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.
Warm Holiday wishes from our family to yoursThe MSHO office will be closed Dec. 19, 2018 - Jan. 1, 2019 Details >~ In Case You Missed It: Watch ASCO’s Webinar on 2019 Medicare Reimbursement Changes ~ PTAC OKs New Payment Model for Community Oncology ~ FDA To Facilitate Access To Unapproved Drugs Details >
February 6, 2019 12:00 - 1:00 PMRegistration is OPEN! Details >List of Oncology Related New/Revised/Deleted HCPCS CodesWATCH OUT! Among other changes; J9310 Rituximab 100 mg DELETED and replaced with J9312 Rituximab 10 mg! Details >Do You Know the Impact of the 2019 Reimbursement Changes on your E/M and Administration Codes?Made exclusively for MSHO, we have created a tool to make the analysis easier! Details >The handouts and recording are available on the MSHO website!Details >
Genentech~ Oncology-related products include: Alecensa® (alectinib) capsules, Avastin® (bevacizumab), Cotellic® (cobimetinib) tablets, Erivedge® (vismodegib), Gazyva® (obinutuzumab), Hemlibra® (emicizumab-kxwh), Herceptin® (trastuzumab), Kadcyla® (ado-trastuzumab emtansine), Perjeta® (pertuzumab) for injection, Rituxan® (rituximab), Rituxan
HycelaTM (rituximab and hyaluronidase human), Tarceva® (erlotinib), Tecentriq® (atezolizumab), VenclextaTM (venetoclax), Zelboraf® (vemurafenib) tablets Details >
December 2018There are no new Oncology related policies/articles this month Details >Part A, Part B and Part A/B News~ 12/18/18 WPS Update to the ESA Rejections RESOLVED ~ WPS Articles that may be of interest to oncology were released in the past 2 weeks. ~ Medicare Hot Links to Fee Schedules and Final Rules Details >Check out these upcoming training events....Including.... ~ Teleconference: **** 01/08/19 New to Medicare National and Local Coverage Determinations **** 01/16/19 Provider Enrollment Ask-the-Contractor **** 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 an article on......~ Suspicion Arises: All Errors, All the Time Details >Recent Oncology Related Articles~ 2019 Medicare Part D Opioid Policies: Training Materials ~ Quality Payment Program: Webinar Library ~ CY 2019 MPFS Final Rule: Summary of Policies MLN Matters Article ~ MLN Catalog: December 2018 ~ Quarterly Provider Update ~ Quality Payment Program: MIPS Resources ~ Physician Fee Schedule Call: Audio Recording and Transcript ~ Physician Compare Preview Period Open through December 31 ~ QRURs and PQRS Feedback Reports: Access Ends December 31 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~ Clarification about AllianceRx Walgreens Prime specialty program ~ Xgeva® to require authorization for BCN AdvantageSM members ~ Enhancements to the 835 - delayed ~ Medical records requests coming soon for risk adjustment audit ~ NASCO starting payment recovery for all URMBT groups ~ Medicare Plus BlueSM PPO manual update coming in January ~ Blue Cross Complete lab services update ~ eviCore to manage two radiopharmaceutical drugs, starting Feb. 1 ~ Tips to differentiate home health care from home infusion services ~ Correction: List of medical drugs in commercial Medical Drug Prior Authorization Program ~ Continuity of Care in place for URMBT members in the medical or radiation oncology programs ~ Attention CT, MRI specialists: Sign up for OptiNet® webinar, opt in for patient referrals ~ Cinqair, Nucala, Xolair added to site of care infusion requirement, beginning Jan. 1 ~ Reminder - New Institutional Blue Care Network edit: NDC DRUG QUANTITY MUST BE GREATER THAN ZERO ~ Medicare Part B medical specialty drug prior authorization lists changing in 2019 ~ BCBSM grants MOC exceptions ~ Some medical benefit drugs for Medicare Advantage members need step therapy, starting January 1 ~ Reminder: Follow these guidelines when billing medical drugs that haven’t been purchased ~ The Record Details >
Last Updated 12/18/18Review the reported payer reimbursement issues MSHO is currently addressing... ~ WPS Medicare Issue with ESA J0881 and J0885 Denials - Completely Resolved! Details >Recent Oncology Related Issues and News~ Medicaid Advantage Pending Issues; MSHO Addressing Managed Medicaid Plans with Medical Drug Benefit Restrictions
Also, in this update..... ~ Providers must enroll in Michigan Medicaid program ~ Medicaid OKs Michigan waiver to negotiate drug prices based on outcomes ~ MSA Bulletin Updates ~ Biller "B" Aware Notices Details >Priority Health Fee Schedule UpdateThey Have Re-posted the 4th Quarter Immunization and Injections Fee Schedule Due To An Error Details >System UpdatesMany 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 ~ Facility claims are in paid status but there's no paid amount for out of state claims ~ Coinsurance and reimbursement are applying incorrect rates for rural health center claims ~ 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: UnitedHealthcare Community Plan~ Medical Benefit Drug Policy had Diagnosis Code Requirements for IVIG ~ Site of Care Policy ~ Outpatient Prior Authorization through Optum Details >
~ Value-Based Clinical Pathways in the World of Reference-Priced Medicare Part B Drugs ~ Senate Democrats Introduce Bill To Allow Government To Block Drug Price Rises Details >
December 2018, Frequently Asked QuestionsTopic: ~ New code for billing a phone call ~ Virtual Check-In coding questions ~ New code for remove evaluation of video or image ~ Modifier 25 ~ What happened with the E & M codes for 2019 Details >
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