Welcome to the Reimbursement Bulletin
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This Bulletin will be published semi-monthly. As always, any comments, suggestions, stories or questions can be sent to billing@msho.org.
~ 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" Details >
Wednesday, October 17, 2018Schoolcraft College - Livonia, MI
Agenda now available and the registration is open! Approved for 7.0 CEUs by both AAPC and PMI! Details >
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 Details >~ PAN Establishes Amyloidosis Assistance Program ~ PAN Foundation Provider Newsletter Details >
September 2018Including... ~ WPS LCD changes related to MolDX changes Details >Part A, Part B and Part A/B NewsArticles that may be of interest to oncology which were released in the past 2 weeks. Details >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! Details >
Region 1 - Performant Recovery, Inc.Latest Issue Being Audited - Facility vs Non-facilty Reimbursement Details >This edition includes articles on......~ When Should You Voluntarily Refund an Overpayment? ~ Humana Medicare Announces Peer-To-Peer Process Changes Details >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 Details >
Regarding Outpatient Hospital Site of Service Drugs~ And an additional IMPORTANT message from MSHO to all outpatient hospital providers Details >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 Details >
Last Updated 9/18/18Review the reported payer reimbursement issues MSHO is currently addressing... ~ Medicare Plus Blue Xgeva Prior Authorization Issue- RESOLVED!! Details >Recent Oncology Related Issues and NewsMedicaid 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 Details >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... Details >~ Changes to Prior Authorization Management ~ Update to UHC Reimbursement Policy Details >~ Aetna OfficeLink Updates
~ BCN Provider News
~ Cigna
~ HAP/HealthPlus ProviderPlus
~ Humana YourPractice
~ UHC NetworkBulletin
~ UHC Medical Policy Update
Details >Featuring this month: HAP Midwest Health Plan~ Who They Are ~ Benefit Requirements ~ Newsletter and Recent Changes Details >
~ FDA Grants Priority Review to Keytruda to Treat Non-Small Cell Lung Cancer Subgroup Details >
~ Medical Economics September Issue ~ Avoiding a compliance and coding tug-of-war at your practice Details >
September 2018, Frequently Asked QuestionsTopics Include: ~ Multiple questions related to Medicare Proposed Changes to E & M Coding and Reimbursement Details >
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