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MSHO Board Review & Recertification

To learn more about MSHO's 6th Annual Hematology and Oncology Board Review & Recertification Course, CLICK HERE.

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CMS Physician Payment Rule Advances Health Equity

Proposed policies will expand behavioral health services, support the President’s Cancer Moonshot, promote innovation, and grow value-based care

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Have You Been Stumped on a Reimbursement Issue and Need Help?

Join an MSHO listserv and get advice from your peers.

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MSHO Featured Corporate Sponsor Assistance Programs

• AVEO ACE 
• Bristol-Myers Squibb Access Support 
• TerSera SupportSource
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WPS Oncology Related LCD Updates

Stay current on new, retired, and revised policies/articles

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WPS Recent Oncology Related News

• Website Redesign: Training Center
• Customer Service Training Closure
• Fee Schedules
• Medicare Hot Links

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CMS-Medicare

Recent Oncology Related Articles

• Proposed CMS Final Rule
• ICD-10 2024 Code Updates
• Tools to Help Lower Medicare D Cost
• And More

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Quality

• CMS Proposes Policy Changes for QPP
• Medicare Physician Fee Schedule Notice of Proposed Rule Making
• Small Practices Resources
• And more

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Recent RAC Monitor Article

This edition includes articles on

• Checking the ID of a Purported Government Agent
• Older Americans Act Programs Being Revamped
• Ongoing Fight Against Healthcare Sticker Shock
• Unveiling the Cost of Delayed Medical Billing

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BCBSM/BCN

Recent Oncology Related News

• Clarification: Xgeva continues to require prior authorization
• Carelon to Expand Existing Prior Authorization Program
• IMRT Delivery Codes
• Billing Chart

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BCBSM/BCN

Publications

• The Record
• BCN Provider News

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Current Payer Issue Tracking Page

Last Reviewed/Updated 7/19/23

• Medicare Plus Blue denying J9190
• Meridian Paying for Labs

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Resolved Payer Issues

Last Reviewed/Updated 7/18/23

• BSBCM PGIP Program Withholds
• Meridian / Wellcare labs

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Health Alliance Plan

• JZ Modifier
• Update to PHE Unwind
• HHS-RADV Initial Validation Audit
• Medical Record Review Projects

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Medicaid

Recent Oncology Related News

Medicaid Updates Include
• Protecting Your Health During Air Quality Events
• MSA Bulletin Updates
• Biller "B" Aware Notices

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Molina

Recent Oncology Related News

• Authorization of Specialty Drugs

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Priority Health Update

• Recall of Multiple Drugs
• Incorrectly Denied Claims for Cigna Members
• You Must Refer Members to In-Network Providers
• Complete 2023 Priority Medicare D-SNP MOC Training
• Post-PHE Coverage Changes

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United Healthcare

• Discarded Drugs and Biologicals Policy
• New Patient Visit Policy 
• And more

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Recent Oncology Related FDA Approvals and Expanded Indications

• Pfizer TALZENNA® in Combination with XTANDI®

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Drug Updates

• AstraZeneca's Imjudo (tremelimumab-actl) Has Been Assigned a Unique HCPCS Code and ASP by CMS

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ASK MSHO

July 2023 Frequently Asked Questions

• G0498
• Start/Stop Times for IV Push

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