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Hem Onc Board Review

For more information or to register, please click here.

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Save The Date - MSHO 12th Annual Payer Update!

Live Event November 10, 2021, Schoolcraft College, Livonia

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MSHO Featured Corporate Sponsor Assistance Program

KaryForward®: Patient Support by Karyopharm

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WPS Oncology Related LCD Updates

July 2021

Updates that may be of interest to oncology including:
• Revisions to Complex Drug Administration and many MolDx updates

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WPS Recent Oncology Related News

Part A, Part B and Part A/B News

Includes articles that may be of interest to oncology released in the past 2 weeks
• Also, Medicare Hot Links to 2021 Final Rules and the WPS Fee Schedules

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Join WPS for a Teleconference, Webinar or Seminar

Check out these upcoming training events:

• On Demand Training: Appeals - Understanding the Basics
• CMS 1500 Billing Basics
• What's New for 2021 - Session 2
• E & M Services for 2021
• 3 day/1 Day Payment Window
• New YouTube Training Available

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CMS-Medicare

Recent Oncology Related Articles

• Quality Payment Program: 2021 APM Incentive Payments
• 2019 Quality Payment Program: Performance Information on Care Compare
• Medicare Secondary Payer
• Importance of Proper Documentation: Provider Minute Video
• Medicare Quarterly Provider Compliance Newsletter
• CMS Reweights 2020 MIPS Cost Category; Apply Now for 2021 MIPS Hardship Exceptions; 2018-2019 Cost Measure Benchmark Files Released
• Recent LearnResource & MedLearn Matters Articles

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Michigan RAC Information

Region 1 - Performant Recovery, Inc.

NEW Under Review:
• Positron Emission Tomography for Initial Treatment Strategy in Oncologic Conditions: Medical Necessity
• Documentation Requirements and Positron Emission Tomography for Initial Treatment Strategy in Oncologic Conditions: Medical Necessity and Documentation Requirements

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Recent RAC Monitor Articles

This edition includes an article on:

• Are Doctors Required to Use Words Rather than Codes?
• No Surprises Act Has Many Surprises

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BCBSM/BCN

Recent Oncology Related News

• Michigan outpatient facilities must bill NDCs with NOCs or commercial claims will reject, starting in August
• Reminder: Check for authorization requirements, not all Blue Cross patients require AIM authorization
• Reminder: Optum now identifies, recovers credit balance overpayments, replacing Conduent
• EmpaveliTM to require prior authorization for commercial members starting June and August
• AduhelmTM, EmpaveliTM and Arcalyst® to require prior authorization for Medicare Advantage members
• Deductible/Maximum information on web-DENIS not available for Saginaw Plumbers and Pipe Fitters group
• Rendering and referring provider cannot have the same NPI
• Specialist team-based care update (Including Oncology)
• Procedure codes *70554 and *70555 to require prior authorization from AIM starting Sept. 1 for Blue Cross commercial and Medicare Plus BlueSM members
• We're adjusting our systems to pay all rituximab claims for the same diagnostic indications for Blue Cross commercial members
• Reimbursement for Lupron Depot® and Eligard® to change on Aug. 1 for all commercial members
• Four additional drugs to require prior authorization for Blue Cross URMBT non-Medicare members, for dates of service on or after Sept. 7

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BCBSM/BCN

Publications

• The Record
• BCN Provider News

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Medicare Plus Blue

Monthly Status Report

Many updates/corrections. Listed below is a sampling of what you will find:
• 835 Recoupment isn't reflected on voucher
• 835 CARC 210 sanction amount is incorrect
• The system is applying a denied authorization to a claim in error
• Multiple RHC Issues

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Payer Issue Tracking Page

Last Reviewed/Updated 7/1/21

Review the reported payer reimbursement issues including clarifications and issues with Medicare Plus Blue Resolutionon Retacrit documentation requests, BCBSM issues Resolved related to biosimilars which will now be covered for all diagnosis that was covered by the brand drug and the resolved issue with AIM No-Auth Denials, Aetna denials for initial inpatient codes

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Medicaid

Recent Oncology Related News

Medicaid Updates Include:
• MSA Bulletin Updates
• Biller "B" Aware Notices

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Newsletters of Interest

• Aetna OfficeLink Updates
• Cigna
• HAP
• Humana YourPractice
• UHC Network Bulletin
• UHC Medical Policy Update
• UHC Reimbursement Policy Update

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Priority Health Update

• Total Health Care (THC) providers new to Priority Health: Register for provider training and onboarding
• Transition of Care for New Priority Health Medicaid Members

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Managed Care Committee Reimbursement TIDBITS

Featuring this month: Meridian Health Plan of Michigan

Tidbits regarding:
• Provider Network Management Representatives
• CMS Regional Office Representative
• Meridian PBM

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ASK MSHO

July 2021, Frequently Asked Questions


• Billing Administration with Free Drug
• NCCN Update Request
• Who Can Perform Advanced Care Planning

MSHO MEMBERS - You can access and search previous FAQs! Scroll to the bottom of the Q & As to find out how!Details >