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.
Direct Result of the Passing of SB 412 - Open Access to Cancer Medication
This Law goes into effect June 8, 2022. This means Michigan Managed Medicaid plans cannot require prior authorization for cancer medications.
AAPC 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.
The 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.
Medicaid 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.
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 2022 Physician Fee Schedule Analyzer Tool
Updated on February 2, 2022, 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 2022 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 2021 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 2021 volume.
The oncology reimbursement landscape continues to present ever-evolving challenges for clinicians and others that work with patients with cancer. As a response to these ongoing challenges, help is available through the NCCN Virtual Reimbursement Resource Room.
WPS 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.
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