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Welcome to the Reimbursement Bulletin
• Patient-Centered Oncology Payment Model Submitted to HHS Alternative Payment Model Advisory Group
• FDA Releases Proposed Rule and Draft Guidance on Drug Importation Into U.S.
• GAO Calls for More Oversight of 340B Drug Pricing Program
• Supreme Court Agrees To Hear Potentially Monumental Case Over Extent To Which States Can Regulate PBMs
• CMS Move to Curb 340B Duplicate Claims Flawed, Hospitals in Program Warn Details >
January 30, 2020 - Lansing, MichiganSenate Bill 612 is set to be considered by the Senate Health Policy and Human Services Committee on January 30th. 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: New to Medicare - Getting Started with the Medicare Program
• Medicare Advantage - How Does It Affect You?
• Care Management Services
• PLUS many additional on demand educational opportunities including E & M training opportunities! Details >
Are you at risk?Are you utilizing the smallest available vial size for all drugs? 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......• CMS Releases New MOON, Important Message from Medicare, and Detailed Notice of Discharge Details >Recent Oncology Related Articles• Quality Payment Program: MIPS 2020 Payment Adjustments
• Quality Payment Program: New MIPS Participation Framework for 2021 Performance Period
• Comparative Billing Reports: Access via CBR Portal
• Adding Patient-Reported Outcomes to Medicare’s Oncology Value-Based Payment Model
• 2020 Eligible Clinician Electronic Clinical Quality Measure Flows
• Payment for Outpatient Clinic Visit Services at Excepted Off-Campus Provider-Based Departments: Updated
• Quality Payment Program: 2019 Resources
• Recent LearnResource & MedLearn Matters Articles Details >
Recent Oncology Related News• Changes to required BCN MCG Affiliation Form
• Blue Cross recovering payments from 340B program participants regarding separately payable drugs or biologicals
• February 13, 2020 ICT Webinar: You've submitted a few claims; now what?
• Avsola and Givlaari will have authorization and site of care requirements for commercial members effective February and March 2020
• Radiation therapy services for A9590 require authorization starting April 1 for all Blue Cross and BCN members
• Blue Cross and BCN Utilization Management Medical Drug List
• Providers should bill 99422 for telemedicine service for BCN Advantage members
• 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
• 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 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 1/21/2020Review 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:
• Best Practices for Avoiding 340B Duplicate Discounts in Medicaid
• Michigan Medicaid Health Plan Common Formulary - Comment by February 21!
• 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 >• Changes to our Secure Mail options Details >
• U.S. Food and Drug Administration Accepts for Priority Review Bristol-Myers Squibb’s Application for Opdivo (nivolumab) Plus Yervoy (ipilimumab) in First-Line Non-Small Cell Lung Cancer Details >
• New Policy Brief on Health Care Price Transparency
• Analysis of Price Transparency via National Cancer Institute–Designated Cancer Centers’ Chargemasters for Prostate Cancer Radiation Therapy 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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