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.
~ Participating Practices Commend CMS for OCM Changes
~ The FDA's Oncology Center of Excellence — Quantifying the Patient Experience
~ Tell Congress to Support Medicaid Coverage of Routine Care Costs for Clinical Trials Details >
March 13, 2019 12:00 - 1:00 PMREGISTER TODAY!!! Details >Wednesday, April 17thSan Marino Club - Troy
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View the amazing agenda!
~ Registration is Open! Details >Wednesday, May 22nd. 12:00 - 1:00 PMSAVE THE DATE!!! Details >
Novartis~ Oncology-related products: Afinitor® (everolimus) tablets, Afinitor DisperzTM (everolimus) tablets for oral suspension, Arzerra® (ofatumumab) injection, Exjade® (deferasirox) tablets for oral suspension, Farydak® (panobinostat) capsules, Femara® (letrozole) tablets, Gleevec® (imatinib mesylate) tablets,
Jadenu® (deferasirox) tablets, Kisqali® (ribociclib) tablets, Kymriah® (tisagenlecleucel) suspension for IV infusion, Mekinist® (trametinib) tablets, Odomzo®(sonidegib), Promacta® (eltrombopag) tablets, Rydapt® (midostaurin) capsules, Sandostatin® (octreotide acetate) for injection, Sandostatin® LAR Depot (octreotide acetate for injectable suspension), Tafinlar® (dabrafenib) capsules, Tasigna® (nilotinib) tablets, Tykerb® (lapatinib) tablets, Votrient® (pazopanib) tablets, Zykadia® (ceritinib) capsules Details >
March 2019Including... multiple MolDx updates! 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: 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......~ Medicare Audit Contractors Demand Providers Perform Self-Audits Details >Recent Oncology Related Articles~ Quality Payment Program: Payment Adjustment Resource
~ First Opinion: Medicare Should Stop Blocking Access To Next-Generation Sequencing For People With Hereditary Cancer
~ Data on Geographic Variation in the Medicare Program
~ Laboratory Blood Counts: Provider Compliance Tips
~ Open Payments: Transparency and You Call — March 13
~ CMS Updates Consumer Resources for Comparing Hospital Quality
~ CMS: Beyond the Policy — New Podcast
~ CAR T-cell Therapy: CMS Proposes Coverage with Evidence Development
~ Appeals Call: Audio Recording and Transcript — New
~ How to Use the Medicare National Correct Coding Initiative Tools Booklet — Revised
~ How to Use the Medicare Coverage Database Booklet — Revised
~ Advance Care Planning Fact Sheet — Reminder
~ Medicare Advance Written Notices of Noncoverage Booklet— Revised
~ Medicare Parts A & B Appeals Process Booklet— Revised
~ QPP Videos: MIPS Data Submission
~ Quality Payment Program 2019 Resources and Webinar Library
~ Recent LearnResource & MedLearn Matters Articles Details >
Recent Oncology Related News~ Medicare Plus Blue PPO manual update coming in April
~ Some professional claims receiving front end edit P022 in error
~ 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 3/4/19Review 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
~ MSA Bulletin Updates
~ Biller "B" Aware Notices Details >March 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
~ Coinsurance and Reimbursement are Applying Incorrect Rates for Rural Health
~ Facility Providers Being Underpaid Due To Pricing Issues Center Claims
~ and many more... Details >News Updates~ Modifier required for 340b payable drugs, recoupment upcoming for 2018 claims Details >~ Aetna OfficeLink Updates
~ BCN Provider News
~ Cigna
~ HAP
~ Humana YourPractice
~ UHC Network Bulletin
~ UHC Medical Policy Update
Details >Featuring this month: Anthem Blue Cross~ No Michigan Anthem patients
~ Anthem performs claims processing BCBSM and BCN for out of state members
~ Policies vary by state Details >
~ These 10 New Drugs Expected In 2019 Are On The Blockbuster Track Details >
~ Cancer Complications: Confusing Bills, Maddening Errors And Endless Phone Calls
~ To increase patient satisfaction, providers need to start talking about costs: survey
~ The High-Stake Risks of High-Priced Pharmaceuticals
~ ACCC Patient Assistance & Reimbursement Guide Now Available
~ Latest Issue of Medical Economics Details >
March 2019, Frequently Asked QuestionsTopic:
~ MIPS Points Required for 2019
~ MIPS Scoring Categories
~ MIPS Small Practice Size
~ Modifier GA
~ Modifier GY
~ 2019 E & M Changes
~ Incident To Drug Provisions Details > |
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