~ PAN Foundation Announces EXPANSION of their new Treatment Transport Program!
~ Latest Issue of Medical Economics Details >
July 2019, Frequently Asked QuestionsTopic:
~ BCBSM $35 Medication Reconcillation
~ Billing for Nplate Overfill
~ Documentation Requirement for NP Scribe
~ Administration Coding Chemo or Non-Chemo
~ 2020 Proposed Rules Details > |
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