like us on facebook connect with us on linkedin follow us on twitter November 20, 2019

Welcome to the Reimbursement Bulletin

MSHO Confidentiality Statement

This Bulletin will be published semi-monthly.  As always, any comments, suggestions, stories or questions can be sent to billing@msho.org

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Important Oncology Related News

~ Congressional leaders support radiation oncology community concerns about proposed Medicare alternative payment model
~ Michigan Cancer Centers to Use mHealth in Value-Based Care Project
~ PBMs, Step Therapy, and QPP Changes Among ASCO’s Priorities at AMA Meeting
~ Hospital Price Transparency Requirements

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MSHO needs your help!

Meridian Medicaid NCD Denial Issue!

PLEASE send MSHO your list of denied NDCs which are payable by traditional Medicaid and on the CHAMPS crosswalk. FINAL REQUEST!

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MSHO Legislative Update Webinar
Key Changes for 2020

Wednesday - December 4, 2019 12:00-1:00 PM

Registration is open - Register today!!!

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Did you miss the MSHO 10th Annual Payer Update?

The handouts are available on the MSHO Website!

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MSHO Featured Corporate Sponsor Assistance Program

Eisai

~ Oncology-related products: Aloxi® (palonosetron hydrochloride) injection, Halaven® (eribulin mesylate), Lenvima® (lenvatinib) capsules

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WPS Oncology Related LCD Updates

November 2019

Including;
~ MolDX Updates
~ Bisphosphonate Drug Therapy

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WPS Recent Oncology Related News

Part A, Part B and Part A/B News

Includes articles that may be of interest to oncology released in the past 2 weeks
~ Also, Medicare Hot Links to Fee Schedules and 2020 Final and Proposed CMS Rules

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Join WPS for a Teleconference, Webinar or Seminar!

Check out these upcoming training events....

Including....
~ Webinars: Medicare Secondary Payer (MSP) Webinar Series, Completing the CMS Form 855B
~ PLUS many more educational opportunities including E & M training opportunities!

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Michigan RAC Information

Region 1 - Performant Recovery, Inc.

Latest Issues Under Review That May be Significant to Oncology...
~ BE READY - NEW - Therapeutic Injections issue approved to begin auditing in December, 2019!

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Recent RAC Monitor Article

This edition includes an article on......

~ “Shoppable Services” Identified by CMS in Final Pricing Rule
~ Hospitals Likely to Face Discharge Difficulties from CMS Policy

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CMS-Medicare

Recent Oncology Related Articles

~ Drug Units in Excess of MUE: Comparative Billing Report in November
~ Drug Units in Excess of MUE: Comparative Billing Report Webinar — December 4
~ MACRA Patient Relationship Categories and Codes: Reporting HCPCS Level II Modifiers
~ Medicare Telehealth Services Video
~ Quality Payment Program: New 2019 Resources
~ Recent LearnResource & MedLearn Matters Articles

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BCBSM/BCN

Recent Oncology Related News

~ Provider appeal time frame extended for Blue Cross' PPO admissions
~ Processing delay for professional medical drug claims
~ Commercial payer Health Alliance Plan edit
~ We're using new codes for online visits starting in January
~ We're adding two medical drugs to commercial site of care requirement starting in January
~ We're updating the Locum Tenens Arrangements policy guideline
~ 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
~ Starting in January, AllianceRx Walgreens Prime is BCN's specialty pharmacy provider

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BCBSM/BCN

Publications

~ The Record
~ BCN Provider News
~ Blues Brief for Oncology Providers

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Medicare Plus Blue

November Monthly Status Report

Many updates/corrections. Listed below is a sampling of what you will find...
~ Providers are getting inaccurate eligibility information from eviCore
~ RHC claim issues
~ Drug claims through the 340B program were incorrectly recovered from providers

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Payer Issue Tracking Page

Last Updated 11/19/19

Review the reported payer reimbursement issues MSHO is currently addressing including WPS & BCBSM.

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Medicaid

Recent Oncology Related Issues and News

Pending Medicaid Issues being Addressed by MSHO:
~ Meridian Medicaid not loading/reimbursing all NCD codes covered by Traditional Medicaid.

Additional Medicaid Updates:
~ MDHHS Soliciting Comments on the Michigan Medicaid Health Plan Common Formulary
~ MSA Bulletin Updates
~ Biller "B" Aware Notices

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Newsletters of Interest

~ Aetna OfficeLink Updates
~ Cigna
~ HAP
~ Humana YourPractice
~ UHC Network Bulletin
~ UHC Medical Policy Update

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Managed Care Committee Reimbursement TIDBITS

Featuring this month: UnitedHealthcare

Tidbits regarding;
~ New Functionality in the Prior Authorization and Notification Tool on Link
~ Eff: 1/1/2020 – Retacrit will be the preferred drug to use over Epogen and Procrit.
~ New Outpatient Hospital Prior Authorization for Injectable Chemotherapy

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Priority Health Update

~ New! View front-end rejections and reasons online
~ Commercial and Medicare formulary changes coming Jan. 1, 2020
~ 2020 Medicare and commercial plans fee schedules are now online
~ We'll no longer mail approval letters for urgent/emergent admissions for Medicare 

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UnitedHealthcare Update

~ Outpatient Injectable Chemotherapy and Related Cancer Therapies Prior Authorization/Notification Updates

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Recent Oncology Related Drug News

~ FDA Renames and Restructures Oncology Office
~ CAR T-cell Therapy Causes Heavy Financial Losses for Hospitals
~ First Rituximab Biosimilar, Truxima, Launches in the United States

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Recent Oncology Related News

~ Medicare Out-Of-Pocket Costs For Cancer Treatment Every Retiree Should Know

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ASK MSHO

November 2019, Frequently Asked Questions

Topic:
~ Interprofessional telephone/internet/electronic health record consultations
~ How to request and update to NCCN
~ Timing and overview of E & M changes approved by CMS in the 2020 Final Rule

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