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.
~ Doctors’ Group Cannot Sue Over Cuts To Medicare Drug Reimbursements
~ BREAKING: HRSA unveils new website to gauge 340B drug prices
~ Access to Care and Drug Pricing: An Update for 2019
~ FDA’s Oncology Center of Excellence Touts 2018 Accomplishments
~ Urge Congress to Support Cancer Treatment Fairness Details >Merck~ Merck is pleased to announce that KEYTRUDA has been approved by the FDA for the adjuvant treatment of patients with melanoma with involvement of lymph node(s) following complete resection. Details >
Wednesday, April 17thSan Marino Club - Troy
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View the amazing agenda!
~ Don't miss this meeting! Register today! Details >Wednesday, May 22nd. 12:00 - 1:00 PMSAVE THE DATE!!! Details >
Pharmacyclics~ Oncology-related products: Imbruvica® (ibrutinib) Details >
April 2019Including... multiple MolDx updates and an update to Human Granulocyte/Macrophage Colony Stimulating Factors Billing and Coding Guidelines! 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: 4/23/19 - Keeping the Medicare Local Coverage Determination Process Straight & 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 Oncology Related Issue Being Audited: Facility vs Non-facilty Reimbursement posted on 9/18/18 Details >This edition includes an articles on......~ An Overview of AMA’s E&M Revisions for 2021
~ Beware: The MIPS Shell Game
~ CMS Revises and Details Extrapolation Rules Details >Recent Oncology Related Articles~ CMS to Revisit National Coverage Determination on NGS Tumor Testing
~ Medicare Enrollment for Physicians and Other Part B Suppliers — Revised
~ Medicare Secondary Payer — Revised
~ Medicare Secondary Payer Provisions Web-Based Training Course — Revised
~ PECOS FAQs — Revised
~ PECOS Technical Assistance Contact Information — Revised
~ Comparing Hospital Quality: CMS Updates Consumer Resources
~ Diagnosis Coding: Using the ICD-10-CM Web-Based Training Course
~ Dual Eligible Beneficiaries under Medicare and Medicaid Booklet — Reminder
~ 8 things physicians need to know about MACRA in 2019
~ 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~ Medicare Plus BlueSM PPO claim reimbursements
~ Effective July 1, KhapzoryTM and Fusilev® will be added the prior authorization program for PPO commercial members
~ Status update on Q2 2019 enhancements to our PPO outpatient facility claims editing process
~ New voucher message will indicate risk allocation amount
~ Coding Advisor's E/M coding educational program started March 18
~ Maintaining current PGIP contact lists
~ 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
~ Start transitioning adult HMO members using infliximab products to Inflectrata
~ Prior-authorization changes coming to AIM authorization program
~ The Record Details >
Last Updated 4/2/19Review the reported payer reimbursement issues MSHO is currently addressing including "Should be" resolved - incorrect Rituxan MUE with BCBSM, incorrect payment for Imfinzi, J9173 and an IMPORTANT additional update to Chemotherapy Induced Anemia Claim Denials for ESAs by WPS! Details >Recent Oncology Related Issues and News~ Medicaid Advantage Pending Issues;
***Molina Medicaid not processing J9999 for Imfinzi in 2018
***UHC Community Plan and Velcade
***MSHO Addressing Managed Medicaid Plans with Medical Drug Benefit Restrictions
Also,
~ MSA Bulletin Updates
~ Biller "B" Aware Notices Details >April 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
~ Patients are receiving bills for two copayments, which is causing confusion at the provider offices
~ and more... Details >~ Aetna OfficeLink Updates
~ BCN Provider News
~ Cigna
~ HAP
~ Humana YourPractice
~ UHC Network Bulletin
~ UHC Medical Policy Update
Details >Featuring this month: Priority Health~ Education: Billing & Reimbursement Series Details >
~ NCCN Panel Digs Into Reality of CAR T-cell Reimbursement Details >
~ Pathways, Oncology APMs, Medical Homes Key to Improving Quality of Care, ASCO Tells Congress
~ Value-Based Care Is Changing Cancer Treatment Decisions as Drug Costs Continue to Rise
~ ACCC Patient Assistance & Reimbursement Guide Now Available
~ Latest Issue of Medical Economics Details >
April 2019, Frequently Asked QuestionsTopic:
~ Billing for adjusting coumadin level
~ Documentation requirement for billing hydration
~ ICD-10 codes that cannot be anywhere on the claim when billing ESA for CIA
~ Rules for billing for supplies with administration codes
~ Medicare MUEs
~ Problems with Marketplace claims and where to submit complaint Details > |
