Welcome to the Reimbursement Bulletin
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This Bulletin will be published semi-monthly. As always, any comments, suggestions, stories or questions can be sent to billing@msho.org.
The MSHO office will be closed Wednesday, November 21 through Friday, November 23Details >~ Oncologists Wary Of Possible Mandatory Radiation Demo
~ Bipartisan Group of More Than 100 Lawmakers Urges Improvements to Prior Authorization Under Medicare Advantage
~ ASCO Resolutions on Step Therapy, Competitive Acquisition Program Proposed at AMA House of Delegates Details >
December 5, 2018 9:00-10:00 AMHAVE YOUR VOICE HEARD!
Register to attend the Oral Chemotherapy Fairness Hearing Details >This year #GivingTuesday falls on November 27thDetails >Wednesday - December 5, 2018 12:00-1:00 PMRegistration is open! Details >
Eisai~ Oncology-related products: Aloxi® (palonosetron hydrochloride) injection, Halaven® (eribulin mesylate), Lenvima® (lenvatinib) capsules Details >
November 2018Includes multiple MolDX updates... Details >Part A, Part B and Part A/B News~ ESA Rejections Addressed and Partially Resolved
~ Articles that may be of interest to oncology which were released in the past 2 weeks. Details >Check out these upcoming training events....Including....
~ Teleconference:
**** 01/08/19 New to Medicare National and Local Coverage Determinations
**** 01/16/19 Provider Enrollment Ask-the-Contractor
**** PLUS many more educational opportunities!
~ New On Demand E & M Training Opportunities Details >
Region 1 - Performant Recovery, Inc.Latest Issue Being Audited - Facility vs Non-facilty Reimbursement Details >This edition includes articles on......~ Highlights of the Medicare Physician Fee Schedule Final Rule
~ Pocket Guide to New E&M Service Changes Details >Recent Oncology Related Articles~ New Proposed Medicare Part B Drug Reimbursement Model Raises Questions
~ Digesting the Medicare Physician Fee Schedule for 2019
~ Patients Over Paperwork November Newsletter
~ Quality Payment Program Year 1 Performance Results
~ QRURs and PQRS Feedback Reports: Access Ends December 31
~ Quality Payment Program: Multi-Payer Other Payer Advanced APMs List
~ Quality Payment Program: Visit the Resource Library Website
~ Medicare Deductible, Coinsurance and Premium Rates: 2019 Update MLN Matters Article
~ ICD-10 and Other Coding Revisions to NCDs MLN Matters Article
~ Medicare Billing: CMS Form CMS-1450 and the 837 Institutional Booklet
~ Medicare Billing: CMS Form CMS-1500 and the 837 Professional Booklet
~ Groups to Sue CMS Over Site-Neutral Payments
~ Final Rules from CMS Offer Something for Everyone
~ Medicare and Medicaid Basics Booklet
~ Quality Payment Program 2018 MIPS Cost Performance Category Web-Based Training Course
~ Quality Payment Program 2018 MIPS Improvement Activities Performance Category Web-Based Training Course
~ Quality Payment Program 2018 MIPS APMs Web-Based Training Course
~ Quality Payment Program 2018 Advanced APMs Web-Based Training Course
~ CMS announces 2019 Medicare Parts A & B premiums and deductibles Details >
Special Webinar Series for Medical and Radiation OncologyTwo new utilization management programs launching January 1, 2019. Multiple webinar opportunities available for Medical and Radiation oncology, as well as clinical and non-clinical staff. Details >Recent Oncology Related News~ December 13, 2018 ICT Webinar: You’ve submitted a few claims; now what?
~ Correction: List of medical drugs in commercial Medical Drug Prior Authorization Program
~ Enhancements to the 835
~ Continuity of Care in place for URMBT members in the medical or radiation oncology programs
~ Attention CT, MRI specialists: Sign up for OptiNet® webinar, opt in for patient referrals
~ Cinqair, Nucala, Xolair added to site of care infusion requirement, beginning Jan. 1
~ Reminder - New Institutional Blue Care Network edit: NDC DRUG QUANTITY MUST BE GREATER THAN ZERO
~ Medicare Part B medical specialty drug prior authorization lists changing in 2019
~ AllianceRx Walgreens Prime specialty pharmacy program starts Jan. 1
~ We're telling BCN Advantage members they don't need referrals
~ BCBSM grants MOC exceptions
~ Onpattro, Poteligeo, Signifor LAR added to medical benefit specialty drug prior authorization program for commercial members
~ Some medical benefit drugs for Medicare Advantage members need step therapy, starting January 1
~ Reminder: Follow these guidelines when billing medical drugs that haven’t been purchased
~ BCBSM November RECORD Details >
Last Updated 11/20/18Review the reported payer reimbursement issues MSHO is currently addressing...
~ WPS Medicare Issue with ESA J0881 and J0885 Denials - PARTIALLY RESOLVED Details >Recent Oncology Related Issues and News~ Medicaid Advantage Pending Issues;
MSHO Addressing Managed Medicaid Plans with Medical Drug Benefit Restrictions
Also, in this update.....
~ Public Comment on MDHHS Medicaid Health Plan Common Formulary - Comments Due by November 23rd
~ Michigan Second State To Pursue Outcomes-Based Contracts For Medicaid Rx Pricing
~ MSA Bulletin Updates
~ Biller "B" Aware Notices Details >Important Updates from MSHO Managed Care Committee Member Robin FreyDetails >Update on Injection and Infusion Services PolicyDetails >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
****Facility claims are in paid status but there's no paid amount for out of state claims
****Coinsurance and reimbursement are applying incorrect rates for rural health center claims
****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: United Healthcare~ UHC is retiring fax numbers used for Medical Prior Auth
~ Optum will begin managing the prior authorization requests for outpatient injectable chemotherapy and related cancer therapies
~ Billing issue for intravenous and subcutaneous immune globulin and Remicade Details >
~ New Medicare Part D Opioid Prescribing Policies for 2019—What You Need to Know
~ IMFINZI® (durvalumab) injection has been assigned a unique HCPCS code by CMS
~ UnitedHealthcare Names 3 Biosimilars Preferred Treatments in 2019 MA Plans Details >
~ Surprise Deal: Cardinal Health Sells Its Specialty Pharmacy (Again)
~ PAN Foundation Updates
~ ASCO Submits Two Comment Letters to the FDA on Modernizing Clinical Trials
~ Physicians' EHR work-arounds Details >
November 2018, Frequently Asked QuestionsTopic:
~ Michigan Rules for Medical Assistants
~ Treating a patient from Inpatient Rehab
~ Drug Waste for Imfinzi
~ Definition of "Step Edit"
~ Electronic Signatures on Orders
~ Medicare CERT Program
~ Billing for 2 Pushes Details > |
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