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.
~ Oncology Reimbursement Reform Leaves Stakeholders With More Questions Than Answers ~ Court Again Rules That HHS’s Medicare 340B Drug Price Cuts Are Illegal, But Gives The Agency A Chance To “Unscramble The Egg” ~ COA News: New PBM Abuses Campaign, Step Therapy in MA Plans, Hill Day Update ~ ASCO Town Hall Brings Tense Conversation About Drug Pricing ~ White House Wants Patients to Know Health-Care Prices Up Front ~ Judge Rips Insurance Company for ‘Immoral, Barbaric’ Cancer Denials Details >AstraZeneca~ Access 360 - Helping Patients Access The Care They Need! 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 >
Teva~ Oncology-related therapeutic products: Bendeka® (bendamustine hydrochloride) for injection, Synribo® (omacetaxine mepesuccinate) for injection, Treanda® (bendamustine HCl) for injection, Trisenox® (arsenic trioxide) for injection ~ Oncology-related supportive care products: Actiq® (oral transmucosal fentanyl citrate) [C-II], Fentora® (fentanyl buccal tablet) [C-II], Granix® (tbo-filgrastim) injection Details >
June 2019Including... Billing and Coding: Human Granulocyte/Macrophage Colony Stimulating Factors & MolDX! 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 Webinar: Qualified Medicare Beneficiary (QMB) Program 7/23 Also On-Demand: Provider Enrollment - Eligible Non-physician Practitioners (NPPs) ** PLUS many more educational opportunities including 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! Details >This edition includes an article on......~ New Guidance Expected for Shared Space Details >Recent Oncology Related Articles~ More than Half of All OCM Providers Could Owe CMS Money if Required to Join in 2-Sided Risk Model ~ CMS Takes Action to Lower Prescription Drug Prices and Increase Transparency ~ April – June Quarterly Provider Update ~ Improper Payment for Intensity-Modulated Radiation Therapy Planning Services ~ Medicare Shared Savings Program: Submit Notice of Intent to Apply Beginning June 11 ~ Laboratory Blood Counts: Provider Compliance Tips ~ Recent LearnResource & MedLearn Matters Articles Details >
Recent Oncology Related News~ Register for the June PGIP Quarterly Meeting Today ~ HCPCS update: New codes added ~ Billing chart: Blues highlight medical, benefit policy changes ~ Providers receiving ineligible for inquiries error will need group NPI to access Medicaid information ~ Medication reconciliation reimbursement increases to $35 ~ 2019 InterQual criteria to be implemented Aug. 1 ~ NaviNet replacing Blue Exchange for online eligibility and claims inquiries; register for access now ~ June 13 ICT Webinar: You've submitted a few claims; now what? ~ Medicare Part B medical specialty drug prior authorization list changing July 22 ~ NASCO conducting payment recovery for URMBT retiree groups ~ 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 >Publications~ The Record ~ BCN Provider News ~ Blues Brief for Oncology Providers Details >June 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 incorrect ~ J0881 and J0884 claims are denying incorrectly (New Issue but corrected on May 10) ~ Providers are getting false eligibility information for processing eviCore claims (New Issue) ~ Radiation oncology claims are taking longer to process because of an internal MPB problem (New Issue) ~ Problems with rural health center claims processing deductibles ~ and more... Details >AIM Specialty Health to manage medical oncology medications for BCN Starting August 1Details >
Last Updated 6/4/19Review 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 NewsMedicaid Advantage Pending Issues; ***Issue Resolved - Molina Medicaid not processing J9999 for Imfinzi ***Issue Resolved - UHC Community Plan and Velcade Denials
Also, ~ MSA Bulletin Updates ~ Biller "B" Aware Notices Details >Meridian Releases HealthHelp for Prior Authorization RequestsDetails >Important Update from MSHO Managed Care Committee Member Robin FreyDetails >~ Aetna OfficeLink Updates
~ Cigna
~ HAP
~ Humana YourPractice
~ UHC Network Bulletin
~ UHC Medical Policy Update
Details >Featuring this month: Managed Medicaid~ Tidbits on Healthy Michigan, Harbor Health Plan and Managed Medicaid Provider Assistance Details >
~ What Pharmacists Should Know About the Pitfalls of Step Therapy ~ Questions raised over cancer drugs in FDA's accelerated approval program Details >
~ PAN Foundation Announces a new Treatment Transport Program! ~ FDA Officials Call for Patient-Friendly Terminology in Oncology ~ Latest Issue of Medical Economics Details >
June 2019, Frequently Asked QuestionsTopic: ~ CPT Code for Concurrent Chemotherapy Infusion ~ Coding CBC without Differential ~ Where to find information on billing for biosimilars ~ Where to find drug pricing for outpatient hospital facilities ~ Rectroactive payments for drugs ~ Definition of an ACO Details >
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