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.
Lilly - MyRightDose Exchange Program for VerzenioDetails >~ CMS Accelerates Innovation and Promotes Patient Access to Medical Technology - Includes changes to the LCD Process for All MACS!
~ ATTENTION ALL MSHO MEMBERS - Managed Medicare Audits on Waste! Details >
Held Wednesday October 17th - Did you miss the opportunity to hear from the Michigan payers?The handouts are available on the MSHO website! Details >Building Healthcare Worker Safety with Facility Design and Engineering ControlsWednesday, October 30, 2018 12:00 - 1:00 PM Details >SAVE THE DATE!
Wednesday - December 5, 2018 12:00-1:00 PMRegistration will open November 1, 2018 Details >
Astellas~ Oncology-related products: Tarceva® (erlotinib) tablets (co-marketed with Genentech, Inc.), Xtandi® (enzalutamide) capsules Details >
October 2018Including...
~ MolDX, ICD-10 Change to Chemotherapy Agents for Non-Oncologic Conditions, ICD-10 Change to Erythropoiesis Stimulating Agents, ICD-10 Change to Human Granulocyte/Macrophage Colony Stimulating Factor, and more... 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....
~ Webinars
**** Medicare Beneficiary Identifier (MBI) Ask-the-Contractor Teleconference (ACT)
10/30/2018
**** Comprehensive Error Rate Testing (CERT) Appeals - 11/07/2018
**** PLUS many more educational opportunities!
~ New On Demand E & M Training Opportunities Details >
Region 1 - Performant Recovery, Inc.Latest Issue Being Audited - Facility vs Non-facilty Reimbursement Details >This edition includes articles on......~ Are Medicare Advantage Plans Creating Excessive Denials? Details >Recent Oncology Related Articles~ Medicare Advantage Plans Found to Improperly Deny Many Claims
~ CMS announces 2019 Medicare Parts A & B premiums and deductibles
~ Proper Use of the KX Modifier for Part B Immunosuppressive Drug Claims
~ Physician Compare: Preview Period and Public Reporting Webcast — October 30
~ LCDs MLN Matters Article
~ ABNs and Dual Eligible Beneficiaries: Special Guidelines
~ QRURs and PQRS Feedback Reports: Access Ends December 31
~ Quality Payment Program: MIPS Resources
~ Improper Payment for Intensity-Modulated Radiation Therapy Planning Services
~ 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
~ Medicare Enrollment for Physicians, NPPs, and Other Part B Suppliers Booklet Details >
Special Webinar Series for Medical and Radiation OncologyTwo new utilization management programs launching January 1, 2019. Multiple webinar opportunities available for Medical and Radiation oncology, as well as clinical and non-clinical staff. Details >Recent Oncology Related News~ October 18, 2018 ICT Webinar: You've submitted a few claims; now what?
~ Onpattro, Poteligeo, Signifor LAR added to medical benefit specialty drug prior authorization program for commercial members
~ We’re adding a Documentation Guidelines tab to Benefit Explainer
~ UPDATE: Claims failing for Diagnosis Code
~ Some medical benefit drugs for Medicare Advantage members need step therapy, starting January 1
~ Medical records requests will begin for commercial initiatives, Oct. 2018
~ Reminder: Follow these guidelines when billing medical drugs that haven’t been purchased
~ BCBSM October RECORD Details >
Last Updated 10/16/18Review the reported payer reimbursement issues MSHO is currently addressing...
~ Medicare Plus Blue Xgeva Prior Authorization Issue- RESOLVED! Details >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 Details >~ Check out the Newest Programs available Details >~ HCCP Dual Eligible Plan
~ Changes to Prior Authorization Management
~ Update to UHC Reimbursement Policy 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 >~ Aetna OfficeLink Updates
~ BCN Provider News
~ Cigna
~ HAP/HealthPlus ProviderPlus
~ Humana YourPractice
~ UHC NetworkBulletin
~ UHC Medical Policy Update
Details >Featuring this month: McLaren Health Plan/CareSource Michigan~ Updated prior authorization list with not many changes
~ McLaren Health Plan now offers a Medicare supplement policy
~ Visit their website Details >
~ CMS Proposes to Require Manufacturers to Disclose Drug Prices in Television Ads
~ No More Secrets: Congress Bans Pharmacist ‘Gag Orders’ On Drug Prices Details >
~ The US Oncology Network Announces Top-Tier MIPS Results
~ Medical Economics Magazine
~ Michigan legislature adopts minimum wage increase and paid sick leave ballot proposals.
~ The Growing Role for Nurse Practitioners & Physician Assistants in Oncology Details >
October 2018, Frequently Asked QuestionsTopic:
~ ATTENTION FINANCIAL NAVIGATORS - Medicare Advantage Plans have been approved to begin to allow "step edits" on Part B administered drugs beginning in 2019! Read these Q & As for more information! Details > |
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