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.
~ New HCPCS Code J0642 for Levoleucovorin Injection
~ CMS To Collect 340B Drug Cost Information
~ ASCO and COA Comments to CMS on Proposed Rules Details >
Wednesday, October 23, 2019Early Bird Registration ends October 9th - REGISTER TODAY! Details >
Astellas~ Oncology-related products: Tarceva® (erlotinib) tablets (co-marketed with Genentech, Inc.), Xospata® (gilteritinib) tablets, Xtandi® (enzalutamide) capsules Details >
October 2019Including;
~ 2020 ICD-10 Code Updates
~ Billing and Coding: Biphosphonate Drug Therapy 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 Events including; Medicare Day of Learning (MDL)
10/29/2019 - Traverse City, MI - 8:00 AM - 4:00 PM
~ Webinars: Medicare Secondary Payer (MSP) Webinar Series, Completing the CMS Form 855B
~ 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 article on......~ Federal Judge Tosses CMS Final Rule Cutting Medicare Payments for Hospital Clinic Services Details >Recent Oncology Related Articles~ CMS’ Discharge Planning Rule Supports Interoperability and Patient Preferences
~ Trump Administration Puts Patients Over Paperwork by Reducing Healthcare Administrative Costs
~ Trump Administration Drives Down Medicare Advantage and Part D Premiums for Seniors
~ Improper Payment for Intensity-Modulated Radiation Therapy Planning Services
~ Medicare Enrollment for Physicians and Other Part B Suppliers — Reminder
~ Quality Payment Program Merit-based Incentive Payment System (MIPS): Promoting Interoperability Performance Category in 2019 Web-Based Training Course
~ Quality Payment Program Merit-based Incentive Payment System (MIPS): Participation in 2019 Web-Based Training Course — Revised
~ Transitioning to an Advanced APM: 2019 Update Web-Based Training Course — Revised
~ PECOS FAQs Booklet — Reminder
~ PECOS Technical Assistance Contact Information Fact Sheet — Reminder
~ Quality Payment Program: New 2019 Resources
~ Recent LearnResource & MedLearn Matters Articles Details >
Recent Oncology Related News~ For Medicare Plus BlueSM PPO, the Specialty Medication Prior Authorization Program is expanding to include all sites of care except inpatient
~ Starting Jan. 1, 2020, Blue Cross' PPO and BCN HMOSM plans will cover hemophilia drugs under members' pharmacy benefits
~ Blue Cross adjusting Medicare Plus Blue claims for drugs, biologicals acquired through 340B Program
~ BCBSM Recoupment Error with E499
~ Blue Cross beginning recovery of Medicare Plus Blue no-cost drug claims paid in error
~ 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
~ Don’t lose out: Corrective action affects value-based reimbursement
~ Effective November 1, Inflectra® is the preferred infliximab product for adult Blue Cross' PPO (commercial) members Details >Publications~ The Record
~ BCN Provider News
~ Blues Brief for Oncology Providers Details >October Monthly Status ReportMany updates/corrections. Listed below is a sampling of what you will find...
~ Providers are getting inaccurate eligibility information from eviCore
~ J0881 and J0885 claims are denying incorrectly (Issue Being Closed)
~ Providers are getting false eligibility information for processing eviCore claims
~ Claims are denying for exceeding units on professional claims when the facility bills with a 59 TC modifier for the same procedure code Details >
Last Updated 10/3/19Review 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 AND what to do if you have rejected claims/appeals. Details >Recent Oncology Related Issues and NewsPending Medicaid Issues being Addressed by MSHO:
~ None at this time.
Additional Medicaid Updates:
~ Proposed Medicaid Policy 1936-Pharmacy
~ 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: McLaren Health PlanTidbits regarding;
~ Service code list requiring Prior Authorization
~ Genetic testing requirements
~ Prescription medication request form online Details >~ New Cancer Therapy Pathways Program
~ Outpatient Injectable Chemotherapy and Related Cancer Therapies Prior Authorization/Notification Updates Details >~ Priority Health Website - Recent News - Modifier 26
~ Step therapy added for select Medicare Part B drugs effective Oct. 1, 2019 Details >
~ Product Specific J-code for LIBTAYO® (cemiplimab-rwlc)
~ The Health 202: Trump Is Finalizing An Executive Order Allowing Imports Of Some Prescription Drugs
Details >
~ ASCO in Action Brief: ASCO’s Survivorship Initiatives
~ Congress Must Improve Prior Authorization to Ensure People With Cancer Have Timely Access to Care
~ How Health Reimbursement Agreements (HRAs) Help Employers Expand Coverage Options for their Employees
~ Patient Advocacy News & Updates: CPAN September 2019 News Bulletin
~ Unanticipated Out of Network Billing Debate to Unfold in Michigan — What You Should Know Details >
October 2019, Frequently Asked QuestionsTopic:
~ Time documentation for prolonged code 99354
~ CBC with no differential code
~ Unlabeled drug coverage
~ Medically Unlikely Edits (MUE) list
~ Examples of medications not reasonable and necessary
~ Details on the RAC audit for prophylactic and diagnostic injections Details > |
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