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Welcome to the Reimbursement Bulletin

MSHO Confidentiality Statement

We recommend you view the Bulletin in your web browser. At the very top, it says, "To view this bulletin in a web browser, click here." 

This Bulletin will be published semi-monthly.  As always, any comments, suggestions, stories or questions can be sent to billing@msho.org

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Important Oncology Related News

~ ATTENTION ALL MSHO MEMBERS - Managed Medicare Audits on Waste!
~ CMS Urged to Drop Proposal That Would Further Reduce Medicare Resources for Most Complex Beneficiaries, Including Those with Cancer
~ MSMS and WCMS Host Roundtable Discussion on MOC
~ Mon, Sep 17, 2018 - Another Proposed Rule Released by CMS "CMS Proposes to Lift Unnecessary Regulations and Ease Burden on Providers"

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MSHO's Fall Reimbursement Meeting

Wednesday, October 17, 2018

Schoolcraft College - Livonia, MI
Agenda now available and the registration is open!
Approved for 7.0 CEUs by both AAPC and PMI!

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MSHO Featured Corporate Sponsor Assistance Program

Teva

~ Oncology-related therapeutic products: Bendeka® (bendamustine hydrochloride) for injection, Synribo® (omacetaxine mepesuccinate) for injection, Treanda® (bendamustine HCl) for injection, Trisenox® (arsenic trioxide) for injection
~ Oncology-related supportive care products: Actiq® (oral transmucosal fentanyl citrate) [C-II], Fentora® (fentanyl buccal tablet) [C-II], Granix® (tbo- lgrastim) injection

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PAN Foundation Updates

~ PAN Establishes Amyloidosis Assistance Program
~ PAN Foundation Provider Newsletter

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WPS Oncology Related LCD Updates

September 2018

Including...
~ WPS LCD changes related to MolDX changes

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WPS Recent Oncology Related News

Part A, Part B and Part A/B News

Articles that may be of interest to oncology which were released in the past 2 weeks.

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Join WPS for a Teleconference, Webinar or Seminar!

Check out these upcoming training events....

Including....
~ CERT Part B Results - 10/17/2018
~ Medicare Beneficiary Identifier (MBI) Ask-the-Contractor Teleconference (ACT) 10/30/2018
~ PLUS many more educational opportunities!

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Michigan RAC Information

Region 1 - Performant Recovery, Inc.

Latest Issue Being Audited - Facility vs Non-facilty Reimbursement

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Recent RAC Monitor Articles

This edition includes articles on......

~ When Should You Voluntarily Refund an Overpayment?
~ Humana Medicare Announces Peer-To-Peer Process Changes

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CMS-Medicare

Recent Oncology Related Articles

~ Open Payments: Key Thresholds for Program Year 2019 Reporting
~ Open Payments: Program Year 2019 Teaching Hospital List
~ Physician Compare: Public Reporting Webinar Materials
~ Annual Clotting Factor Furnishing Fee: 2019 Update MLN Matters Article
~ Influenza Vaccine Payment Allowances: Annual Update MLN Matters Article
~ Influenza Virus Vaccine Code: January 2019 Update MLN Matters Article
~ Complying with Documentation Requirements for Lab Services Fact Sheet
~ MIPS Targeted Review Request: Deadline October 1
~ 2019 eCQM Flows for EPs
~ 2016 PQRS and 2018 Value Modifier Experience Reports
~ Claims for Biosimilar Drug Code Q5108
~ Diagnosis Coding: Using the ICD-10-CM Web-Based Training Course
~ Medicare Enrollment for Physicians, NPPs, and Other Part B Suppliers Booklet

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BCBSM/BCN Recent MSHO Q & A

Regarding Outpatient Hospital Site of Service Drugs

~ And an additional IMPORTANT message from MSHO to all outpatient hospital providers

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BCBSM/BCN

Recent Oncology Related News

~ Medicare Plus Blue PPO weekly claims adjustment report: Sept. 22
~ System issue affects professional providers who didn't use modifier 26 when billing for professional component of a service performed in a facility
~ Updates to PPO professional, outpatient claim editing process coming in December
~ Reminder: Follow these guidelines when billing medical drugs that haven’t been purchased
~ Medicare Plus BlueSM PPO manual update coming in October
~ Renflexis® requires authorization for BCN AdvantageSM starting Oct. 1
~ Change to Provider Taxonomy Code field – New name, same information
~ Phone numbers change for BCN Case Management and Care Transition programs
~ National drug code (NDC) unit or basis for measurement code (code qualifier)
~ Medicare Advantage compliance audits to begin Oct. 1
~ Starting Oct. 1, additional specialty medications require authorization for BCN AdvantageSM members
~ We’ve canceled the modifier 25 payment adjustment for evaluation and management services
~ Register for a medical specialty drug prior-authorization web tool refresher course
~ Effective Oct. 1, Prolia® and Xgeva® are subject to a site-of-care requirement for BCN HMOSM members

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Payer Issue Tracking Page

Last Updated 9/18/18

Review the reported payer reimbursement issues MSHO is currently addressing...
~ Medicare Plus Blue Xgeva Prior Authorization Issue- RESOLVED!!

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Medicaid

Recent Oncology Related Issues and News

Medicaid Advantage Pending Issues;
**** Total Healthcare approving Aloxi!
**** Meridian approving Neulasta!

Also, in this update.....
**** Proposed Medicaid Policy on Claims for Medicaid Beneficiaries Eligible for Medicare
**** MSA Bulletin Updates
**** Biller "B" Aware Notices

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Medicare Plus Blue

System Updates

~ Many updates/corrections. Listed below is a sampling of what you will find...
****Voided claims are incorrectly denying as duplicates
****Claims are denying against the Medicare 72 hour rule
****Coinsurance and reimbursement are applying incorrect rates for rural health center claims
****Specialty versus primary care physician copayments, wrong copay applied
****and more...

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United Healthcare Update

~ Changes to Prior Authorization Management
~ Update to UHC Reimbursement Policy

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Newsletters of Interest

~ Aetna OfficeLink Updates
~ BCN Provider News
~ Cigna
~ HAP/HealthPlus ProviderPlus
~ Humana YourPractice
~ UHC NetworkBulletin
~ UHC Medical Policy Update

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Managed Care Committee Reimbursement TIDBITS

Featuring this month: HAP Midwest Health Plan

~ Who They Are
~ Benefit Requirements
~ Newsletter and Recent Changes

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Recent Oncology Related Drug News

~ FDA Grants Priority Review to Keytruda to Treat Non-Small Cell Lung Cancer Subgroup

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Recent Oncology Related News

~ Medical Economics September Issue
~ Avoiding a compliance and coding tug-of-war at your practice

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ASK MSHO

September 2018, Frequently Asked Questions

Topics Include:
~ Multiple questions related to Medicare Proposed Changes to E & M Coding and Reimbursement

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