Welcome to the Reimbursement Bulletin
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.
~ WPS Medicare High Dollar Reviews
~ MIPS 2019 Payment Adjustment Confusion
~ CMS proposes Coverage with Evidence Development for Chimeric Antigen Receptor (CAR) T-cell Therapy Details >AstraZeneca~ AZ Oncology ID is your resource for biomarker testing to help patients receive the most appropriate, personalized treatment. Details >
March 13, 2019 12:00 - 1:00 PMREGISTER TODAY!!!
~
Submit any questions you would like answered during this program before 3/1/19 Details >March 21 - 22, 2019ATTENTION ONCOLOGY BILLERS
~ Do not miss this amazing opportunity to become a Certified Hematology Oncology Coder!!
~LAST CALL to Register! Details >Wednesday, April 17thSan Marino Club - Troy
~
View the amazing agenda!
~ Registration is Open! Details >
Janssen Biotech, Inc.~ Oncology-related products include: Darzalex® (daratumumab), Doxil® (doxorubicin HCl liposome injection), Erleada™ (apalutamide), Procrit® (epoetin alfa), Sylvant® (siltuximab), Yondelis® (trabectedin), Zytiga® (abiraterone acetate) Details >
February 2019Including...
~ Human Granulocyte/Macrophage Colony Stimulating Factors Billing and Coding Guidelines
~ 2019 MolDX Updates
~ Drug Administration Coding - Effective February 1, 2019 Details >Part A, Part B and Part A/B NewsIncludes articles that may be of interest to oncology released in the past 2 weeks
~ Also, Medicare Hot Links to Fee Schedules and Final Rules Details >Check out these upcoming training events....Including....
** Teleconference: 3/5/19 - New to Medicare, Getting Started with Provider Enrollment & 4/25/19 - Working with Not Otherwise Classified (NOC) Procedure Codes
** 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 includes an articles on......~ Lawsuit by Policyholders Targets Anthem Details >Recent Oncology Related Articles~ New Medicare Card: 0 not O
~ Open Payments: Transparency and You Call — March 13
~ CLIA Program and Medicare Laboratory Services Fact Sheet— Revised
~ Medicare Advance Written Notices of Noncoverage Booklet— Revised
~ Medicare Parts A & B Appeals Process Booklet— Revised
~ Quality Payment Program: Overview of APMs for Year 3 Webinar — February 21
~ QPP Videos: MIPS Data Submission
~ Quality Payment Program 2019 Resources and Webinar Library
~ Recent LearnResource & MedLearn Matters Articles Details >
Recent Oncology Related News~ Processing delay for professional medical drug claims
~ Start transitioning adult HMO members using infliximab products to Inflectrata
~ Prior-authorization changes coming to AIM authorization program
~ Reminder: Check for authorization requirements, not all Blue Cross patients require AIM authorization
~ The Record Details >
Last Updated 2/19/19Review the reported payer reimbursement issues MSHO is currently addressing including ESA denials by WPS and incorrect Rituxan MUE with BCBSM 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.....
~ Issue in Bridges System in December Giving Resident Aliens Full Medicaid in Error
~ Michigan Medicaid Drug Carve-out Update
~ Public Comment on MDHHS Medicaid Health Plan Common Formulary IS OPEN
~ MSA Bulletin Updates
~ Biller "B" Aware Notices Details >February Monthly Status ReportMany 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
~ Claims denying against the Medicare 72 hour rule
~ 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 >News Updates~ Modifier required for 340b payable drugs, recoupment upcoming for 2018 claims
~ Reminder: No longer accepting fax submissions for record requests and appeals starting March 4
~ Provider website pages moving outside of login
~ Reminder: Effective Jan. 1, step therapy added for Medicare Part B drugs
~ System updates associated with CMS releases Details >~ Aetna OfficeLink Updates
~ BCN Provider News
~ Cigna
~ HAP
~ Humana YourPractice
~ UHC Network Bulletin
~ UHC Medical Policy Update
Details >Featuring this month: Cigna~ Cigna patient required to meed with independent genetic counselor prior to undergoing certain genetic tests
~ Updated website
~ Outreach program for patient's pharmaceutical treatment patterns and options Details >
~ Americans have the right to know their health care and hospital costs
~ ACCC Patient Assistance & Reimbursement Guide Now Available
~ Latest Issue of Medical Economics Details >
February 2019, Frequently Asked QuestionsTopic:
~ New/Updated bortezomib codes
~ Documentation requirements for drugs billed by NDC
~ MIPS adjustments on drugs
~ Billing a long push as an infusion
~ Requirements for documentation of waste
~ Procrit MUE and denials
~ Billing Medicare for packaged drugs Details > |
