Welcome to the Reimbursement Bulletin
We recommend you view the Bulletin in your web browser. At the very top, it says, "To view this bulletin in a web browser, click here."
This Bulletin will be published semi-monthly. As always, any comments, suggestions, stories or questions can be sent to billing@msho.org. We hope you enjoy this issue!
Merck~ Merck’s KEYTRUDA® (pembrolizumab) Plus Pemetrexed (ALIMTA®) and Platinum Chemotherapy Reduced the Risk of Death by Half Compared with Chemotherapy Alone as First-Line Treatment for Advanced Nonsquamous NSCLC in Phase 3 KEYNOTE-189 Study Details >~ UnitedHealthcare Reminder: National Drug Code (NDC) Requirement Policy
~ ASCO Summary of the Proposed Rule for the CY 2019 Medicare Physician Fee Schedule and Quality Payment Program
~ The Proposed 2019 E&M Overhaul: A Preliminary Financial Impact Analysis
~ CMS Empowers Patients and Ensures Site-Neutral Payment in Proposed Rule
~ Radiation Oncology Proposed Rule Summary by ASTRO Details >
~ Update on Denials from WPS Medicare for Treanda, J9033
~ Outpatient Hospital Denials for ESAs Details >Wednesday, October 17, 2018Schoolcraft College - Livonia, MI
SAVE THE DATE! Details >Wednesday, July 25, 2018Recording and handouts are available on the MSHO website! Details >
SeattleGenetics~ Oncology-related products: Adcetris® (brentuximab vedotin) Details >~ Co-pay Accumulator Programs
~ Pan Foundation Provider Newsletter Details >
August 2018Including...
~ CMS Re-work of the National Coverage Determination for ESAs Still Pending - NO UPDATE
~ WPS LCD changes related to ESA Q-codes, HIFU in the treatment of Recurrent Prostate Cancer, MolDX changes, Added C9467 for Rituximab and hyaluronidase human, 10 mg (for outpatient hospital use only) Details >Part A, Part B and Part A/B NewsArticles that may be of interest to oncology which were released in the past 2 weeks. Details >Check out these upcoming training events....Including....
~ Evaluation and Management Webinar - 08/14/18 Documentation
~ Webinar - 08/14/18 Evaluation and Management Services: Documentation Examples
~ Webinar - 08/15/18 WPS GHA Learning Center Changes
~ Webinar - 09/12/18 CERT Overview
~ Teleconference - 09/19/18 Waivers to Extend Timely Filing
PLUS many more educational opportunities! Details >
Region 1 - Performant Recovery, Inc.August 2018 - No New Updates Details >This edition includes articles on......~ Responses to Proposed E&M Code Changes Emerge: CMS, Are You Listening?
~ News Alert: CMS Posts 2019 IPPS Final Rule, Heralding Major Changes to Admission Order Regulation Details >Recent Oncology Related Articles~ As MACRA Heads Toward Third Year, Congress Urged to Consider How Proposed CMS Changes Will Impact Medicare Beneficiaries with Cancer
~ CMS Grants New Technology Add-On Payment to Vyxeos® (daunorubicin and cytarabine) Liposome for Injection
~ Qualified Medicare Beneficiary Program Billing Requirements FAQs
~ 2018 QRDA III Implementation Guide for Eligible Professionals
~ Physician Fee Schedule Proposed Rule: Understanding 3 Key Topics Listening Session – August 22
~ Provider Minute Video: Physician Orders/Intent to Order Laboratory Services and Other Diagnostic Services
~ PECOS Technical Assistance Contact Information Fact Sheet
~ E/M Coding Reform: Recording of Panel Discussion
~ CLFS and Laboratory Services Payment: Quarterly Update MLN Matters Article Details >
Recent Oncology Related News~ Commercial Medical Drug Prior Authorization Program adds 3 groups, as of Sept. 1
~ Medicare Advantage compliance audits to begin Oct. 1
~ Additional fee schedules added to web-DENIS
~ Starting Oct. 1, additional specialty medications require authorization for BCN Advantage members
~ Billing chart: Blues highlight medical, benefit policy changes
~ We’ve canceled the modifier 25 payment adjustment for evaluation and management services
~ New radiation oncology program benefits providers offering ‘gold standard’ of care
~ Register for a medical specialty drug prior-authorization web tool refresher course
~ Effective Oct. 1, Prolia® and Xgeva® are subject to a site-of-care requirement for BCN HMOSM members Details >
Last Updated 8/7/18Review the reported payer reimbursement issues MSHO is currently addressing...
~Priority Health Split Claims Causing Rejections **RESOLVED - Priority Has Agreed To Remove The Edit Effective Immediately!!!
~ WPS Medicare Doing Take Backs on Treanda, J9033 Details >Recent Oncology Related Issues and NewsMedicaid Advantage Pending Issues; Meridian approving Neulasta! Also, in this update..... Public Comment on MDHHS Medicaid Health Plan Common Formulary, MSA Bulletins, Biller "B" Aware Notices Details >News Updates~ Priority removed requirement to submit all services on one single claim
~ Medicare chart reviews starting soon
~ Request elective retrospective authorizations through Clear Coverage starting Aug. 15 Details >System Updates~ Many updates/corrections. Listed below is a sampling of what you will find...
****Voided claims are incorrectly denying as duplicates
****Claims are denying against the Medicare 72 hour rule
****Coinsurance and reimbursement are applying incorrect rates for rural health center claims
****Specialty versus primary care physician copayments, wrong copay applied
****and more... Details >~ Aetna OfficeLink Updates
~ BCN Provider News
~ Cigna
~ HAP/HealthPlus ProviderPlus
~ Humana YourPractice
~ UHC NetworkBulletin
~ UHC Medical Policy Update
Details >Featuring this month: Aetna/Cofinity~ Online Manual for Health Care Professionals
~ 180 Day Dispute Filing Standard
~ Drug Infusion Site of Care Policy Details >
~ TAILORx: Many Women With Early Breast Cancer Can Avoid Chemotherapy
~ FDA Discontinues Iclusig® REMS Program
~ Eisai and Merck Announce FDA Grants Breakthrough Therapy Designation for LENVIMA® (lenvatinib) in Combination with KEYTRUDA® (pembrolizumab) as Therapy for Previously Treated Patients with Advanced and/or Metastatic non-MSI-H/pMMR Endometrial Carcinoma
~ Celgene Bows To White House Pressure After Raising Prices For Cancer Drug Details >
~ Be Counted: Complete the 2018 ASCO Practice Census Today
~ MIPS Scoring Guide: How to succeed under the new CMS payment model
~ News Alert: 2019 ICD-10-CM Coding Guidelines Have Been Released Details >
August 2018, Frequently Asked QuestionsTopics Include:
~ Office Visit Coding Changes for 2019
~ Nurse Practitioner Education
~ Visit New Patient vs Established Patient
~ Free Transportation for Chemotherapy Appointments Details > |
|
