Reimbursement Overview

One of the most frustrating issues facing members of the Society is overdue payments, especially rejections for approved drugs in approved tumor types by approved methods. These issues are being addressed head on through liaison committees at the carrier level. This allows us to combine the efforts of our membership to pinpoint and prioritize issues to be addressed by insurance companies. Our main goal is to get insurance companies to correct system problems so future claims will be paid on first submission.

Please keep in mind that MSHO cannot directly submit status claims for our member offices. The liaison process is not to get a single claim paid, but to prevent system errors.

MSHO works directly with our member practices to provide a mechanism to educate and support our reimbursement personnel throughout the state. If your practice is a member of MSHO and you are involved in reimbursement, please be sure to check the MSHO event page to obtain information on the next MSHO Reimbursement Meeting.

01/14/2021

Apply for the ASH Congressional Fellowship

Deadline to apply is Friday, January 29, 2021

01/06/2021

COVID Relief Bill and Consolidated Appropriations Act Included Many Changes Affecting Your Medicare Payments!

Read the MSHO update about the 2% sequestration delay, increase to physician fee schedule payments, no G2211, additional Radiation Oncology Model delay, increased clinical trial access and more...

12/16/2020

CMS Released Most Favored Nation (MFN) Model Interim Final Rule

Changes reimbursement for Part B Drugs!

The Model begins on Jan. 1, 2021, affects outpatient hospital and private practice, and will operate for seven years.

12/02/2020

ASCO “Most Favored Nation” Comments

Misguided and Will Decrease Access to Cancer Care

12/02/2020

ASCO New Rules on Physician Self-Referrals and Incentives Comments

Offer Clarity and Flexibility Amid Shift to Value-Based Care

12/02/2020

COA “Most Favored Nation” Comments

Opposes Dangerous, Misguided “Most Favored Nation” Experiment Policy Will Harm Patients and Cancer Providers’ Ability to Access Lifesaving Drugs

AAPC

AAPC LogoAAPC is the world’s largest training and credentialing organization for the business of healthcare, with more than 175,000 members worldwide who work in medical coding, medical billing, clinical documentation improvement, medical auditing, healthcare compliance, revenue cycle management, and practice management.

AHA Coding Clinic Advisor

Aha Coding Clinic LogoThe Coding Clinic for ICD-9-CM was established in 1984 to help everyone who had an interest and dedication in improving the accuracy and uniformity of medical record coding. The newsletter was created to provide coding advice, official coding decisions, and news related to the use of ICD-9-CM.

Michigan Department of Health & Human Services

Michigan Department Of Health And Human Services LogoMedicaid Health Plan Pharmacy Benefit - This webpage is designed to provide easy access for members and providers looking for information on the drugs and supplies covered by Michigan Medicaid Health Plans.

Medicaid Bulletin

Michigan Medical Billers Association

MMBA logo MMBA is a non-profit organization dedicated to the Education and Professional Advancement of Medical Billers. MMBA is best known for organizing educational seminars on medical billing and related topics to keep members abreast of industry hot topics and current issues. Speakers representing third party payers and experts from various health care fields are often asked to participate.

MSHO 2021 Physician Fee Schedule Analyzer Tool

MSHO LogoUpdated on January 18, 2021, with Newly Released Medicare Fee Schedules.

To make analyzing the financial impact of the Medicare Physician Fee Schedule changes easier, we have created MICHIGAN specific tools. The tools incorporate the latest fee schedule released by WPS which includes the changes in the 2021 Physician Fee Schedule Final Rule.  This Excel spreadsheet will help analyze the impact of the Evaluation and Management codes as well as the Administration codes.  

Be sure to choose the correct spreadsheet for your locality (01 or 99). To determine the annual impact, you will need to input your approximate “units billed” during 2020 for each code in the yellow space provided. The tool will automatically give you the impact of the change for that specific code, as well as a grand total of all codes at the bottom of the spreadsheet based on your 2020 volume.

Final 2021 Local 01 MSHO Fee Schedule Analyzer Tool 

Final 2021 Local 99 MSHO Fee Scheule Analyzer Tool 

WPS

Wps LogoWPS Government Health Administrators (WPS GHA) has served Medicare beneficiaries since 1966, providing over 50 years of service to the Centers for Medicare & Medicaid Services (CMS) and the Medicare program. Their mission is to provide service and value considered by their customers to be the very best. They remain committed to providing the best in service to Medicare beneficiaries and providers through emphasis on uncompromising business ethics and long-term sustained performance excellence. It has long been their goal to serve their Medicare customers more effectively while lowering our costs and improving productivity.

LCD Updates

Teleconferences