like us on facebook connect with us on linkedin follow us on twitter January 08, 2020

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

Important Oncology Related News

~ CMS Announces Important Updates for MIPS Participants
~ Hope and Some Skepticism Whether Oncology Payment Models Will Work
~ Five Things Doctors Need to Know about 2020 Medicare Fee Schedule

Details >
Section Header

Health Can't Wait Hearing

January 30, 2020 - Lansing, Michigan

Senate Bill 612 is still set to be considered by the Senate Health Policy and Human Services Committee on January 30th at 1 pm. WE NEED YOU THERE!

Details >
Section Header

MSHO Featured Corporate Sponsor Assistance Program

Pfizer

~ Patient support for Retacrit (epoetin alfa-epbx) and Nivestym (filgrastim-aafi) and other Pfizer products through Pfizer Oncology Together

Details >
Section Header

WPS Oncology Related LCD Updates

January 2020

Including;
~ Multiple MolDX Updates
~ 2020 CPT/HCPCS Code Updates
~ Erythropoiesis Stimulating Agents (ESAs)

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 including a link to the REVISED Part B Fee Schedule
~ Also, Medicare Hot Links to Fee Schedules and 2020 Final and Proposed CMS Rules

Details >

Join WPS for a Teleconference, Webinar or Seminar!

Check out these upcoming training events....

Including....
~ Webinars: What's New for 2020 on 1/9 (Registration closes 1/8)
~ What Changed with Local Coverage Determinations (LCDs)
~ PLUS many additional on demand 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...
~ BE READY - NEW ISSUES including - ESAs for Cancer Patients and Therapeutic Injections issue approved to begin auditing in December, 2019!

Details >

Recent RAC Monitor Articles

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

~ Special Bulletin: OIG Looks at Medicare Advantage Risk Score Audits

Details >

CMS-Medicare

Recent Oncology Related Articles

~ Adding Patient-Reported Outcomes to Medicare’s Oncology Value-Based Payment Model
~ 2020 Eligible Clinician Electronic Clinical Quality Measure Flows
~ Provider Minute Video: The Importance of Proper Documentation
~ Payment for Outpatient Clinic Visit Services at Excepted Off-Campus Provider-Based Departments: Updated
~ Medicare Promoting Interoperability Program 2020 Webinar — January 16
~ Quality Payment Program: 2019 Resources
~ Recent LearnResource & MedLearn Matters Articles

Details >
Section Header

BCBSM/BCN

Recent Oncology Related News

~ Blue Cross and BCN Utilization Management Medical Drug List
~ Providers should bill 99422 for telemedicine service for BCN Advantage members
~ Reminder: AllianceRx Walgreens Prime is BCN’s specialty pharmacy provider
~ We're adding two medical drugs to the site-of-care program for Blue Cross and Blue Care Network commercial members starting April 1, 2020
~ Reminder: Here’s how to find help
~ New specialist value-based reimbursement opportunity
~ Updated - 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
~ The oncology management program will include Medicare Advantage plans starting Jan. 1, 2020

Details >

BCBSM/BCN

Publications

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

Details >

Medicare Plus Blue

January Monthly Status Report

Many updates/corrections. Listed below is a sampling of what you will find...
~ 835 Recoupment isn't reflected on voucher
~ AIM Authorizations aren't loading for PET scans
~ J0881 and J0885 claims are being denied incorrectly
~ Providers are getting inaccurate eligibility information from eviCore
~ RHC claim issues
~ and more...

Details >
Section Header

Payer Issue Tracking Page

Last Updated 1/7/2020

Review the reported payer reimbursement issues MSHO is currently addressing including BCBSM NDC vs minimum fee schedule problems.

Details >

Medicaid

Recent Oncology Related Issues and News

Pending Medicaid Issues being Addressed by MSHO:
~ Meridian Medicaid (and others) 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 >

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: Molina Healthcare of Michigan

Tidbits regarding;
~ Molina Servicing Area
~ Three ways to verify member eligibility
~ Requirement to utilize the "Claim Dispute Request Form"

Details >

Priority Health Update

~ Provider training is now available for the PriorityMedicare D-SNP Model of Care
~ Flublok vaccine now covered for commercial members

Details >
Section Header

Recent Oncology Related Drug News

~ Trump Administration Unveils Plan To Allow States To Buy Cheaper Drugs From Canada

Details >
Section Header

Recent Oncology Related News

~ Financial Impact of Patient Assistance Programs, Safety Net Options for Cancer Care

Details >
Section Header

ASK MSHO

January 2020, Frequently Asked Questions

Topic:
~ One condition Chronic Care Management codes
~ Supervision changes for private practice
~ Annual or quarterly HCPCS codes updates
~ BCBSM Treatment Planning Codes

Details >