like us on facebook connect with us on linkedin follow us on twitter September 28, 2022

To learn more about MSHO's 13th Annual
Fall Payer Update, 
CLICK HERE.

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Registration Open for MSHO's 13th Annual Payer Update!

Live Event November 9, 2022 - Schoolcraft College, Livonia

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WPS Oncology Related LCD Updates

September 2022

Numerous retired and revised policies/articles

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WPS Recent Oncology Related News

Part A, Part B and Part A/B News

• Draft LCD Open Meeting
• Upcoming System Maintenance Affecting Self-Service Tools
• Claim Timely Filing Exceptions - Issues
• Medicare Hot Links to 2022 Final Rules and the WPS Fee Schedules

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CMS-Medicare

Recent Oncology Related Articles

• CMS 365-day lookback period
• Revised Enrollment Form CMS-855O
• October 2022 Update of the Hospital Outpatient Prospective Payment System (OPPS)
• Medicare Telehealth Services for 2023 – CMS Proposes Substantial Changes
• October 2022 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
• Hospice Quality Reporting Program: New Resources
• HCPCS Application Summaries & Coding Decisions: Drugs & Biologicals
• Recent LearnResource & MedLearn Matters Articles

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Michigan RAC Information

Region 1 - Performant Recovery, Inc.

Be sure to audit yourself before the RAC audits you!

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Recent RAC Monitor Articles

This edition includes articles on

• How Companion Testing Is Expected to Improve Healthcare and Refine Medicare Auditing
• Two OIG Audits, Plus Outpatient Colectomies

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BCBSM/BCN

Recent Oncology Related News

• BCN updates billing and reimbursement information for midlevel, or nonphysician, practitioners
• How BCN Advantage will reimburse carrier-priced codes starting Jan. 1, 2023
• Medicare Plus BlueSM PPO weekly claims reprocessing report: Oct. 1, 2022
• CMS delays release of 2022 3rd-quarter HCPCS codes
• And many more

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BCBSM/BCN

Publications

• The Record
• BCN Provider News

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Payer Issue Tracking Page

Last Reviewed/Updated 9/28/22

Review the reported payer reimbursement issues
• 8/12 Resolution to BCBSM Phesgo Issue and Denials for Auth Exceeds Allowed

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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 News

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Priority Health Update

• New clinical edit goes into effect Oct. 15, 2022
• "Unspecified Codes" clinical edit goes into effect on Oct. 11, 2022
• Check out our newly updated Medicaid billing webpage
• New clinical edit: Principal or first-listed diagnosis codes
• Legacy THC providers must wrap up claims, appeals by Dec. 31, 2022

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Drug Updates

• Step-Edit Lifted for Novartis' Kisqali, Providing Freedom of Choice Within the CDK 4/6 Class for First-Line Metastatic Disease

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ASK MSHO

Frequently Asked Questions

• Capturing Tumor Board discussions in an E/M outpatient visit

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