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.
~ Priority Health Removing Prior Authorization Requirement for Drug Related Clinical Trials
~ CMS to allow copay accumulators, cut exchange user fees
~ The Health Resources & Services Administration Launches a Website to Increase Pricing Transparency in the 340B Program
~ Prior Authorization Bill Expected in Congress This Summer
~ Radiation Oncologists Urge Congress To Remove Obstacles To Cancer Patients’ Treatment Options
~ The PAN Foundation Opens New Carcinoid Syndrome Patient Assistance Fund Details >
Wednesday, May 22nd 12:00 - 1:00 PMRegistration is open! Register today! Details >
Pfizer~ Oncology-related products: Aromasin® (exemestane tablets), Bavencio® (avelumab) injection (co-marketed with EMD Serono, Inc.), Besponsa® (inotuzumab ozogamicin), Bosulif® (bosutinib) tablets, Camptosar® (irinotecan HCl injection), Daurismo™ (glasdegib), Ellence® (epirubicin hydrochloride injection), Emcyt® (estramustine phosphate sodium capsules), Ibrance® (palbociclib), Idamycin PFS® (idarubicin hydrochloride for injection), Inlyta® (axitinib) tablets, Lorbrena® (lorlatinib), Mylotarg™
(gemtuzumab ozogamicin), Sutent® (sunitinib malate), Talzenna™ (talazoparib), Torisel® (temsirolimus) injection, Vitrakvi® (larotrectinib) (co-marketed with Loxo Oncology Inc.), Vizimpro® (dacomitinib), Xalkori® (crizotinib) capsules, Zinecard® (dexrazoxane for injection) Details >
May 2019Including... multiple MolDx updates and retirement of Drugs and Biologics (Non-chemotherapy) 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....
In-Person Event; "Medicare Day of Learning" in Kalamazoo on 8/20
Teleconferences including; "Provider Enrollment for Non-physician Practitioners" on 5/15 & "New to Medicare-Handling Overpayments" on 6/4
** PLUS many more educational opportunities including On-Demand E & M training opportunities! Details >
Region 1 - Performant Recovery, Inc.NEW - Latest Issues Under Review That May be Significant to Oncology - Complex Coding Validation and Subsequent Hospital and Discharge Day Posted in April, 2019!
~ Also, CMS Announcement - Recover Audits: Improvements to Protect Taxpayer Dollars and put Patients over Paperwork Details >This edition includes an articles on......~ CMS Mulls Regulating Shared Space in Provider-based Settings
~ Opinion: Too Much Money, Too Little ROI in Today’s Healthcare
~ The Pharm Report: Oligopoly and Drug Pricing Details >Recent Oncology Related Articles~ Open Payments: Review and Dispute Data by May 15
~ Medicare Overpayments — Revised
~ Medicare Offers To Partially Raise Payment For Cancer CAR-Ts
~ CMS Reopens National Coverage Determination for NGS Testing in Advanced Cancer
~ Payment for Outpatient Services Provided to Beneficiaries Who Are Inpatients of Other Facilities
~ Medicare Billing: CMS Form CMS-1450 and the 837 Institutional — Reminder
~ Medicare Billing: CMS Form CMS-1500 and the 837 Professional — Reminder
~ Quality Payment Program: MIPS 2019 Call for Measures/Activities Ends July 1
~ Proper Use of the KX Modifier for Part B Immunosuppressive Drug Claims
~ 2019 MIPS Group Participation
~ PECOS for Physicians and NPPs — Revised
~ Provider Minute Video: The Importance of Proper Documentation
~ A revised Telehealth Services Medicare Learning Network Booklet is available
~ Quality Payment Program Merit-based Incentive Payment System (MIPS): Quality Performance Category in 2019 Web-Based Training Course — Revised
~ Recent LearnResource & MedLearn Matters Articles Details >
Recent Oncology Related News~ PGIP and risk allocations apply to most procedure codes, effective April 1
~ The Michigan Radiation Oncology Quality Consortium: A publishing powerhouse
~ Enhancements to the 835
~ Molina commercial payer claims edit 277CA in error
~ SCIO Health Analytics' post-pay outpatient audits start on May 1
~ Blue Cross updated phone line servicing prompts for medical drug authorizations
~ Professional: Injection Fee Schedule Added to web-DENIS
~ Blue Care Network updates professional fees July 1
~ Commercial payer - AARP missing edit in 277CA report
~ 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
~ The Record Details >
Last Updated 5/7/19Review the reported payer reimbursement issues MSHO is currently addressing including IMPORTANT update to Chemotherapy Induced Anemia Claim Denials for ESAs by WPS and Medicare Plus Blue working on wrongful denials for Imfinzi, J9173. Details >Recent Oncology Related Issues and News~ Medicaid Advantage Pending Issues;
***Molina Medicaid not processing J9999 for Imfinzi
***UHC Community Plan and Velcade
~ UHC Community Plan - ATTENTION BILLERS - Wrongful Denial Code N767
~ CMS Finalizes Rule to Protect Medicaid Provider Payments
~ Analysis of PBM Spread Pricing in Michigan Medicaid Managed Care
~ Michigan Medicaid Health Plan Common Formulary Comments
Also,
~ MSA Bulletin Updates
~ Biller "B" Aware Notices Details >May 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
~ 835 CARC 210 sanction amount i incorrect (new issue)
~ Claims denying against the Medicare 72 hour rule
~ Coinsurance and Reimbursement are Applying Incorrect Rates for Rural Health
~ Problems with rural health center claims processing deductibles
~ Patients are receiving bills for two copayments, which is causing confusion at the provider offices
~ and more... Details >AIM Specialty Health to manage medical oncology medications for BCN Starting August 1Details >~ Aetna OfficeLink Updates
~ BCN Provider News
~ Cigna
~ HAP
~ Humana YourPractice
~ UHC Network Bulletin
~ UHC Medical Policy Update
Details >Featuring this month: Medicare Advantage Plans~ Tidbits on Aetna Advantage, Medicare Plus Blue and Humana Advantage! Details >
~ ASH President: Medicare Proposal for CAR-T a Promising Step Forward
~ Drugmakers Reveal List Prices Online After Pressure From Trump Details >
~ 10 ways to reduce the burden of prior authorizations
~ Prior Authorization Obstacles Unnecessarily Delay Patient Access To Cancer Treatments, Physician Survey Finds
~ PBM Horror Stories Volume V: Dangerous Health Care Middlemen & Bureaucracies
~ CBO’s Report On Single-Payer Health Care Holds More Questions Than Answers
~ The Four Pillars of an Ideal Two-sided Risk Value-based Payment Model in Medical Oncology
~ ACCC Patient Assistance & Reimbursement Guide
~ Latest Issue of Medical Economics Details >
May 2019, Frequently Asked QuestionsTopic:
~ RAC recoupment timing
~ List of drugs that can be used with chemotherapy administration codes
~ Hierarchical Condition Codes and ACOs
~ Nurse level visit (99211) and billing for chemo teach
~ Rituxan vs Rituxan Hycela coding Details > |
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