like us on facebook connect with us on linkedin follow us on twitter May 22, 2019

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

Section Header

Important Oncology Related News

~ Comprehensive Strategy to Foster Innovation for Transformative Medical Technologies
~ CMS Final Rule Maintains Protections for Part D Beneficiaries with Cancer; Safeguards Still Needed Under Medicare Advantage and Part B
~ COA Launches Major National Campaign to Stop PBM Abuses and Highlight Patient Horror Stories
~ CMS Statement: Delay in Final CAR T-cell therapy NCD
~ DHHS Managed Care Plan Contract Managers

Details >

A Message From Your E-bulletin Sponsor

AMGEN

~ Neulasta Onpro is available at no extra cost beyond that of the Neulasta Pre-filled Syringe (for commercially insured patients)...

Details >
Section Header

MSHO & ASTRO Radiation Oncology Coding 101 Webinar

Held on Wednesday, May 22nd

If you missed this webinar; the recording and handouts are available on the MSHO website!

Details >

MSHO 10th Annual Payer Update

Wednesday, October 23, 2019

SAVE THE DATE!

Details >
Section Header

MSHO Featured Corporate Sponsor Assistance Program

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 >
Section Header

WPS Oncology Related LCD Updates

May 2019

Including... multiple MolDx updates and retirement of Drugs and Biologics (Non-chemotherapy)

Details >

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

Details >

Join WPS for a Teleconference, Webinar or Seminar!

Check out these upcoming training events....

Including....
In-Person Event; "Medicare Day of Learning" in Kalamazoo on 8/20
Teleconferences including; "New to Medicare-Handling Overpayments" on 6/4
** PLUS many more educational opportunities including On-Demand E & M training opportunities!

Details >
Section Header

Michigan RAC Information

Region 1 - Performant Recovery, Inc.

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 >

Recent RAC Monitor Articles

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

~ Recovery Audits: Improvements to Protect Taxpayer Dollars and Put Patients over Paperwork
~ Federal Judge Upholds Successful Challenge of 340B Reimbursement Cuts
~ Medicare Advantage Plan Denials. Now What?

Details >

CMS-Medicare

Recent Oncology Related Articles

~ Improper Payment for Intensity-Modulated Radiation Therapy Planning Services
~ MIPS Improvement Activities Performance Category in 2019 Webinar — May 23
~ Medicare Part B Immunization Billing: Seasonal Influenza Virus, Pneumococcal, and Hepatitis B — Reminder
~ Medicare Shared Savings Program: Submit Notice of Intent to Apply Beginning June 11
~ Laboratory Blood Counts: Provider Compliance Tips
~ Hospital Outpatient Prospective Payment System— Revised
~ Recent LearnResource & MedLearn Matters Articles

Details >
Section Header

BCBSM/BCN

Recent Oncology Related News

~ Medicare Part B medical specialty drug prior authorization list changing July 22, 2019
~ NASCO conducting payment recovery for URMBT retiree groups
~ 2 employer groups joining the PPO commercial medical drug prior authorization program
~ Blue Cross tackling cost of prescription drugs
~ Molina commercial payer claims edit 277CA in error
~ SCIO Health Analytics' post-pay outpatient audits start on May 1
~ Blue Care Network updates professional fees July 1
~ Medicare Plus Blue PPO claim reimbursement policy changes effective July 1
~ Effective July 1, Khapzory and Fusilev® will be added the prior authorization program for PPO commercial members effective July 1
~ The Record

Details >
Section Header

Payer Issue Tracking Page

Last Updated 5/22/19

Review the reported payer reimbursement issues MSHO is currently addressing including Medicare Plus Blue update on wrongful denials for Imfinzi, J9173.

Details >

Medicaid

Recent Oncology Related Issues and News

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

Also,
~ Medicaid Drug Rebate Program Manufacturer Release 110
~ MSA Bulletin Updates
~ Biller "B" Aware Notices

Details >

Medicare Plus Blue

May 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
~ 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 >

Blue Care Network Alert

AIM Specialty Health to manage medical oncology medications for BCN Starting August 1

Details >

Meridian Update

Meridian Releases HealthHelp for Prior Authorization Requests

Details >

Priority Health

Important Update from MSHO Managed Care Committee Member Robin Frey

Details >

Newsletters of Interest

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

Details >

Managed Care Committee Reimbursement TIDBITS

Featuring this month: Medicare Advantage Plans

~ Tidbits on Aetna Advantage, Medicare Plus Blue and Humana Advantage!

Details >
Section Header

Recent Oncology Related Drug News

~ FDA Finalizes Rules for When a Biosimilar is ‘Interchangeable’ with a Biologic
~ FDA finalizes guidance on what counts as an interchangeable biosimilar; Six Things To Know
~ HHS Finalizes Rule Requiring Manufacturers Disclose Drug Prices in TV Ads to Increase Drug Pricing Transparency

Details >
Section Header

Recent Oncology Related News

~ 10 ways to reduce the burden of prior authorizations
~ Prior Authorization Obstacles Unnecessarily Delay Patient Access To Cancer Treatments, Physician Survey Finds
~ Latest Issue of Medical Economics

Details >
Section Header

ASK MSHO

May 2019, Frequently Asked Questions

Topic:
~ 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 >