Welcome to the Reimbursement Bulletin

Special Report Provides Guidance to Oncology Practices on Resuming Cancer Care During COVID-19 Pandemic

Governor Whitmer Signs Executive Order Expanding Telehealth Options for Michiganders

Copay Maximizers Are Displacing Accumulators—But CMS Ignores How Payers Leverage Patient Support

MSHO Telehealth Coverage Updates

Updated As New Information Emerges!

MSHO Featured Corporate Sponsor Assistance Program

Seattle Genetics - SeaGen Secure

WPS Oncology Related LCD Updates

May 2020

Including:
• Multiple MolDX Updates!

Join WPS for a Teleconference, Webinar or Seminar!

Check out these upcoming training events:

• 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!

CMS-Medicare

Recent Oncology Related Articles

• Telephone Evaluation and Management Visits
• COVID-19: Office Hours Call - May 21
• Medicare FFS 2nd Level Appeals: Submission Options
• Price Transparency: Requirement to Post Cash Prices Online for COVID-19 Diagnostic Testing
• Telehealth Video: Medicare Coverage and Payment of Virtual Services
• COVID-19: Modified Ordering Requirements for Laboratory Billing
• Hospital OPPS: New Coronavirus Specimen Collection Code
• Evaluation and Management Services — Revised
• Quality Payment Program: 2020 Resources
• Recent LearnResource & MedLearn Matters Articles

BCBSM/BCN

Recent Oncology Related News

• NASCO conducting payment recovery for all accounts including MOS and excluding FEP and ITS HOST
• Telehealth billing changes and new telehealth FAQ document
• Blue Cross PPO commercial claims for out-of-state Blue Cross PPO members may have processed incorrectly
• Register for the June PGIP quarterly meeting today
• Blue Cross offering virtual care options for members and convenient ways to get their prescriptions filled
• Specialist value-based reimbursement update
• Medicare Part B medical specialty drug prior authorization list is changing in June

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

Payer Issue Tracking Page

Last Updated 5/20/2020

Review the reported payer reimbursement issues MSHO is currently addressing including the response from BCBSM regarding reimbursement by NDC which is still being investigated! We also need additional Medicaid examples!!

Newsletters of Interest

• Aetna OfficeLink Updates
• Cigna
• HAP
• Humana YourPractice
• UHC Network Bulletin
• UHC Medical Policy Update

Priority Health Update

• Financial relief for members and employers in response to COVID-19
• Collecting copays from Medicare Advantage members
• Medical policy updates
• Prophylactic Cancer Risk Reduction Surgery - 91508
• Updated process for peer-to-peer reviews starts July 1
• Commercial formulary changes coming July 1, 2020
• Biosimilars preferred over Herceptin, Avastin and Rituxan, effective July 1

Recent Oncology Related FDA Approvals/Changes

Updated Dosing Information for Merck's KEYTRUDA® (pembrolizumab) Injection 100 mg

Program Offers Patients Free Transportation to Cancer Appointments During Pandemic

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