PROCEED WITH CAUTIOUS OPTIMISM
The recent decision by the Centers for Medicare and Medicaid Services (CMS) to cover allogeneic hematopoietic cell transplantation (alloHCT) for eligible patients with sickle cell disease (SCD), myelofibrosis, and multiple myeloma (MM) is a boon for hematology.
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), passed earlier this year, repealed the fundamentally flawed Sustainable Growth Rate formula and introduced significant changes in how Medicare will pay oncologists for the care they provide in the coming years.
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 laision 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.
MSHO Reimbursement meetings are held twice a year at locations throughout the state.