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Welcome to the Reimbursement Bulletin
Merck• KEYTRUDA (pembrolizumab): Additional Indication Details >
Did you know that when choosing the level of service based on time for an E & M telehealth visit to Medicare you can include the time it takes the provider to prepare to see the patient or order medications or document the medical record? Read the first question in the FAQ's! Details >Tuesdays - Lunch and Learn Weekly Webinar Series 4/21 - 5/12Register Today for the April 28th Session - Best Practices in Financial Navigation! Details >
Novartis Patient Assistance FoundationDetails >
April 2020Including:
• MolDX
• Billing and Coding: Bisphosphonate Drug Therapy 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:• Care Management Services
• Locating a Local Coverage Determination (LCD)
• New to Medicare - Fundamentals of Reimbursement
• New to Medicare - Appeals and Overpayments
• New to Medicare - Last Call for 2020
• PLUS many additional on-demand educational opportunities including E & M training opportunities! Details >
Recent Oncology Related Articles• Trump Administration Launches New Toolkit to Help States Navigate COVID-19 Health Workforce Challenges
• CMS COVID-19 Stakeholder Engagement Calls
• COVID-19 Call: Audio Recording and Transcript
• Medicare Overpayments — Revised
• Medicare Fraud & Abuse: Prevent, Detect, and Report Web-Based Training Course — Revised
• Updated Questions and Answers on COVID-19
• Using CS Modifier When Cost-Sharing is Waived
• Medicare FFS Claims: 2% Payment Adjustment Suspended (Sequestration)
• CMS Approves Approximately $34 Billion for Providers with the Accelerated/Advance Payment Program for Medicare Providers in One Week
• Quality Payment Program: MIPS Extreme and Uncontrollable Circumstances Policy in Response to COVID-19
• Pneumococcal Pneumonia Vaccination: Eligibility Transactions Includes DOS Starting April 13
• Medicare Advance Written Notices of Noncoverage — Revised
• Coronavirus Major Policy Changes
• 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...
• Including - Bone Marrow Transplants, ESAs for Cancer Patients, and Therapeutic Injections! Details >
Recent Oncology Related News• Blue Cross has extended authorization dates on select medical and pharmacy benefit drugs for Medicare Advantage & Commercial members
•Blue Cross and BCN revise the Telehealth for medical providers guide
• No-cost telehealth services to members expanded plus general telehealth clarifications
• Sarclisa® will require prior authorization starting May 15 for BCN HMOSM, Medicare Plus BlueSM PPO and BCN AdvantageSM members
• Economic assistance to providers during COVID-19 pandemic
•New COVID-19 diagnosis code effective April 1, 2020
• Choices for virtual care communications sent to members
• We're granting a 90-day extension to claim submission time limits
• Medicare Part B medical specialty drug prior authorization list is changing in June
• We're adding site-of-care requirements for Lemtrada and Tysabri for commercial members, starting May 1 Details >Publications• The Record
• BCN Provider News Details >Monthly Status ReportMany updates/corrections. Listed below is a sampling of what you will find:
• 835 Recoupment isn't reflected on voucher
• Evaluation and Management services claims are incorrectly being denied
• J0881 and J0885 claims are being denied incorrectly
• RHC claim issues
• and more Details >
Last Updated 4/22/2020Review 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:
• Michigan Seeks Approval to Streamline Medicaid; Request would provide easier access to coverage while keeping residents safe during COVID-19 outbreak
• 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: Priority HealthTidbits regarding:
• Dedicated COVID-19 Provider Page
• Expanded services for telephone visits, e-visits and hosted visits
• Will allow the office visit codes for telehealth Details >• Changes coming Jun. 15, 2020 to how we display corrected claims in your remittance advices
• COVID-19 update: Care management codes billable virtually, additional telemedicine clarification
• COVID-19 update: Moving providers to different locations and credentialing new providers to support COVID-19 volumes Details >
April 2020, Frequently Asked Questions with COVID-19 Focus• Physician "Incident To"
• Sequestration
• Place of Service 02
• Nurse Phone Calls
• Definition of Qualified Healthcare Professional
• Waiver Co-Pays
• Place of Service
• Telehealth Phone Calls
• Patient Consent Requirements
• Definition Patient Initiated
• Phone Calls
• Check in - G2012
• Medical Decision Making
• PA/NP Telemedicine "Incident To" Details > |
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