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.
Warm Holiday wishes from our family to yoursThe MSHO office will be closed December 19th - January 1st Details >~ 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 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 - NEW ISSUES including - ESAs for Cancer Patients and Therapeutic Injections issue approved to begin auditing in December, 2019! Details >This edition includes an article on......~ New Physician Supervision Requirement Changes ~ Happy Holidays: Update Your EMRs and Review Your Procedures Details >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 Details >
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 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 12/18/19Review 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: ~ Proposed Pharmacy Carve-Out Policy - Comment before January 17! ~ 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 >~ MDHHS to host webinar on Healthy Michigan Plan work requirements coming Jan. 1, 2020 ~ 2020 CPC+ and PCP Incentive Program manuals available Details >
~ CMS Administrator Seema Verma Criticizes High Drug Launch Prices ~ Mounting Drug Shortages Delay Treatments For Patients With Bladder Cancer Details >
~ ASTRO Issues New Guideline On Radiation Therapy For Basal, Squamous Cell Skin Cancers ~ Surprising Swings In Momentum For Legislation On Surprise Medical Bills 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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