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.
~ HHS Walks Back New Policy On Drug Coupons
>>> Every Financial Counselor MUST Read This Article
~ Trump Administration to Appeal Ruling Blocking Price Disclosure for Drug Ads Details >Amgen~ Download the newly released Resource Guides for KANJINTI (trastuzumab-anns) and MVASI (bevacizumab-awwb) which includes information on preparation, administration, coding, patient support, and so much more! Details >
Wednesday, October 23, 2019Registration is OPEN - REGISTER TODAY! Details >
Incyte~ Oncology-related products: Jakafi® (ruxolitinib) tablets Details >
September 2019Including;
~ Revised Erythropoiesis Stimulating Agents (ESAs) - Effective August 29, 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....
~ Teleconferences: Observation - Clinical coverage and Billing Criteria 9/26
~ Webinars: Appeals Webinar Series 9/18, 9/25,10/2 - Medicare Secondary Payer Series 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 - no oncology related new issues posted since. Details >This edition includes an articles on......~ Promises of Improvements Met with Skepticism as CMS Issues New Rules
~ CMS Fights Growing Number of Appeals Details >Recent Oncology Related Articles~ Physician Fee Schedule Listening Session: Audio Recording and Transcript
~ OPPS and ASC Listening Session: Audio Recording and Transcript
~ Medicare Plan Finder Gets an Upgrade for the First Time in a Decade
~ Comparative Billing Reports: We Want Your Feedback
~ MACRA Patient Relationship Categories and Codes: Reporting HCPCS Level II Modifiers
~ CAR T-Cell Cancer Therapy Available to Medicare Beneficiaries Nationwide
~ Chronic Care Management Services
~ ICD-10-CM, ICD-10-PCS, CPT, and HCPCS Code Sets
~ Medicare Raises Payments for CAR-T Therapies
~ 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~ Are you missing out on your value based reimbursement incentive payments?
~ McLaren Medicaid erroneous rejection
~ We're resuming Medicare Plus BlueSM PPO place-of-service audits in September
~ Effective November 1, Inflectra® is the preferred infliximab product for adult Blue Cross' PPO (commercial) members
~ Medicare Part B medical specialty drug prior authorization list is changing in October
~ 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 >September 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 (System corrected on May 10 with reprocessing of claims complete by 9/30)
~ Providers are getting false eligibility information for processing eviCore claims
~ Evicore denying A9513 Radiation and Oncology claims in error and more... Details >
Last Updated 9/4/19Review the reported payer reimbursement issues MSHO is currently addressing including WPS, BCBSM, Medicare Plus Blue and Meridian, including the resolution of the MDS Retacrit issue with WPS Medicare. Details >Recent Oncology Related Issues and NewsPending Medicaid Issues being Addressed by MSHO:
~Meridian Update on - Meridian Medicaid issues and Crossover Claims Not Being Processed and Problems with their Website
~ New Contact Person for help with Total Health Care claims processing issues
Additional Medicaid Updates:
~ 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: HAPTidbits regarding;
~ Genetic Testing
~ NDC Coding Requirements
~ Appeal Limitations Details >Updates to Requirements for Specialty Medical Injectable DrugsYou’ll need to use a new process to request a prior authorization once the existing authorization expires or if you change the therapy Details >Step therapy added for select Medicare Part B drugs effective Oct. 1, 2019Details >
~ Why It’s So Difficult to Reduce Drug Prices
~ UnitedHealthcare Will Prefer Amgen's Anticancer Biosimilars Beginning in October Details >
~ ONS Holds Fourth Annual Capitol Hill Days
~ PBMs: Driving Up Costs and Lowering Quality Care in America
~ Latest Issue of Medical Economics Details >
September 2019, Frequently Asked QuestionsTopic:
~ IV vs Push administration coding
~ Drug Waste
~ Use of JW modifier for waste less than the HCPCS unit
~ New vs Established Patient Billing
~ Nurse Practitioner Education Billing
~ Chemo Drugs with both a professional and a facility charge Details > |
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