like us on facebook connect with us on linkedin follow us on twitter January 09, 2019

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

~ 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

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Webinar - WPS Outpatient Hospital Webinar

March 13, 2019 12:00 - 1:00 PM

SAVE THE DATE!

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MSHO Hosted a Legislative Update Webinar on the Key Reimbursement Changes for 2019

The handouts and recording are available on the MSHO website!

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MSHO 2019 HCPCS Code Update

List of Oncology Related New/Revised/Deleted HCPCS Codes

WATCH 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

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The MSHO 2019 Physician Fee Schedule Analyzer Tool

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!

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MSHO Featured Corporate Sponsor Assistance Program

Bristol-Myers Squibb Oncology

~ Oncology-related products include: Empliciti™ (elotuzumab), Opdivo® (nivolumab), Sprycel® (dasatinib), Yervoy® (ipilimumab)

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WPS Oncology Related LCD Updates

January 2019

Including...
~ 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

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WPS Recent Oncology Related News

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

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Join WPS for a Teleconference, Webinar or Seminar!

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

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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 an article on......

~ Physician Advisors: Bridging the Gap Between Confusion and Clarity in Healthcare

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CMS-Medicare

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

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BCBSM/BCN Launching AIM Specialty Health Initiative

Special Webinar Series for Medical and Radiation Oncology

Two 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.

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BCBSM/BCN

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

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Payer Issue Tracking Page

Last Updated 1/8/19

Review the reported payer reimbursement issues MSHO is currently addressing...

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Medicaid

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

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Medicare Plus Blue

System Updates

Many 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...

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Newsletters of Interest

~ Aetna OfficeLink Updates
~ BCN Provider News
~ Cigna
~ HAP
~ Humana YourPractice
~ UHC Network Bulletin
~ UHC Medical Policy Update

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Managed Care Committee Reimbursement TIDBITS

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

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Recent Oncology Related Drug News

~ International drug pricing model concerns oncologists, others who work with Medicare consumers

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Recent Oncology Related News

~ Cigna and Express Scripts Seal $54 Billion Merger
~ Aetna and CVS Health
~ Latest Issue of Medical Economics

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ASK MSHO

January 2018, Frequently Asked Questions

Topic:
~ 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

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