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.
~ Hospitals Blast CMS’ Proposed 340B Survey
~ Step Therapy in Oncology: It’s Complicated
~ ASCO Resolutions on Step Therapy and QPP Adopted at AMA House of Delegates Interim Meeting
~ ASCO Launches Update to the Patient-Centered Oncology Payment Model Details >
The recording and handouts are available on the MSHO Website. Handouts include the 2020 Physician Fee Schedule Analyzer Tool.Details >
Sanofi Genzyme~ Oncology-related products: ELITEK® (rasburicase), JEVTANA® (cabazitaxel), Mozobil® (plerixafor injection), Thymoglobulin® [anti-thymocyte globulin (rabbit)], and ZALTRAP® (ziv-aflibercept) Details >
December 2019Including;
~ Not Otherwise Classified Chemotherapy Agents (NOC) Billing and Coding Guidelines
~ MolDX 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: Completing the CMS Form and Exploring Medicare Resources
~ PLUS additional on demand educational opportunities including 3 day/1 day Payment Window and E & M training opportunities! Details >
Region 1 - Performant Recovery, Inc.Latest Issues Under Review That May be Significant to Oncology...
~ BE READY - TWO NEW ISSUES including - Therapeutic Injections issue approved to begin auditing in December, 2019! Details >This edition includes an article on......~ Price Transparency: Two Rules for the Same Issue
~ Hospitals Price Transparency Rule: Next Stop the Courthouse Details >Recent Oncology Related Articles~ Patients Over Paperwork Newsletter
~ Physician Fee Schedule and Hospital OPPS/ASC Call: Audio Recording and Transcript
~ Promoting Interoperability Programs: Updated list of eCQMs
~ Improper Payment for Intensity-Modulated Radiation Therapy Planning Services
~ Remittance Advice Resources and FAQs — Revised
~ Drug Units in Excess of MUE: Comparative Billing Report in November
~ 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~ J0642 replaces J3490 and J3590 when billing levoleucovorin (khapzory)
~ Authorization requests for CAR-T cell therapy drugs for Medicare Advantage members
~ EDI Clearinghouse Connection Changes – Cofinity
~ December 13, 2019 ICT Webinar: You've submitted a few claims; now what?
~ Provider appeal time frame extended for Blue Cross' PPO admissions
~ 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
~ 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 >December Monthly Status ReportMany updates/corrections. Listed below is a sampling of what you will find...
~ 835 Recoupment isn't reflected on voucher
~ Providers are getting inaccurate eligibility information from eviCore
~ RHC claim issues
~ and more... Details >
Last Updated 12/4/19Review 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: UnitedHealthcare Community PlanTidbits regarding;
~ Eff: 1/1/2020 – UHCCP has a table that lists the preferred oncology products and respective non-preferred products
~ Up to date medical policies
~ New Site of Service requirements effective 2/1/2020 Details >~ Outpatient Injectable Chemotherapy and Related Cancer Therapies Prior Authorization/Notification Updates Details >~ Register now for our 2020 Virtual Office Advisory webinars
~ 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 Details >
~ CMS Administrator Seema Verma Criticizes High Drug Launch Prices
~ Mounting Drug Shortages Delay Treatments For Patients With Bladder Cancer Details >
~ ASH Releases New Clinical Practice Guidelines on Immune Thrombocytopenia
~ ONS-ASCO Webinar on Offering Clinical Trials to Patients Details >
December 2019, Frequently Asked QuestionsTopic:
~ For Outpatient Hospital - Definition of Direct and General Supervision
~ Skilled Nursing Facility Bundled Payment List
~ Pre-existing Policy for Medigap Plans
~ AMA CPT Administration Code Changes
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~ New 2020 Codes for Chronic Care Management
~ Medicare Advantage Step Edit Issue
~ New Oncology HCPCS Codes for 2020 Details > |
