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.
~ CMS Announces New Model to Lower Drug Prices in Medicare Part D and Transformative Updates to Existing Model for Medicare Advantage
~ ASCO Joins Groups Urging Congress to Reject Proposed Changes to Medicare Part D
~ Ad Campaign Highlights Broad Patient and Provider Opposition to Proposed Medicare Change
~ CMS Opens Data Submission Period for MIPS from January 2 - April 2 Details >
February 6, 2019 12:00 - 1:00 PMRegistration is OPEN! Details >March 13, 2019 12:00 - 1:00 PMSAVE THE DATE!
~Registration will open Tuesday, January 29th! Details >March 21 - 22, 2019Registration is OPEN! Details >Medical Oncology Reimbursement 101 WebinarAvailable on the MSHO website! 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~ 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....
**** Webinar: 2/12/19 - New to Medicare, Exploring Resources
**** Teleconference: 2/20/19 Provider Enrollment Revalidation
**** PLUS many more educational opportunities including On-Demand E & M training opportunities! Details >
Region 1 - Performant Recovery, Inc.Nothing new specific to Medical Oncology - Latest Issue Being Audited: Facility vs Non-facilty Reimbursement posted on 9/18/18 Details >This edition does not include any articles specific to medical oncology......We will check again next edition! Details >Recent Oncology Related Articles~ GAO Report on Episode-Based Payment Models including the Oncology Care Model
~ Hospice Election Statement Lack Required Information
~ Comparative Billing Report Webinar on Intensity-Modulated Radiation Therapy Webinar
~ New Electronic System for Provider Reimbursement Review Board Appeals Call — February 5
~ NCCI PTP Edits: Quarterly Update MLN Matters Article
~ ICD-10 and Other Coding Revisions to NCDs MLN Matters Article 2019
~ Local Coverage Determinations MLN Matters Article
~ Proper Use of the KX Modifier for Part B Immunosuppressive Drug Claims
~ Hospital OPPS: January 2019 Update MLN Matters Article
~ Medicare Billing: Form CMS-1500 and the 837 Professional Web-Based Training Course
~ 2019 Medicare Part D Opioid Policies: Training Materials
~ MLN Catalog: December 2018
~ Quality Payment Program: 2019 Resources
~ Quality Payment Program: Webinar Library
~ Recent LearnResource & MedLearn Matters Articles Details >
Recent Oncology Related News~ New prior authorization for opioid dosages over 90 morphine mg equivalents per day
~ February 11, 2019 ICT Webinar: You've submitted a few claims; now what?
~ NASCO conducting payment recovery for General Motors
~ Payment recovery, rebilling advice for incorrect 340B modifier drug claims
~ Medicare Plus Blue PPO drug administration coding
~ AIM Specialty Health outage
~ Not all Blue Cross members require AIM authorization
~ The Record Details >
Last Updated 1/23/19Review 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.....
~ Medicaid Enrollees Must Have Access to High-quality Cancer Care, ASCO Writes in Comments to CMS
~ Public Comment on MDHHS Medicaid Health Plan Common Formulary IS OPEN
~ 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 >
~ New Standards for Safe Handling of Hazardous Drugs Focus on Developing Evidence-Based Measures Details >
~ Understanding CMS Advanced Practitioner Professional Billing
****ATTENTION MSHO MEMBERS - READ THIS ARTICLE!
Also....
~ ACCC Patient Assistance & Reimbursement Guide Now Available
~ 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 > |
