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.
~ 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 >AMGEN~ Neulasta Onpro is available at no extra cost beyond that of the Neulasta Pre-filled Syringe (for commercially insured patients)... Details >
Held on Wednesday, May 22ndIf you missed this webinar; the recording and handouts are available on the MSHO website! Details >Wednesday, October 23, 2019SAVE THE DATE! 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; "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.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......~ 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 >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 >
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 >
Last Updated 5/22/19Review the reported payer reimbursement issues MSHO is currently addressing including Medicare Plus Blue update 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 Denials
Also, ~ Medicaid Drug Rebate Program Manufacturer Release 110 ~ 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 >Meridian Releases HealthHelp for Prior Authorization RequestsDetails >Important Update from MSHO Managed Care Committee Member Robin FreyDetails >~ 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 >
~ 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 >
~ 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 >
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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