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Welcome to the Reimbursement Bulletin
MSHO Telehealth Coverage UpdatesMSHO is supporting our members by creating payer resources, clarifying coding and billing requirements, inquiring with and tracking payer policies and creating a Telehealth FAQ Details >AstraZeneca• Enhertu (fam-trastuzumab deruxtecan-nxki) Access and Support Details >
Moving to a Virtual Fomat - Details coming soon!Details >Held March 11, 2020 - Handouts are still available!Details >
Genomic Access Program: Oncotype DX Reimbursement AssistanceDetails >
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 - 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• HHS Finalizes Historic Rules to Provide Patients More Control of Their Health Data • COVID-19: Test Pricing; Diagnostic Lab Tests, Pricing & Codes; and EHB Coverage • Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment MLN Matters® Article • Essential Health Benefits (EHB) Coverage • CMS Sends More Detailed Guidance to Providers about COVID-19 • Administrative Simplification: Claim Status Basics • Quality Payment Program: MIPS 2019 Data Submission Period Open through March 31 • 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 - Bone Marrow Transplants, ESAs for Cancer Patients, and Therapeutic Injections! Details >
Recent Oncology Related News• Blue Cross and 14 health organizations will share financial risk for patient care, quality and health outcomes • Medicare Part B medical specialty drug prior authorization list is changing in June • Blue Cross Blue Shield of Michigan and Blue Care Network will waive member copays and deductibles for COVID-19 tests • Update to Medicare Plus BlueSM PPO Manual coming in April • 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 • 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 3/17/2020Review 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: • 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 >• New process for submitting post-claim appeals and medical records effective Mar. 19, 2020 • Get smarter access to the information you need • Stay up to date on the latest Priority Health provider news 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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