like us on facebook connect with us on linkedin follow us on twitter August 21, 2019

Welcome to the Reimbursement Bulletin

MSHO Confidentiality Statement

This Bulletin will be published semi-monthly.  As always, any comments, suggestions, stories or questions can be sent to billing@msho.org

Section Header

Other Important Oncology Related News

~ Statement from ASH President Roy Silverstein, MD, on Medicare Reimbursement for CAR T-Cell Therapy
~ CAR T-Cell Therapy Coverage Decision Improves Medicare Beneficiary Access to Cancer Care
~ The Politics of Step Therapy

Details >

CMS Releases Proposed Rules for 2020

~ CMS released the Proposed Rules for Physician Fee Schedule, Hospital Outpatient and Quality Payment Program - Review the Proposed Rules and summaries from CMS, ASCO, ASH, ACCC and COA

Details >
Section Header

MSHO 10th Annual Payer Update

Wednesday, October 23, 2019

Registration is OPEN - REGISTER TODAY!

Details >
Section Header

MSHO Featured Corporate Sponsor Assistance Program

Bayer

~ Oncology-related product: Nubeqa® (darolutamide), AliqopaTM (copanlisib) for injection, Nexavar® (sorafenib) tablets, Stivarga® (regorafenib) tablets, Xofigo® (radium Ra 223 dichloride) injection

Details >
Section Header

WPS Oncology Related LCD Updates

August 2019

Including;
~ New Billing and Coding: Erythropoiesis Stimulating Agents (ESAs)
~ Erythropoiesis Stimulating Agents (ESAs) - Effective August 1, 2019
~ Immune Globulins - Effective August 13, 2019
~ MolDX: Molecular Diagnostic Tests (MDT) - Effective January 1, 2019

Details >

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 2020 Proposed and 2019 Final CMS Rules

Details >

Join WPS for a Teleconference, Webinar or Seminar!

Check out these upcoming training events....

Including....
~ Teleconferences: Observation - Clinical coverage and Billing Criteria 9/26
~ Webinars: Appeals Webinar Series 9/18 - 9/25 - 10/2, Medicare Secondary Payer Series 8/15 - 9/25
~ PLUS many more educational opportunities including E & M training opportunities!

Details >
Section Header

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

Details >

Recent RAC Monitor Articles

This edition includes an articles on......

~ 2020 OPPS: Hospital Price Transparency Under Scrutiny
~ 2020 OPPS/APC Proposed Update Defines Physician Supervision

Details >

CMS-Medicare

Recent Oncology Related Articles

~ CAR T-Cell Cancer Therapy Available to Medicare Beneficiaries Nationwide
~ MACRA Patient Relationship Categories and Codes: Learn More
~ Radiation Oncology Model Listening Session — August 22
~ Chronic Care Management Services
~ ICD-10-CM, ICD-10-PCS, CPT, and HCPCS Code Sets
~ Medicare Raises Payments for CAR-T Therapies
~ Doctors Caucus Urges Agencies to Reconsider Step Therapy
~ Quality Payment Program: 2019 Resources
~ Recent LearnResource & MedLearn Matters Articles

Details >
Section Header

Blues 201 - AIM Specialty Health Webinars

MSHO Members - Don't miss this opportunity 9/24 and 9/26!

Details >

BCBSM/BCN

Recent Oncology Related News

~ McLaren Medicaid erroneous rejection
~ We're resuming Medicare Plus BlueSM PPO place-of-service audits in September
~ Clarification: Preferred infliximab strategy for adult Blue Cross' PPO (commercial) members
~ Effective November 1, Inflectra® is the preferred infliximab product for adult Blue Cross' PPO (commercial) members
~ August 26, 2019 ICT Webinar: You've submitted a few claims; now what?
~ Medicare Part B medical specialty drug prior authorization list is changing in October
~ We're adding drugs to prior authorization, site of care programs for PPO members, effective October 2019

Details >

BCBSM/BCN

Publications

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

Details >

Medicare Plus Blue

August Monthly Status Report

Many updates/corrections. Listed below is a sampling of what you will find...
~ 835 Recoupment Isn't Reflected on the Voucher
~ J0881 and J0885 claims are denying incorrectly (Newer Issue but corrected on May 10 with reprocessing of claims complete by 8/31)
~ NEW ISSUE - Providers are getting false eligibility information for processing eviCore claims
~ Radiation oncology claims are taking longer to process and/or denying incorrectly because of an internal MPB problem (New Issue)
~ Coinsurance and reimbursement applying incorrect rates for rural health should be fixed by 8/30
~ Voided claims are incorrectly denying as duplicates
~ and more...

Details >
Section Header

Payer Issue Tracking Page

Last Updated 8/20/19

Review the reported payer reimbursement issues MSHO is currently addressing including WPS, BCBSM, Medicare Plus Blue and Meridian.

Details >

Medicaid

Recent Oncology Related Issues and News

~ Pending Issues being Addressed by MSHO; MHP Update on - Meridian Medicaid issues and Crossover Claims Not Being Processed and Problems with their Website
~ New Contact Person for help with 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 >

Newsletters of Interest

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

Details >

Managed Care Committee Reimbursement TIDBITS

Featuring this month: Aetna/Cofinity

Tidbits regarding;
~ Cofinity vs Aetna
~ Appeals and Grievances Department
~ No more duplicate remits
~ How to request a Peer to Peer Review with Michigan Aetna

Details >

Priority Health Update

Step therapy added for select Medicare Part B drugs effective Oct. 1, 2019

Details >
Section Header

Recent Oncology Related Drug News

~ New Package for Keytruda
~ UnitedHealthcare Will Prefer Amgen's Anticancer Biosimilars Beginning in October
~ Trump health official: Controversial drug pricing move is 'top priority'
~ Now Available - Amgen’s Biosimilars MVASI™ (bevacizumab-awwb) and KANJINTI™ (trastuzumab-anns)

Details >
Section Header

Recent Oncology Related News

~ ONS Holds Fourth Annual Capitol Hill Days
~ Study: 4 in 10 Patients Faced Surprise Bills In 2016 After Visiting In-Network Hospitals
~ Latest Issue of Medical Economics

Details >
Section Header

ASK MSHO

August 2019, Frequently Asked Questions

Topic:
~ 2020 Proposed Rule changes for drugs or administration codes
~ New RAC audits on injections!
~ Medicare coverage of oral drugs used to enhance the anti-neoplastic effect of the primary drug
~ Targeted Probe Edit - Negative Results
~ Medicare definition of hemophilia
~ E2 Payment Status for Mvasi Q5107

Details >