like us on facebook connect with us on linkedin follow us on twitter July 17, 2019

Welcome to the Reimbursement Bulletin

MSHO Confidentiality Statement

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

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Important Oncology Related News

~ Medicaid Patients Need Clinical Trial Access, Coalition Tells Congress
~ Executive Order Aims to Provide Transparent Information About the Price and Quality of Care
~ Trump Abandons Drug Pricing Proposal That Would Have Ended Certain Drug Rebates
~ Federal Judge Blocks Trump Rule To Require Drug Prices In TV Ads
~ Did you miss COA's OCM 2.0 Model Webinar? Listen to the recording!
~ MSMS Update - Now Available: 2018 MIPS Performance Feedback, Final Score and MIPS Targeted Review
~ CMS Proposing Bundled Payment Model For Radiation Oncology
~ COA Statement on Proposed Radiation Oncology Alternative Payment Model

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A Message From Your E-bulletin Sponsor

Merck

~ Dosing and Testing Requirements for Keytruda (pembrolizumab)

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MSHO 10th Annual Payer Update

Wednesday, October 23, 2019

SAVE THE DATE!
~ Registration will open in August!

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MSHO Managed Care Committee Volunteer Positions Open

We Need Your Help!

Are you willing to keep an eye on one payer while MSHO and other committee members keeps an eye on others? Working as a team we have a better chance of staying on top of the multitude of payer changes! Consider joining the MSHO Managed Care Committee!

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MSHO Featured Corporate Sponsor Assistance Program

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

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WPS Oncology Related LCD Updates

July 2019

Including multiple MolDX Updates

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WPS Recent Oncology Related News

Part A, Part B and Part A/B News

Includes articles that may be of interest to oncology released in the past 2 weeks
~ Also, Medicare Hot Links to Fee Schedules and Final Rules

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Join WPS for a Teleconference, Webinar or Seminar!

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!

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Michigan RAC Information

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!

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Recent RAC Monitor Articles

This edition includes an article on......

~ Payer Used 2003 Coding Clinic to Decrease Reimbursement

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CMS-Medicare

Recent Oncology Related Articles

~ CMS: Beyond the Policy Podcast: Throwback to HIMSS Conference
~ Open Payments: Program Year 2018 Data
~ CMS Proposes New Electronic Prior Authorization Process to Speed Access to Care
~ Quality Payment Program: 2019 Resources
~ Recent LearnResource & MedLearn Matters Articles

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BCBSM/BCN

Recent Oncology Related News

~ Dart Container, group number 71750, changing its prior authorization vendor
~ HCPCS Procedure Code errors incorrectly appearing on some claims
~ We're adding drugs to prior authorization, site of care programs for PPO members, effective October 2019
~ NovoLogix® user interface enhancements coming soon
~ Register now for an AIM Specialty Health® oncology management program webinar
~ Comprehensive lists of requirements for medical specialty drugs and pharmacy benefit drugs available

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BCBSM/BCN

Publications

~ The Record
~ BCN Provider News
~ Blues Brief for Oncology Providers

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Medicare Plus Blue

July Monthly Status Report

Many 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...

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Blue Care Network Alert

AIM Specialty Health to manage medical oncology medications for BCN Starting August 1

Be sure to attend one of the Webinars available in June, July, August and September!!

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Payer Issue Tracking Page

Last Updated 7/16/19

Review 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.

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Medicaid

Recent Oncology Related Issues and News

~ Pending Issues being Addressed by MSHO; Still awaiting MHP Update on - Meridian Medicaid Crossover Claims Not Being Processed and Problems with their Website
~ Total Health Care claims processing issues

Additional Updates:
~ IMPORTANT NOTICE: Medicaid Third-Party Liability Information is reported incorrectly in CHAMPS!
~ MSA Bulletin Updates
~ Biller "B" Aware Notices

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Newsletters of Interest

~ Aetna OfficeLink Updates
~ Cigna
~ HAP
~ Humana YourPractice
~ UHC Network Bulletin
~ UHC Medical Policy Update

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Managed Care Committee Reimbursement TIDBITS

Featuring this month: Meridian Health Plan of Michigan

Tidbits regarding;
~ REMINDER - Use HealthHelp for prior auth for Medical and Radiation Oncology
~ Meridian Plan Types
~ Contact outside of Meridian Medicaid for Claims Assistance

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Recent Oncology Related News

~ House Subcommittee Considers Bills Addressing Patient Health Care Costs and Access Issues
~ Physicians See More Pay Tied To Patient Satisfaction And Outcomes
~ PAN Foundation Announces EXPANSION of their new Treatment Transport Program!
~ Latest Issue of Medical Economics

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ASK MSHO

July 2019, Frequently Asked Questions

Topic:
~ BCBSM $35 Medication Reconcillation
~ Billing for Nplate Overfill
~ Documentation Requirement for NP Scribe
~ Administration Coding Chemo or Non-Chemo
~ 2020 Proposed Rules

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