like us on facebook connect with us on linkedin follow us on twitter December 18, 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

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Happy Holidays!!!

Warm Holiday wishes from our family to yours

The MSHO office will be closed December 19th - January 1st

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Important Oncology Related News

~ Payment for Outpatient Clinic Visit Services at Excepted Off-Campus Provider-Based Departments
~ Redesigning Oncology Care: A Look at CMS’ Proposed Oncology First Model
~ Provider Perspective: Kashyap Patel, MD, Sees Collaboration Going Into Oncology Care First
~ CVS Health Launches New Approach to Oncology Management
~ 340B Program-Participating Hospitals Object To CMS’s Proposed Cuts To 340B Program Reimbursement: CMS’s Recent Information Collection Request

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Did you miss the MSHO Legislative Update Webinar Key Changes for 2020?

The recording and handouts are available on the MSHO Website. Handouts include the 2020 Physician Fee Schedule Analyzer Tool.

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MSHO Featured Corporate Sponsor Assistance Program

Sanofi Genzyme

~ Oncology-related products: ELITEK® (rasburicase), JEVTANA® (cabazitaxel), Mozobil® (plerixafor injection), Thymoglobulin® [anti-thymocyte globulin (rabbit)], and ZALTRAP® (ziv-aflibercept)

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WPS Oncology Related LCD Updates

December 2019

Including;
~ Not Otherwise Classified Chemotherapy Agents (NOC) Billing and Coding Guidelines
~ MolDX

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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 2020 Final and Proposed CMS Rules

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Join WPS for a Teleconference, Webinar or Seminar!

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!

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Michigan RAC Information

Region 1 - Performant Recovery, Inc.

Latest Issues Under Review That May be Significant to Oncology...
~ BE READY - NEW ISSUES including - ESAs for Cancer Patients and Therapeutic Injections issue approved to begin auditing in December, 2019!

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Recent RAC Monitor Articles

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

~ New Physician Supervision Requirement Changes
~ Happy Holidays: Update Your EMRs and Review Your Procedures

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CMS-Medicare

Recent Oncology Related Articles

~ Hospital Price Transparency Call: Audio Recording and Transcript
~ Medicare Promoting Interoperability Program 2020 Webinar — January 16
~ Disproportionate Share Hospital — Revised
~ Federally Qualified Health Center — Revised
~ Physician Fee Schedule and Hospital OPPS/ASC Call: Audio Recording and Transcript
~ Quality Payment Program: 2019 Resources
~ Recent LearnResource & MedLearn Matters Articles

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BCBSM/BCN

Recent Oncology Related News

~ New specialist value-based reimbursement opportunity
~ Medicare Part B medical specialty drug authorization: Clarification regarding Prolia and Xgeva
~ Medicare Part B medical specialty drug prior authorization list is changing in March
~ Blue Cross provides resources to avoid medical drug claim rejections, payment delays
~ 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

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BCBSM/BCN

Publications

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

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Medicare Plus Blue

December Monthly Status Report

Many 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...

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Payer Issue Tracking Page

Last Updated 12/18/19

Review the reported payer reimbursement issues MSHO is currently addressing including WPS & BCBSM.

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Medicaid

Recent Oncology Related Issues and News

Pending Medicaid Issues being Addressed by MSHO:
~ Meridian Medicaid not loading/reimbursing all NCD codes covered by Traditional Medicaid.

Additional Medicaid Updates:
~ Proposed Pharmacy Carve-Out Policy - Comment before January 17!
~ 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: UnitedHealthcare Community Plan

Tidbits 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

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UnitedHealthcare Update

~ Outpatient Injectable Chemotherapy and Related Cancer Therapies Prior Authorization/Notification Updates

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Priority Health Update

~ MDHHS to host webinar on Healthy Michigan Plan work requirements coming Jan. 1, 2020
~ 2020 CPC+ and PCP Incentive Program manuals available

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Recent Oncology Related Drug News

~ CMS Administrator Seema Verma Criticizes High Drug Launch Prices
~ Mounting Drug Shortages Delay Treatments For Patients With Bladder Cancer

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Recent Oncology Related News

~ ASTRO Issues New Guideline On Radiation Therapy For Basal, Squamous Cell Skin Cancers
~ Surprising Swings In Momentum For Legislation On Surprise Medical Bills

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ASK MSHO

December 2019, Frequently Asked Questions

Topic:
~ 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

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