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.
~ 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 Details >Merck~ Dosing and Testing Requirements for Keytruda (pembrolizumab) Details >
Wednesday, October 23, 2019SAVE THE DATE! ~ Registration will open in August! Details >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! 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 an article on......~ Payer Used 2003 Coding Clinic to Decrease Reimbursement Details >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 Details >
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 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 7/16/19Review 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; 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 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 >
~ 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 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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