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.
~ 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 Details >
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! Details >Wednesday - December 4, 2019 12:00-1:00 PMRegistration is open - Register today!!! Details >The handouts are available on the MSHO Website!Details >
Eisai~ Oncology-related products: Aloxi® (palonosetron hydrochloride) injection, Halaven® (eribulin mesylate), Lenvima® (lenvatinib) capsules Details >
November 2019Including;
~ MolDX Updates ~ Bisphosphonate 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 Final and Proposed CMS Rules Details >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! Details >
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! Details >This edition includes an article on......~ “Shoppable Services” Identified by CMS in Final Pricing Rule ~ Hospitals Likely to Face Discharge Difficulties from CMS Policy Details >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 Details >
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 Details >Publications~ The Record ~ BCN Provider News ~ Blues Brief for Oncology Providers Details >November Monthly Status ReportMany 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 Details >
Last Updated 11/19/19Review the reported payer reimbursement issues MSHO is currently addressing including WPS & BCBSM. Details >Recent Oncology Related Issues and NewsPending 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 Details >~ Aetna OfficeLink Updates
~ Cigna
~ HAP
~ Humana YourPractice
~ UHC Network Bulletin
~ UHC Medical Policy Update
Details >Featuring this month: UnitedHealthcareTidbits 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 Details >~ 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 Details >~ Outpatient Injectable Chemotherapy and Related Cancer Therapies Prior Authorization/Notification Updates Details >
~ 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 Details >
~ Medicare Out-Of-Pocket Costs For Cancer Treatment Every Retiree Should Know Details >
November 2019, Frequently Asked QuestionsTopic: ~ 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 Details >
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