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Affected claims will be reprocessed and recoupment of any money demanded for previously paid claims due to this issue will be halted and/or returned to providers.On March 6, Bristol-Myers Squibb announced that the U. Food and Drug Administration (FDA) approved a supplemental biologics license application updating the nivolumab (Opdivo®) dosing schedule to include 480 mg infused every four weeks (Q4W).

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Access this newsletter by clicking on Oplinc’s Best Practices Review Newsletter Archive.

OBAMA ADMINISTRATION HALTS PART B DRUG MODEL On Thursday, December 15, the Obama administration announced that the proposed Medicare Part B Drug Model would not move forward at this time.

On March 1, 2018 CMS notified MACs of a Common Working File (CWF) issue causing certain allowable services with dates of service January 1, 2018 through February 27, 2018 to deny incorrectly indicating the service is part of Skilled Nursing Facility (SNF) Consolidated Billing (CB).

In some cases overpayment demand letters were issued for claims that were previously paid. CMS says no provider action is necessary at this time.

But I also wanted more details of what you do on the job, what an average day is like, and how deals and modeling (or lack thereof) work.

We’re going to cover all that and more in Part 2, including: Here we go: Got Lifestyle?

On November 1, 2017, CMS issued the 2018 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule with comment period (CMS-1678-FC).

The CY 2018 Medicare Physician Fee Schedule Final Rule was placed on display at the Federal Register on November 2, 2017.

If you are using the new Q4W dosing schedule be aware that HCPCS J9299 nivolumab, 1 mg has a current Medically Unlikely Edit (MUE) value of 440 units.

An MUE for a HCPCS/CPT code is the maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service.

In a statement explaining the decision to halt the proposed program, a CMS spokesperson said, “While CMS was working to address these concerns, the complexity of the issues and the limited time available led to…

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