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Welcome to the Reimbursement Bulletin

MSHO Confidentiality Statement

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

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Important Oncology Related News

~ HCPCS Quarterly Update - New C-codes and J-codes effective April 1, 2019
~ Review Your Quality Payment Program Performance Information Before it is Publicly Reported
~ Medicaid Reimbursement To Treat Cancer Patients With Radiation Therapy Varies Widely, Study Shows
~ Doctors’ Group Cannot Sue Over Cuts To Medicare Drug Reimbursements
~ Updated ASCO and ASH Guidelines on Managing Anemia Support Safety, Efficacy of Biosimilar ESAs

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MSHO & ASTRO Radiation Oncology Coding 101 Webinar

Wednesday, May 22nd. 12:00 - 1:00 PM

Registration opens tomorrow, April 19!

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Did You Miss MSHO's Spring Reimbursement Meeting?

The handouts are available on the MSHO website!

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MSHO Featured Corporate Sponsor Assistance Program

Pharmacyclics

~ Oncology-related products: Imbruvica® (ibrutinib)

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WPS Oncology Related LCD Updates

April 2019

Including... multiple MolDx updates and an update to Human Granulocyte/Macrophage Colony Stimulating Factors Billing and Coding Guidelines!

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WPS Recent Oncology Related News

Part A, Part B and Part A/B News

Includes articles that may be of interest to oncology released in the past 2 weeks
~ Also, Medicare Hot Links to Fee Schedules and Final Rules

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Join WPS for a Teleconference, Webinar or Seminar!

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!

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Michigan RAC Information

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

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Recent RAC Monitor Articles

This edition includes an articles on......

~ OIG Inspector Daniel Levinson Resigns
~ An Overview of AMA’s E&M Revisions for 2021
~ Beware: The MIPS Shell Game
~ CMS Revises and Details Extrapolation Rules

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CMS-Medicare

Recent Oncology Related Articles

~ Provider Minute Video: The Importance of Proper Documentation
~ A revised Telehealth Services Medicare Learning Network Booklet is available
~ MIPS: Quality Performance Category in 2019 Web-Based Training Course
~ Quality Payment Program CMS Web Interface and CAHPS for MIPS Survey: Register by July 1
~ Patients Over Paperwork April Newsletter
~ Physician Compare: Supplemental Preview Period Open until April 27
~ Open Payments: Review and Dispute Data by May 15
~ Comparative Billing Report on Subsequent Hospital Visits
~ 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

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BCBSM/BCN

Recent Oncology Related News

~ Commercial payer - AARP missing edit in 277CA report
~ Some Blue Cross Blue Shield professional claims were processed twice
~ Re-authorize Blue Cross as your billing agent in new system by May 24
~ Medicare Plus Blue PPO claim reimbursements
~ Effective July 1, Khapzory and Fusilev® will be added the prior authorization program for PPO commercial members
~ Start transitioning adult HMO members using infliximab products to Inflectrata
~ Prior-authorization changes coming to AIM authorization program
~ The Record

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Payer Issue Tracking Page

Last Updated 4/16/19

Review 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!

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Medicaid

Recent Oncology Related Issues and News

~ Medicaid Advantage Pending Issues;
***Molina Medicaid not processing J9999 for Imfinzi in 2018
***UHC Community Plan and Velcade

Also,
~ MSA Bulletin Updates
~ Biller "B" Aware Notices

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Medicare Plus Blue

April Monthly Status Report

Many 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...

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Newsletters of Interest

~ Aetna OfficeLink Updates
~ BCN Provider News
~ Cigna
~ HAP
~ Humana YourPractice
~ UHC Network Bulletin
~ UHC Medical Policy Update

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Managed Care Committee Reimbursement TIDBITS

Featuring this month: Priority Health

~ Education: Billing & Reimbursement Series

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Recent Oncology Related News

~ No More 99201? What’s Coming in 2021 for E/M
~ Value-Based Care Is Changing Cancer Treatment Decisions as Drug Costs Continue to Rise
~ PBM Middlemen Continue to Dodge Responsibility for Patient Suffering and Rising Drug Prices
~ ACCC Patient Assistance & Reimbursement Guide
~ Latest Issue of Medical Economics

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ASK MSHO

April 2019, Frequently Asked Questions

Topic:
~ 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

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