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Welcome to the Reimbursement Bulletin

MSHO Confidentiality Statement

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Spring Reimbursement Meeting

Tuesdays - Lunch and Learn Weekly Webinar Series 4/21 - 5/12

Register Today for the April 21st Webinar
• WPS Medicare - 2020 Updates to Chronic, Principal, and Transitional Care Management Services!

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2020 Community Oncology Conference

The must-attend community oncology conference of the year!

Free for all Health Care and Practice Professionals
APRIL 23-24, 2020 - Register Today!

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WPS Oncology Related LCD Updates

April 2020

Including:
• MolDX
• Billing and Coding: 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 CMS Rules

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Join WPS for a Teleconference, Webinar or Seminar!

Check out these upcoming training events:

• Care Management Services
• Locating a Local Coverage Determination (LCD)
• New to Medicare - Fundamentals of Reimbursement
• New to Medicare - Appeals and Overpayments
• New to Medicare - Last Call for 2020
• PLUS many additional on-demand educational opportunities including E & M training opportunities!

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CMS-Medicare

Recent Oncology Related Articles

• Coronavirus Major Policy Changes
• Billing for Professional Telehealth Distant Site Services During the Public Health Emergency - Revised
• New ICD-10-CM diagnosis code, U07.1, for COVID-19
• Quality Payment Program and Quality Reporting Program/Value Based Purchasing Program COVID-19 Relief
• Clinical Laboratory Improvement Amendments (CLIA) Guidance During COVID-19 Emergency
• Quality Payment Program: 2020 Resources
• Recent LearnResource & MedLearn Matters Articles

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Michigan RAC Information

Region 1 - Performant Recovery, Inc.

Latest Issues Under Review That May be Significant to Oncology...
• Including - Bone Marrow Transplants, ESAs for Cancer Patients, and Therapeutic Injections!

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BCBSM/BCN

Recent Oncology Related News

• We're granting a 90-day extension to claim submission time limits
• We've updated the Telehealth procedure codes for COVID-19 and our telehealth guides for medical providers and for behavioral health providers
• Ranitidine market withdrawal
• Billing for COVID-19 drive-through testing
• COVID-19 testing and treatment covered at no member cost-sharing
• Blue Cross and BCN extend no-cost telehealth services to members through June 30 and include behavioral health
• Telehealth overview guides available
• Medicare Part B medical specialty drug prior authorization list is changing in June
• We're adding site-of-care requirements for Lemtrada and Tysabri for commercial members, starting May 1

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BCBSM/BCN

Publications

• The Record
• BCN Provider News

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Medicare Plus Blue

Monthly Status Report

Many updates/corrections. Listed below is a sampling of what you will find:
• 835 Recoupment isn't reflected on voucher
• Evaluation and Management services claims are incorrectly being denied
• J0881 and J0885 claims are being denied incorrectly
• RHC claim issues
• and more

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Payer Issue Tracking Page

Last Updated 4/7/2020

Review the reported payer reimbursement issues MSHO is currently addressing including the response from BCBSM regarding reimbursement by NDC and problems with payments below the minimum fee schedule!

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Medicaid

Recent Oncology Related News

Medicaid Updates Include:
• Michigan Seeks Approval to Streamline Medicaid; Request would provide easier access to coverage while keeping residents safe during COVID-19 outbreak
• 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: Priority Health

Tidbits regarding:
• Dedicated COVID-19 Provider Page
• Expanded services for telephone visits, e-visits and hosted visits
• Will allow the office visit codes for telehealth

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Priority Health Update

• Changes to CMS's National Correct Coding Initiative resulting in some claims reprocessing, starting Apr. 1, 2020
• Healthy Michigan Plan work requirements canceled, effective immediately

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ASK MSHO

April 2020, Frequently Asked Questions with COVID-19 Focus

•Physician "Incident To"
• Sequestration
• Place of Service 02
• Nurse Phone Calls
• Definition of Qualified Healthcare Professional
• Waiver Co-Pays
• Place of Service
• Telehealth Phone Calls
• Patient Consent Requirements
• Definition Patient Initiated
• Phone Calls
• Check in - G2012
• Medical Decision Making
• PA/NP Telemedicine "Incident To"

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