Welcome to the Reimbursement Bulletin
This Bulletin will be published semi-monthly. As always, any comments, suggestions, stories or questions can be sent to billing@msho.org.
~ CMS Releases Physician Fee Schedule and Outpatient Hospital Final Rules!
~ Community Needs More Time to Assess and Comment on CMMI’s Proposed Oncology Care First Model
~ COA Commends CMS for Site Parity and 340B Reforms in 2020 OPPS Final Rule
~ Despite Court Ruling, CMS Presses on with 340B Programs Cuts
~ CMS Finalizes Updates to E&M Codes, Establishes MIPS Value Pathways
~ CMS’s Mandatory Radiation Oncology Payment Model: Negative Reactions in the Radiation Oncology Treatment Community Details >MerckInformation About KEYTRUDA® (pembrolizumab) including dosing and testing requirements, medication guide and prescribing information. Details >
Meridian Medicaid NCD Denial Issue!Please send MSHO your list of denied NDCs which are payable by traditional Medicaid and on the CHAMPS crosswalk. Details >Wednesday - December 4, 2019 12:00-1:00 PMRegistration is open - Register today!!! Details >The handouts are available on the MSHO Website!Details >
Eisai~ Oncology-related products: Aloxi® (palonosetron hydrochloride) injection, Halaven® (eribulin mesylate), Lenvima® (lenvatinib) capsules Details >
November 2019Including;
~ MolDX Updates
~ Bisphosphonate Drug Therapy 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 2020 Final and Proposed CMS Rules Details >Check out these upcoming training events....Including....
~ Webinars: Medicare Secondary Payer (MSP) Webinar Series, Completing the CMS Form 855B
~ 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 - no oncology related new issues posted since. Details >This edition includes an article on......~ Site Neutral Payment Policy and 340B in the CMS Crosshairs Details >Recent Oncology Related Articles~ The Future of Medicare Program Integrity
~ Home Health Agencies: CY 2020 Payment and Policy Changes and CY 2021 Home Infusion Therapy Benefit
~ Quality Payment Program: Participation Status Tool Includes Second Snapshot of Data
~ Hospital Outpatient Prospective Payment System— Reminder
~ Telehealth Services — Reminder
~ Physician Self-Referral Regulations Proposed Rule
~ Proper Use of the KX Modifier for Part B Immunosuppressive Drug Claims
~ Quality Payment Program: MIPS Dates and Deadlines
~ Quality Payment Program: New 2019 Resources
~ Recent LearnResource & MedLearn Matters Articles Details >
Recent Oncology Related News~ Reminder: Check for authorization requirements, not all Blue Cross patients require AIM authorization
~ We're adding two medical drugs to commercial site of care requirement starting in January
~ We're updating the Locum Tenens Arrangements policy guideline
~ The oncology management program will include Medicare Advantage plans starting Jan. 1, 2020
~ Starting Jan. 1, 2020, Blue Cross' PPO and BCN HMOSM plans will cover hemophilia drugs under members' pharmacy benefits
~ Starting in January, AllianceRx Walgreens Prime is BCN's specialty pharmacy provider Details >Publications~ The Record
~ BCN Provider News
~ Blues Brief for Oncology Providers Details >November Monthly Status ReportMany updates/corrections. Listed below is a sampling of what you will find...
~ Providers are getting inaccurate eligibility information from eviCore
~ RHC claim issues
~ Drug claims through the 340B program were incorrectly recovered from providers Details >
Last Updated 11/6/19Review the reported payer reimbursement issues MSHO is currently addressing including WPS & BCBSM. Details >Recent Oncology Related Issues and NewsPending Medicaid Issues being Addressed by MSHO:
~ Meridian Medicaid not loading/reimbursing all NCD codes covered by Traditional Medicaid.
Additional Medicaid Updates:
~ The Centers for Medicare & Medicaid Services (CMS) issued Manufacturer Release #111
~ MDHHS Soliciting Comments on the Michigan Medicaid Health Plan Common Formulary
~ 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: UnitedHealthcareTidbits regarding;
~ New Functionality in the Prior Authorization and Notification Tool on Link
~ Eff: 1/1/2020 – Retacrit will be the preferred drug to use over Epogen and Procrit.
~ New Outpatient Hospital Prior Authorization for Injectable Chemotherapy Details >~ New Cancer Therapy Pathways Program
~ Outpatient Injectable Chemotherapy and Related Cancer Therapies Prior Authorization/Notification Updates Details >~ We're making changes to our remittance advice (RA) and explanation of benefit (EOB) codes for commercial and Medicare APC claims effective Nov. 1, 2019
~ Changes to remittance advice (RA) and explanation of benefit (EOB) codes effective Oct. 7, 2019 Details >
~ A severe shortage hits a drug used for cancer, immune disorders, epilepsy, causing canceled treatments and rationing Details >
~ Patients Need Protection from Surprise Medical Bills, Organizations Tell Congress
~ New Policy Brief Explains How Co-pay Accumulators, Maximizers Increase Cost of Cancer Care for Patients
~ Michigan Legislature Spikes CON’s Limitations on Cancer Treatment
~ HHS Proposal to Reform of Stark Law and Anti-Kickback Statute is Good First Step, But More Changes Needed Details >
November 2019, Frequently Asked QuestionsTopic:
~ Interprofessional telephone/internet/electronic health record consultations
~ How to request and update to NCCN
~ Timing and overview of E & M changes approved by CMS in the 2020 Final Rule Details > |
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