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.
~ Hospitals Blast CMS’ Proposed 340B Survey ~ Step Therapy in Oncology: It’s Complicated ~ ASCO Resolutions on Step Therapy and QPP Adopted at AMA House of Delegates Interim Meeting ~ ASCO Launches Update to the Patient-Centered Oncology Payment Model Details >
The recording and handouts are available on the MSHO Website. Handouts include the 2020 Physician Fee Schedule Analyzer Tool.Details >
Sanofi Genzyme~ Oncology-related products: ELITEK® (rasburicase), JEVTANA® (cabazitaxel), Mozobil® (plerixafor injection), Thymoglobulin® [anti-thymocyte globulin (rabbit)], and ZALTRAP® (ziv-aflibercept) Details >
December 2019Including;
~ Not Otherwise Classified Chemotherapy Agents (NOC) Billing and Coding Guidelines ~ MolDX 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: Completing the CMS Form and Exploring Medicare Resources ~ PLUS additional on demand educational opportunities including 3 day/1 day Payment Window and E & M training opportunities! Details >
Region 1 - Performant Recovery, Inc.Latest Issues Under Review That May be Significant to Oncology... ~ BE READY - TWO NEW ISSUES including - Therapeutic Injections issue approved to begin auditing in December, 2019! Details >This edition includes an article on......~ Price Transparency: Two Rules for the Same Issue ~ Hospitals Price Transparency Rule: Next Stop the Courthouse Details >Recent Oncology Related Articles~ Patients Over Paperwork Newsletter ~ Physician Fee Schedule and Hospital OPPS/ASC Call: Audio Recording and Transcript ~ Promoting Interoperability Programs: Updated list of eCQMs ~ Improper Payment for Intensity-Modulated Radiation Therapy Planning Services ~ Remittance Advice Resources and FAQs — Revised ~ Drug Units in Excess of MUE: Comparative Billing Report in November ~ MACRA Patient Relationship Categories and Codes: Reporting HCPCS Level II Modifiers ~ Medicare Telehealth Services Video ~ Quality Payment Program: New 2019 Resources ~ Recent LearnResource & MedLearn Matters Articles Details >
Recent Oncology Related News~ J0642 replaces J3490 and J3590 when billing levoleucovorin (khapzory) ~ Authorization requests for CAR-T cell therapy drugs for Medicare Advantage members ~ EDI Clearinghouse Connection Changes – Cofinity ~ December 13, 2019 ICT Webinar: You've submitted a few claims; now what? ~ Provider appeal time frame extended for Blue Cross' PPO admissions ~ We're using new codes for online visits starting in January ~ We're adding two medical drugs to commercial site of care requirement starting in January ~ 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 >December Monthly Status ReportMany updates/corrections. Listed below is a sampling of what you will find... ~ 835 Recoupment isn't reflected on voucher ~ Providers are getting inaccurate eligibility information from eviCore ~ RHC claim issues ~ and more... Details >
Last Updated 12/4/19Review 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: ~ 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: UnitedHealthcare Community PlanTidbits regarding; ~ Eff: 1/1/2020 – UHCCP has a table that lists the preferred oncology products and respective non-preferred products ~ Up to date medical policies ~ New Site of Service requirements effective 2/1/2020 Details >~ Outpatient Injectable Chemotherapy and Related Cancer Therapies Prior Authorization/Notification Updates Details >~ Register now for our 2020 Virtual Office Advisory webinars ~ New! View front-end rejections and reasons online ~ Commercial and Medicare formulary changes coming Jan. 1, 2020 ~ 2020 Medicare and commercial plans fee schedules are now online Details >
~ CMS Administrator Seema Verma Criticizes High Drug Launch Prices ~ Mounting Drug Shortages Delay Treatments For Patients With Bladder Cancer Details >
~ ASH Releases New Clinical Practice Guidelines on Immune Thrombocytopenia ~ ONS-ASCO Webinar on Offering Clinical Trials to Patients Details >
December 2019, Frequently Asked QuestionsTopic: ~ For Outpatient Hospital - Definition of Direct and General Supervision ~ Skilled Nursing Facility Bundled Payment List ~ Pre-existing Policy for Medigap Plans ~ AMA CPT Administration Code Changes ~ ~ New 2020 Codes for Chronic Care Management ~ Medicare Advantage Step Edit Issue ~ New Oncology HCPCS Codes for 2020 Details >
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