like us on facebook connect with us on linkedin follow us on twitter May 06, 2020

Welcome to the Reimbursement Bulletin

MSHO Confidentiality Statement

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Spring Reimbursement Meeting

Lunch and Learn Weekly Webinar Series - 5/12

Register Today for the May 12th Session - Responding to a RAC Audit!

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Updated - MSHO Telehealth Coverage Updates

NEW - Telephone E/M Visits (99441 - 99443) added to CMS Telehealth Services and include payment parity to office visit coding (99212 - 99214)!

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WPS Oncology Related LCD Updates

April 2020

Including:
• Multiple MolDX Updates!

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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 - 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!

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CMS-Medicare

Recent Oncology Related Articles

• CMS COVID-19 Office Hours Calls
• CMS Reevaluates Accelerated Payment Program, Suspends Advance Payment Program
• Advanced Practice Registered Nurses, Anesthesiologist Assistants, and Physician Assistants
• Dual Eligible Beneficiaries Under Medicare and Medicaid — Revised
• Hospital Outpatient Prospective Payment System — Revised
• How to Use the Searchable Medicare Physician Fee Schedule — Revised
• 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
• Medicare FFS Claims: 2% Payment Adjustment Suspended (Sequestration)
• Quality Payment Program: MIPS Extreme and Uncontrollable Circumstances Policy in Response to COVID-19
• Medicare Advance Written Notices of Noncoverage — Revised
• Coronavirus Major Policy Changes
• 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...
• Including - Bone Marrow Transplants, ESAs for Cancer Patients, and Therapeutic Injections!

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BCBSM/BCN

Recent Oncology Related News

• Processing delay for professional medical drug claims
• List of COVID-19 temporary changes now available
• Temporary relaxation of HIPAA compliance requirements for telehealth visits has been extended through May 31, 2020
• Recommendations for submitting authorization requests for medical oncology drugs to AIM
• BCBSM temporary fee schedule changes for home health care, home infusion therapy, and some professional fees plus early effective date for anesthesia fee change due to COVID-19
• Blue Cross has extended authorization dates on select medical and pharmacy benefit drugs for 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
• 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

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BCBSM/BCN

Publications

• The Record
• BCN Provider News

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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
• Evaluation and Management services claims are incorrectly being denied
• J0881 and J0885 claims are being denied incorrectly
• RHC claim issues
• and more

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Payer Issue Tracking Page

Last Updated 5/5/2020

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! We also need additional Medicaid examples!!

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Medicaid

Recent Oncology Related News

Medicaid Updates Include:
• 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: Medicare Advantage Plans

Tidbits regarding:
• Telehealth Requirement
• Switching Between Traditional and Advantage Plans
• Switching Prescription Plans

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Priority Health Update

• Updated process for peer-to-peer reviews starts July 1
• Commercial formulary changes coming July 1, 2020
• Change Healthcare to begin Medicare chart reviews
• We’ve made changes to how we process and give updates on provider requests
• Supporting facilities with extra funding: DRG uplift and suspending Medicare Advantage sequestration
• Biosimilars preferred over Herceptin, Avastin and Rituxan, effective July 1

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ASK MSHO

May 2020, Frequently Asked Questions

• Observation Status Billing
• Increased telehealth phone call reimbursement, do we have to status our claims?
• Telemedicine MDM and Time?
• Medicare telehealth position 11 vs 02

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