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.
~ Important Reimbursement Alert Related to Billing of Drug Waste to Medicare Plus Blue
~ Cigna Creates New Program to Pay for High-Price Gene Therapies
~ ASTRO Comments To The Centers For Medicare And Medicaid Services Regarding Their Proposed Radiation Oncology Alternative Payment Model
~ COA Formal Comments to CMS on Proposed Radiation Oncology Alternative Payment Model (RO Model) Details >AstraZeneca~ The AstraZeneca Access 360TM program provides personal support to help streamline access and reimbursement for select AstraZeneca medicines. Take a look at the REDESIGNED MyAccess360.com! 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......~ CMS Tightens Rules Governing Reporting on Affiliated Parties
~ Medicare Audits: Deference to the Agency or the Judges? Details >Recent Oncology Related Articles~ MIPS Targeted Review Request Deadline September 30
~ Local Coverage Determination Meetings
~ Advance Care Planning — Revised
~ Medicare Billing: CMS Form CMS-1500 and the 837 Professional — Revised
~ Medicare Secondary Payer— Revised
~ Radiation Oncology Listening Session: Audio Recording and Transcript
~ Medicare Secondary Payer Provisions Web-Based Training Course — Revised
~ Quality Payment Program for Merit-based Incentive Payment System (MIPS) APMs in 2019 Web-Based Training Course — Revised
~ 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~ BCBSM Recoupment Error with E499
~ Blue Cross beginning recovery of Medicare Plus Blue no-cost drug claims paid in error
~ NASCO conducting payment recovery for Trinity Health
~ NASCO starting payment recovery for Woodbridge Holdings Inc.
~ Sign up for September provider webinars
~ Starting in January, AllianceRx Walgreens Prime is BCN's specialty pharmacy provider
~ New Edits for BCN HMO and BCN Advantage claims reporting V, W, X or Y diagnosis codes
~ Are you missing out on your value based reimbursement incentive payments?
~ 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 9/17/19Review the reported payer reimbursement issues MSHO is currently addressing including WPS, BCBSM, Medicare Plus Blue, Meridian. This update includes information on the resolution of the MDS Retacrit issue with WPS Medicare. Details >Recent Oncology Related Issues and NewsPending Medicaid Issues being Addressed by MSHO:
~ None at this time.
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 >~ Priority Health Website - Recent News - Modifier 26
~ Step therapy added for select Medicare Part B drugs effective Oct. 1, 2019 Details >
~ New Packaging for Keytruda
~ Here’s What We Know About How Drugs Are Priced — And What We Don’t
~ UnitedHealthcare Will Prefer Amgen's Anticancer Biosimilars Beginning in October 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 > |
