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Welcome to the Reimbursement Bulletin

MSHO Confidentiality Statement

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MSHO & WPS Outpatient Hospital Webinar

March 11, 2020 - 12:00-1:00 PM

NEXT WEEK! Register Today!

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CHONC Workshop and Exam

March 30 - 31, 2020 - Walsh College, Troy

Register Today!

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Spring Reimbursement Meeting

April 21, 2020 - Kensington Hotel - Ann Arbor

Register Today!

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WPS Oncology Related LCD Updates

March 2020

Including:
• Multiple MolDX Updates and Retiring Clinical Social Worker Policy

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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 CMS Rules

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Join WPS for a Teleconference, Webinar or Seminar!

Check out these upcoming training events:

• New to Medicare - Understanding the Payment Basics
• New to Medicare - Policy, Documentation and Medical Review
• Care Management Services
• PLUS many additional on-demand educational opportunities including E & M training opportunities!

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CMS-Medicare

Recent Oncology Related Articles

• Quality Payment Program: MIPS 2019 Data Submission Period Open through March 31
• Open Payments: Your Role in Health Care Transparency Call — March 19
• Medicare Quarterly Provider Compliance Newsletter, Volume 10, Issue 2
• Open Payments Registration
• Quality Payment Program: Updated Explore Measures Tool
• Medicare Part B Immunization Billing: Seasonal Influenza Virus, Pneumococcal, and Hepatitis B
• Quality Payment Program: 2019 Data Submission Videos
• Quality Payment Program: 2020 Resources
• Recent LearnResource & MedLearn Matters Articles

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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!

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Recent RAC Monitor Articles

This edition includes an article on:

• Why Auditors Can’t be Unbiased
• The New World of Auditing

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BCBSM/BCN

Recent Oncology Related News

• Medicare Plus Blue PPO to recover full payment for unbundled IMRT codes
• Check for authorization requirements, not all Blue Cross patients require AIM authorization
• Palforzia and Tepezza will have authorization and site-of-care requirements for commercial members effective March and May 2020
• NEW UPDATE - NASCO started payment recovery for Ford on Feb. 26
• Medicare Part B medical specialty drug prior authorization list is changing in April
• We're removing zoledronic acid drugs from the Medicare Part B medical specialty drug prior authorization list in March
• Radiation therapy services for A9590 require authorization starting April 1 for all Blue Cross and BCN members
• Sign up for upcoming training webinars
• Radiation therapy services for A9590 require prior authorization for all Blue Cross, BCN members starting April 1
• Important information about peer-to-peer reviews and appeals
• Two medical drugs going on commercial site-of-care program, starting April 1
• Updates made to procedure codes for online visits
• We're adding site-of-care requirements for Lemtrada and Tysabri for commercial members, starting May 1

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BCBSM/BCN

Publications

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

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Medicare Plus Blue

Monthly Status Report

Many updates/corrections. Listed below is a sampling of what you will find:
• 835 Recoupment isn't reflected on voucher
• J0881 and J0885 claims are being denied incorrectly
• RHC claim issues
• and more

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Payer Issue Tracking Page

Last Updated 3/3/2020

Review the reported payer reimbursement issues MSHO is currently addressing including the response from BCBSM regarding reimbursement by NDC and problems with payments below the minimum fee schedule!

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Medicaid

Recent Oncology Related News

Medicaid Updates Include:
• Understanding the Interplay Between State Medicaid Programs and 340B
• 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

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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: Humana

Tidbits regarding:
• Education opportunities
• How to obtain faster approvals
• Mandatory fraud and abuse training

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Priority Health Update

• Change to facility retrospective authorization review time frame

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ASK MSHO

March 2020, Frequently Asked Questions

• Treating a VA Patient
• CMS Step Edit Letter
• New Single Chronic Care Management Code

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