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.
~ 340B Commission’s Final Report on the 340B Drug Discount Program
~ ASTRO Releases Updated Radiation Oncology Safety Guide
~ Urge Congress to Support Cancer Treatment Fairness
~ News Alert: E&M Changes Coming Soon Details >Eli Lilly and Company~ We are proud that our oncology medicines are a part of novel combination therapies. The FDA recently approved one of our cancer medicines to be used in combination with an immuno-oncology treatment and platinum chemotherapy. Details >
Wednesday, April 17thSan Marino Club - Troy
~
View the amazing agenda!
~ Registration is Open! Details >Wednesday, May 22nd. 12:00 - 1:00 PMSAVE THE DATE!!! Details >Handouts are available on the MSHO websiteDetails >
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......~ CMS Revises and Details Extrapolation Rules Details >Recent Oncology Related Articles~ Update on MIPS Adjustment Error: CMS Correcting Issue, No Provider Action Required
~ 8 things physicians need to know about MACRA in 2019
~ PECOS FAQs — Revised
~ PECOS Technical Assistance Contact Information — Revised
~ Comparing Hospital Quality: CMS Updates Consumer Resources
~ E/M When Performed with Superficial Radiation Treatment — Revised
~ Diagnosis Coding: Using the ICD-10-CM Web-Based Training Course
~ Dual Eligible Beneficiaries under Medicare and Medicaid Booklet — Reminder
~ Quality Payment Program: Payment Adjustment Resource
~ QPP Videos: MIPS Data Submission
~ Quality Payment Program 2019 Resources and Webinar Library
~ Recent LearnResource & MedLearn Matters Articles Details >
Recent Oncology Related News~ A message from Dr. S. George Kipa
~ Use form to request criteria for BCN authorization decisions (non-behavioral health)
~ Additional changes to BCN process for requesting peer-to-peer review of non-behavioral health cases
~ April 4, 2019 ICT Webinar: You've submitted a few claims; now what?
~ Starting April 1, Fasenra, Radicava part of site-of-care requirement for HMO members
~ 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
~ The Record Details >
Last Updated 3/20/19Review the reported payer reimbursement issues MSHO is currently addressing including RESOLVED - incorrect Rituxan MUE with BCBSM, incorrect payment for Imfinzi, J91723 and a resolution/update related to WPS and ESA denials! Details >Recent Oncology Related Issues and News~ Medicaid Advantage Pending Issues;
Molina Medicaid not processing J9999 for Imfinzi in 2018
MSHO Addressing Managed Medicaid Plans with Medical Drug Benefit Restrictions
Also,
~ 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 >~ 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 >
~ U.S. Congress Invites Pharmacy Benefit Managers To Third Drug Pricing Hearing
~ MSMS among groups calling for improvements in prior authorization process
~ 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 > |
|
