Welcome to the Reimbursement Bulletin
This Bulletin will be published semi-monthly. As always, any comments, suggestions, stories or questions can be sent to billing@msho.org.
~ CMS released the Proposed Rules for Physician Fee Schedule, Hospital Outpatient and Quality Payment Program - Review the Proposed Rules and summaries from CMS, ASCO, ASH, ACCC and COA Details >~ ASTRO’s Perspective on the Proposed CMS Radiation Oncology APM ~ Medicare pilot gives physicians access to patients' claims data ~ Senate bill’s drug pricing provision raises industry alarms ~ ASCO - Drug Pricing Bill Should Protect Patients, Encourage Biosimilars, and Interoperability ~ COA Statement on Senate Finance Committee “Drug Pricing Reduction Act” ~ Oncologists Appeal Dismissal Of Medicare Drug Reimbursement Cut Lawsuit Details >
Wednesday, October 23, 2019SAVE THE DATE! ~ Registration will open soon! Details >
Bayer~ Oncology-related product: Nubeqa® (darolutamide), AliqopaTM (copanlisib) for injection, Nexavar® (sorafenib) tablets, Stivarga® (regorafenib) tablets, Xofigo® (radium Ra 223 dichloride) injection Details >
August 2019Including;
~ New Billing and Coding: Erythropoiesis Stimulating Agents (ESAs)
~ Erythropoiesis Stimulating Agents (ESAs) - Effective August 1, 2019
~ Immune Globulins - Effective August 13, 2019
~ MolDX: Molecular Diagnostic Tests (MDT) - Effective January 1, 2019 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 2020 Proposed and 2019 Final CMS Rules Details >Check out these upcoming training events....Including.... ~ In-Person Event: "Medicare Day of Learning" in Kalamazoo on 8/20 ~ Teleconferences: Observation - Clinical coverage and Billing Criteria 9/26 ~ Webinars: Appeals Webinar Series 9/18 - 9/25 - 10/2, Medicare Secondary Payer Series 8/15 - 9/25 ~ 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......~ How Patient Rights are Being Impacted by Medicare Advantage Plans’ Use of Long Observation Stays ~ The Unfair Advantage of Medicare Advantage Plans Details >Recent Oncology Related Articles~ Medicare Raises Payments for CAR-T Therapies ~ Doctors Caucus Urges Agencies to Reconsider Step Therapy ~ Medicare Releases Final Local Coverage Determination Providing Coverage of Optune® for Newly Diagnosed Glioblastoma ~ CMS Regional Office Requests our Input ~ CMS Advances MyHealthEData with New Pilot to Support Clinicians ~ July – September Quarterly Provider Update ~ Physician Fee Schedule Proposed Rule: Understanding 3 Key Topics Listening Session — August 12 ~ OPPS and ASC Proposed Rule Listening Session — August 14 ~ Skilled Nursing Facility 3-Day Rule Billing ~ Quality Payment Program Web-Based Training Course ~ Importance of Proper Documentation: Provider Minute Video ~ Changes to the Laboratory National Coverage Determination (NCD) Edit Software for October 2019 ~ Quality Payment Program: 2019 Resources ~ Recent LearnResource & MedLearn Matters Articles Details >
MSHO Members - Don't miss this opportunity 9/24 and 9/26!Details >Recent Oncology Related News~ August 26, 2019 ICT Webinar: You've submitted a few claims; now what? ~ Reminder: Check for authorization requirements, not all Blue Cross patients require AIM authorization ~ Reminder: Effective August 1, authorizations must be obtained from AIM Specialty Health® for most medical oncology and supportive care ~ Billing prohibitions apply to dual eligible beneficiaries in QMB program ~ Medicare Part B medical specialty drug prior authorization list is changing in October ~ Due to coding error, select claims may be resubmitted for reprocessing, payment adjustment ~ We're adding drugs to prior authorization, site of care programs for PPO members, effective October 2019 Details >Publications~ The Record ~ BCN Provider News ~ Blues Brief for Oncology Providers Details >August Monthly Status ReportMany updates/corrections. Listed below is a sampling of what you will find... ~ 835 Recoupment Isn't Reflected on the Voucher ~ J0881 and J0885 claims are denying incorrectly (Newer Issue but corrected on May 10 with reprocessing of claims complete by 8/31) ~ NEW ISSUE - Providers are getting false eligibility information for processing eviCore claims ~ Radiation oncology claims are taking longer to process and/or denying incorrectly because of an internal MPB problem (New Issue) ~ Coinsurance and reimbursement applying incorrect rates for rural health should be fixed by 8/30 ~ Voided claims are incorrectly denying as duplicates ~ and more... Details >
Last Updated 8/7/19Review the reported payer reimbursement issues MSHO is currently addressing including WPS, BCBSM, Medicare Plus Blue and Meridian. Details >Recent Oncology Related Issues and News~ Pending Issues being Addressed by MSHO; MHP Update on - Meridian Medicaid issues and Crossover Claims Not Being Processed and Problems with their Website ~ Total Health Care claims processing issues
Additional Updates: ~ IMPORTANT NOTICE: Medicaid Third-Party Liability Information is reported incorrectly in CHAMPS! ~ MSA Bulletin Updates ~ Biller "B" Aware Notices Details >~ Aetna OfficeLink Updates
~ Cigna
~ HAP
~ Humana YourPractice
~ UHC Network Bulletin
~ UHC Medical Policy Update
Details >Featuring this month: Aetna/CofinityTidbits regarding; ~ Cofinity vs Aetna ~ Appeals and Grievances Department ~ No more duplicate remits ~ How to request a Peer to Peer Review with Michigan Aetna Details >Step therapy added for select Medicare Part B drugs effective Oct. 1, 2019Details >
~ Specialty Pharmacies and PBMs Hop On the 340B Money Train ~ NOW AVAILABLE - Amgen’s Biosimilars MVASI™ (bevacizumab-awwb) and KANJINTI™ (trastuzumab-anns) ~ Medicare Boosts Payment For Breakthrough Cancer Therapy Details >
~ Cancer Clinic Closures Limit Access To Care, Increase Medicare Spending ~ Surprise Billing Legislation Must Protect Patients, Networks, and Providers, Physicians Tell Congress ~ Latest Issue of Medical Economics Details >
August 2019, Frequently Asked QuestionsTopic: ~ 2020 Proposed Rule changes for drugs or administration codes ~ New RAC audits on injections! ~ Medicare coverage of oral drugs used to enhance the anti-neoplastic effect of the primary drug ~ Targeted Probe Edit - Negative Results ~ Medicare definition of hemophilia ~ E2 Payment Status for Mvasi Q5107 Details >
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