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 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 >
January 30, 2020 - Lansing, MichiganSenate 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 >February 5, 2020 12:00 - 1:00 PMRegistration is OPEN! Details >
Pfizer~ Patient support for Retacrit (epoetin alfa-epbx) and Nivestym (filgrastim-aafi) and other Pfizer products through Pfizer Oncology Together Details >
January 2020Including;
~ Multiple MolDX Updates ~ 2020 CPT/HCPCS Code Updates ~ Erythropoiesis Stimulating Agents (ESAs) Details >Part A, Part B and Part A/B NewsIncludes 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 >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 >
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......~ Special Bulletin: OIG Looks at Medicare Advantage Risk Score Audits Details >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 >
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 >Publications~ The Record ~ BCN Provider News ~ Blues Brief for Oncology Providers Details >January Monthly Status ReportMany 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 >
Last Updated 1/7/2020Review the reported payer reimbursement issues MSHO is currently addressing including BCBSM NDC vs minimum fee schedule problems. Details >Recent Oncology Related Issues and NewsPending 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 >~ Aetna OfficeLink Updates
~ Cigna
~ HAP
~ Humana YourPractice
~ UHC Network Bulletin
~ UHC Medical Policy Update
Details >Featuring this month: Molina Healthcare of MichiganTidbits regarding; ~ Molina Servicing Area ~ Three ways to verify member eligibility ~ Requirement to utilize the "Claim Dispute Request Form" Details >~ Provider training is now available for the PriorityMedicare D-SNP Model of Care ~ Flublok vaccine now covered for commercial members Details >
~ Trump Administration Unveils Plan To Allow States To Buy Cheaper Drugs From Canada Details >
~ Financial Impact of Patient Assistance Programs, Safety Net Options for Cancer Care Details >
January 2020, Frequently Asked QuestionsTopic: ~ One condition Chronic Care Management codes ~ Supervision changes for private practice ~ Annual or quarterly HCPCS codes updates ~ BCBSM Treatment Planning Codes Details >
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