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.
~ COA Issues Formal Comments on CMS Internal Pricing Proposal ~ ASCO Weighs in on CAP Demo in Drug Pricing Proposal ~ HHS Advisory Group Recommends Implementing Oncology Payment Model Based on ASCO’s PCOP ~ CMS Finalizes “Pathways to Success,” an Overhaul of Medicare’s National ACO Program Details >
February 6, 2019 12:00 - 1:00 PMRegistration is OPEN! Details >March 13, 2019 12:00 - 1:00 PMSAVE THE DATE! Details >March 21 - 22, 2019Registration is OPEN! Details >The handouts and recording are available on the MSHO website!Details >List of Oncology Related New/Revised/Deleted HCPCS CodesWATCH OUT! ~ Trelstar HCPCS Code is J3315 and NOT J3316 as originally reported by CMS ~ J9173 Imfinzi and J9229 Besponsa are not listed on the CMS ASP File ~ REMINDER 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 >
Bristol-Myers Squibb Oncology~ Oncology-related products include: Empliciti™ (elotuzumab), Opdivo® (nivolumab), Sprycel® (dasatinib), Yervoy® (ipilimumab) Details >
January 2019Including... ~ Multiple MolDx Updates ~ 2019 CPT/HCPCS Code Update ~ Coding Radiopharmaceutical Agents ~ Erythropoiesis Stimulating Agents ~ Human Granulocyte/Macrophage Colony Stimulating Factor ~ Not Otherwise Classified Chemotherapy Agents, Removing Rituxin Hycela from the NOC list Details >Part A, Part B and Part A/B News~ HOT OFF THE PRESS - WPS GHA Re-awarded CMS J8 Contract WPS ~ Also included - articles that may be of interest to oncology released in the past 2 weeks ~ Medicare Hot Links to Fee Schedules and Final Rules Details >Check out these upcoming training events....Including.... ~ Teleconference: **** 01/16/19 Provider Enrollment Ask-the-Contractor **** 01/17/19 Understanding What Happens During the TPE Process **** 2/20/19 Provider Enrollment Revalidation **** PLUS many more educational opportunities! ~ 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......~ Physician Advisors: Bridging the Gap Between Confusion and Clarity in Healthcare Details >Recent Oncology Related Articles~ Billing for Stem Cell Transplants ~ Laboratory Date of Service Exception Policy ~ Watch ASCO’s Webinar on 2019 Medicare Reimbursement Changes ~ CMS Physician Fee Schedule Call: Audio Recording and Transcript ~ CY 2019 MPFS Final Rule: Summary of Policies MLN Matters Article ~ 2019 Medicare Part D Opioid Policies: Training Materials ~ MLN Catalog: December 2018 ~ Quarterly Provider Update ~ Quality Payment Program: 2019 Resources ~ Quality Payment Program: Webinar Library ~ Recent LearnResource & MedLearn Matters Articles Details >
Special Webinar Series for Medical and Radiation OncologyTwo new utilization management programs launching January 1, 2019. There are still a few webinar opportunities available for Medical and Radiation oncology, as well as clinical and non-clinical staff. Details >Recent Oncology Related News~ 2019 benefit information delayed for some groups ~ NASCO starting payment recovery for small business groups ~ New user-friendly prompts coming to Pharmacy Prior Authorization Help Desk ~ Updated clinical practice guidelines now available ~ Don't issue referrals for BCN Advantage members staying in network ~ Updates to our PPO clinical editing appeals process ~ Clarification about AllianceRx Walgreens Prime specialty program ~ The Record Details >
Last Updated 1/8/19Review the reported payer reimbursement issues MSHO is currently addressing... 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..... ~ MDHHS identified an issue with provider-initiated claim adjustments submitted December 14, 2018, through December 20, 2018, that caused claims and service lines to be denied as duplicates ~ MSA Bulletin Updates ~ Biller "B" Aware Notices Details >System UpdatesMany updates/corrections. Listed below is a sampling of what you will find... ~ 835 Recoupment Isn't Reflected on the Voucher ~ Voided Claims Incorrectly Denying as Duplicates ~ Facility Claims in Paid Status but No Paid Amount for Out of State Claims ~ Coinsurance and Reimbursement are Applying Incorrect Rates for Rural Health Center Claims ~ and many more... Details >~ Aetna OfficeLink Updates
~ BCN Provider News
~ Cigna
~ HAP
~ Humana YourPractice
~ UHC Network Bulletin
~ UHC Medical Policy Update
Details >Featuring this month: Molina Healthcare of Michigan~ Drug Authorizations and Waste Requirement ~ Drugs added to the authorization list for DOS after October 1, 2018 ~ Molina's Provider Portal Features Details >
~ International drug pricing model concerns oncologists, others who work with Medicare consumers Details >
~ Cigna and Express Scripts Seal $54 Billion Merger ~ Aetna and CVS Health ~ Latest Issue of Medical Economics Details >
January 2018, Frequently Asked QuestionsTopic: ~ Supervising Physician Signature ~ Billing the new Rituxan Code Concern ~ Drug Company Price Increases and Getting Paid by Medicare ~ Step Edits for Medicare Advantage Plans ~ Correct code for Injectable Dexamethasone ~ 340B Drug Reimbursement in 2019 Details >
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