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Live Event November 10, 2021 - Schoolcraft College, LivoniaDetails >
August 2021Updates that may be of interest to oncology including:
• Revisions to Complex Drug Administration and many MolDx updates Details >Part A, Part B and Part A/B NewsIncludes 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 Details >Check out these upcoming training events:• Teleconference: ABN: What’s New and What’s Not • On Demand Training: Appeals - Understanding the Basics • E & M Services for 2021 • 3 day/1 Day Payment Window • New YouTube Training Available Details >
Recent Oncology Related Articles• Medicare Secondary Payer Provisions Web-Based Training — Revised • ICD-10-CM Codes: FY 2022 • Medicare Advance Written Notices of Noncoverage — Revised • Medicare Billing: Form CMS-1500 and 837 Professional Web-Based Training — Revised • Medicare Billing: Form CMS-1450 and 837 Institutional Web-Based Training — Revised • COVID-19 Accelerated and Advance Payment (CAAP): New Frequently Asked Questions (FAQs) Now Available • Recent LearnResource & MedLearn Matters Articles Details >Region 1 - Performant Recovery, Inc.MSHO NOTE: Many MSHO members have reported recent RAC audits related to waste and single dose vials!
Also, newest approved issues listed on RAC website: • Positron Emission Tomography for Initial Treatment Strategy in Oncologic Conditions • Next Generation Sequencing Medical Necessity and Documentation Requirements Details >This edition includes articles on:• New CMS Proposal Presents Head-Scratching Issues • New, Major Regulations Face Providers • OIG Telehealth Audits Ramping Up Details >
Recent Oncology Related News• AIM Released Clinical Appropriateness Guidelines Appropriate Use Criteria: Febrile Neutropenia Risk • August 24, 2021 ICT Webinar: You've submitted a few claims; now what? • Procedure codes *70554 and *70555 to require prior authorization from AIM starting Sept. 1 for Blue Cross commercial and Medicare Plus BlueSM members • Four additional drugs to require prior authorization for Blue Cross URMBT non-Medicare members, for dates of service on or after Sept. 7 • RybrevantTM requires prior authorization for dates of service on or after Sept. 27 for most members • Payment for certain drugs administered by health care provider changing in October • Additional drugs require prior authorization for Blue Cross URMBT non-Medicare members, starting Nov. 1 • AsparlasTM to require prior authorization for Blue Cross URMBT non-Medicare members, starting Nov. 1 • We're adjusting our systems to pay all rituximab claims for the same diagnostic indications for Blue Cross commercial members Details >Publications• The Record • BCN Provider News • Just Released - Blues Brief for Oncology Providers Details >Monthly Status ReportMany 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 Details >
Last Reviewed/Updated 8/3/21Review the reported payer reimbursement issues including: • MPB diagnosis loading for biosimilars to match brand drugs, claims being reprocessed • Aetna denials for initial inpatient codes & need to bill with consultation codes - Aetna's Response Details >Recent Oncology Related NewsMedicaid Updates Include: • MSA Bulletin Updates • Biller "B" Aware Notices Details >• Aetna OfficeLink Updates
• Cigna
• HAP
• Humana YourPractice
• UHC Network Bulletin
• UHC Medical Policy Update
• UHC Reimbursement Policy Update
Details >• MDHHS has updated the billing requirements for G2025 • Are you a new provider to Priority Health? Details >Featuring this month: Aetna/CofinityTidbits regarding: • Aetna commercial looking for consultation codes, not initial visit codes • Aetna bought by CVS • New research presented at ASCO 2021 reinforces promise of CVS Health’s Transform Oncology Care program Details >
Both in-person and online - September 24 - 25Details >
August 2021, Frequently Asked Questions• Proposed Rule Split/Shared - Bill Under the Provider Which Spent the Most Time • Overview of Proposed Changes to Split/Shared Visits • Aetna Still Wants Consultation Codes For Commercial Plans
MSHO MEMBERS - You can access and search previous FAQs! Scroll to the bottom of the Q & As to find out how!
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