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Welcome to the Reimbursement Bulletin
Pfizer• Patient support for Ruxience (rituximab-pvvr), Trazimera (trastuzumab-qyyp), and Zirabev (bevacizumab-bvzr) and other Pfizer products through Pfizer Oncology Together Details >
March 11, 2020 - 12:00-1:00 PMNEXT WEEK! Register Today! Details >March 30 - 31, 2020 - Walsh College, TroyRegister Today! Details >April 21, 2020 - Kensington Hotel - Ann ArborRegister Today! Details >
March 2020Including:
• Multiple MolDX Updates and Retiring Clinical Social Worker Policy 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 CMS Rules Details >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! Details >
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 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! Details >This edition includes an article on:• Why Auditors Can’t be Unbiased • The New World of Auditing Details >
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 Details >Publications• The Record • BCN Provider News • Blues Brief for Oncology Providers Details >Monthly Status ReportMany 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 Details >
Last Updated 3/3/2020Review 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! Details >Recent Oncology Related NewsMedicaid 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 Details >• Aetna OfficeLink Updates
• Cigna
• HAP
• Humana YourPractice
• UHC Network Bulletin
• UHC Medical Policy Update
Details >Featuring this month: HumanaTidbits regarding: • Education opportunities • How to obtain faster approvals • Mandatory fraud and abuse training Details >• Change to facility retrospective authorization review time frame Details >
March 2020, Frequently Asked Questions• Treating a VA Patient • CMS Step Edit Letter • New Single Chronic Care Management Code Details >
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