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 Proposal to Reform of Stark Law and Anti-Kickback Statute is Good First Step, But More Changes Needed ~ ASCO in Action Brief: Co-pay Accumulators and Co-pay Maximizers ~ Including Financial Assistance in ASP a Dangerous Proposal for Patients With Cancer ~ Rule Buried in Proposed Medicare Fee Schedule Could Have 'Chilling Effect' Details >LillyVerzenio® (abemaciclib) Significantly Extends Life Details >
Your voice is the key to our success at the Capitol!Wednesday, October 30th
Radisson Hotel, 111 North Grand Ave., Lansing, MI Details >Wednesday, October 23, 2019Registration Ends October 16th! Details >Wednesday - December 4, 2019 12:00-1:00 PMSave the Date!!! 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......~ HHS Unveils Proposals to Tweak Key Regulations Details >Recent Oncology Related Articles~ Physician Self-Referral Regulations Proposed Rule ~ Quality Payment Program: MIPS Dates and Deadlines ~ Proper Use of the KX Modifier for Part B Immunosuppressive Drug Claims ~ Medicare Overpayments ~ PECOS for Physicians and NPPs ~ Quality Payment Program: New 2019 Resources ~ Recent LearnResource & MedLearn Matters Articles Details >
Recent Oncology Related News~ Internet Claim Tool issues ~ Duplicate Medicare crossover claims received from August 17, 2019 ~ We're reprocessing HCPCS code C9031 for a reimbursement rate correction ~ Links have been fixed for AIM oncology webinars ~ MDHHS Healthy Michigan Plan webinar Oct. 24, 2019 ~ The oncology management program will include Medicare Advantage plans starting Jan. 1, 2020 ~ Starting Jan. 1, 2020, Blue Cross' PPO and BCN HMOSM plans will cover hemophilia drugs under members' pharmacy benefits ~ Blue Cross adjusting Medicare Plus BlueSM claims for drugs, biologicals acquired through 340B Program ~ Starting in January, AllianceRx Walgreens Prime is BCN's specialty pharmacy provider ~ 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 10/16/19Review the reported payer reimbursement issues MSHO is currently addressing including WPS & BCBSM. 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 ~ MDHHS Soliciting Comments on the Michigan Medicaid Health Plan Common Formulary ~ 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 >~ We're making changes to our remittance advice (RA) and explanation of benefit (EOB) codes for commercial and Medicare APC claims effective Nov. 1, 2019 ~ Changes to remittance advice (RA) and explanation of benefit (EOB) codes effective Oct. 7, 2019 Details >
~ Product Specific J-code for ELZONRIS' (tagraxofusp-erzs) ~ Product Specific J-code for LIBTAYO® (cemiplimab-rwlc) Details >
~ Complimentary Webinar: CMS' Proposed Radiation Bundling: Disaster or Boon? ~ Coding for Hospital Observations ~ 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 >
|
|