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June 2020Including:
• Multiple MolDX policy changes 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 CMS Rules Details >Check out these upcoming training events:• 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! Details >
Recent Oncology Related Articles• Now Available: Fact Sheet for State and Local Governments - CMS Programs & Payment for Care in Hospital Alternate Care Sites
• New COVID-19 FAQs on Medicare Fee-for-Service Billing
• CMS CERT A/B MAC Outreach & Education Task Force
• Telephone Evaluation and Management Visits
• Medicare FFS 2nd Level Appeals: Submission Options
• Telehealth Video: Medicare Coverage and Payment of Virtual Services
• Evaluation and Management Services — Revised
• Quality Payment Program: 2020 Resources
• Recent LearnResource & MedLearn Matters Articles Details >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! Details >This edition includes an article on:• Confusion Remains over Medicare Guidance on Treating Patient Homes as Hospital Departments Details >
Recent Oncology Related News• Temporary relaxation of HIPAA compliance requirements for telehealth visits has been extended until further notice
• CMS expands coverage of telehealth codes
• Blue Cross is changing retrospective audits appeal time frames for Medicare Plus Blue
• UPDATED: More COVID-19-related utilization management changes
• Medical benefit specialty drug prior authorization lists are changing in July and August for Medicare Plus BlueSM PPO, BCN HMOSM and BCN AdvantageSM members
• Blue Cross offering virtual care options for members and convenient ways to get their prescriptions filled Details >Publications• The Record
• BCN Provider News Details >Monthly Status ReportMany updates/corrections. Listed below is a sampling of what you will find:
• 835 Recoupment isn't reflected on voucher
• J0881 and J0885 claims are being denied incorrectly
• RHC claim issues
• G0463 Incorrect Rejections have been adjusted and issue is being closed
• and more Details >
Last Updated 6/2/2020Review the reported payer reimbursement issues MSHO is currently addressing including the response from BCBSM regarding reimbursement by NDC which is still being investigated! Also, URMBT groups not covering many drugs. Details >Recent Oncology Related NewsMedicaid Updates Include:
• Proposed policy on Implementation of a Single Preferred Drug List (PDL)
• MSA Bulletin Updates
• Biller "B" Aware Notices Details >• Aetna OfficeLink Updates
• Cigna
• HAP
• Humana YourPractice
• UHC Network Bulletin
• UHC Medical Policy Update
Details >• Financial relief for members and employers in response to COVID-19
• Collecting copays from Medicare Advantage members
• Medical policy updates
• Updated process for peer-to-peer reviews starts July 1
• Commercial formulary changes coming July 1
• Biosimilars preferred over Herceptin, Avastin and Rituxan - July 1 Details >• UnitedHealthcare COVID-19 End Date and Billing Guidance
• Cancer Therapy Pathways Program Opportunities Details >• Telehealth Claims Being Reprocessed at the Non-Facility Rate Details >Featuring this month: Managed MedicaidTidbits regarding:
• UHCCP- E-Prescribing Policy On Hold
• Molina/Medicare Claim Recovery Process
• Blue Cross Complete Telehealth Information Details >
June 2020, Frequently Asked Questions• Who can bill the Telehealth originating site code Q3014?
• Should we prepare for the end of telehealth in a patient's home?
• Billing a consultation without a face to face with patient
• Medicare
• Difference between Copay Accumulator and Copay Maximizer
• CKD Patient and Medicare Primary Timing Details > |
