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JA and JB Modifier Requirement - Did You Miss This Update from WPS?

Are you using the Route of Administration Modifier JA or JB that became effective on January 11, 2021?

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WPS Oncology Related LCD Updates

January 2021

Updates that may be of interest to oncology including:
• Billing and Coding: Radiopharmaceutical Agents and MolDX Changes

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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 2021 Proposed CMS Rules and the WPS Fee Schedules

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Join WPS for a Teleconference, Webinar or Seminar

Check out these upcoming training events:

• OIG Work Plan
• New On Demand Training for E & M Services
• New YouTube Training Available

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Recent Oncology Related Articles

• Payment for Outpatient Clinic Visit Services at Excepted Off-Campus Provider-Based Departments
• Physician Fee Schedule Update
• 2020 MIPS Extreme and Uncontrollable Circumstances Exception Application: Deadline February 1
• Extension of Medicare IVIG Demonstration through December 31, 2023
• Importance of Proper Documentation: Provider Minute Video
• Non-Physician Outpatient Services Provided Before or During Inpatient Stays: Bill Correctly
• Telehealth Services: Bill Correctly
• Advance Care Planning — Revised
• Recent LearnResource & MedLearn Matters Articles

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Michigan RAC Information

Region 1 - Performant Recovery, Inc.

No New Oncology Related Issues Since March, 2020:
• Latest under review at that time included: - Bone Marrow Transplants, ESAs for Cancer Patients, and Therapeutic Injections

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Recent RAC Monitor Articles

This edition includes articles on:

• Medicaid Suspension Lifted Due to Lack of Evidence of Intent
• The Eagle Has Landed . . . Finally!

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Recent Oncology Related News

• Changes in coverage decisions for some 2021 CPT codes
• Commercial payer AmeriHealth Administrator claim edit
• Medical benefit specialty drug prior authorization list changing in April for most members
• Medicare-covered telehealth services reminder
• Mark your calendar — 2021 PGIP Quarterly meeting dates
• Provider 1099s to be mailed by Jan. 31, 2021
• Some drugs not payable when administered by a health care professional to Blue Cross and BCN commercial members, starting April 1, 2021
• For nonpreferred filgrastim products, submit prior authorization requests using NovoLogix® for all members, starting April 1, 2021
• Changes coming to preferred products for drugs covered under the medical benefit for most members, starting April 1, 2021
• CMS 2021 HCPCS codes delayed
• Telehealth codes remain billable through the end of the PHE for Medicare Advantage members
• We're expanding High Technology Radiology Prior Authorization program with AIM to Michigan FEP members
• BCBSM/BCN:  New, Secure Provider Website in 2021

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• The Record
• BCN Provider News
• Blues Brief for Oncology Providers

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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
• System is applying denied authorization to claim in error
• Authorizations coming through are causing claim denials, multiple RHC Issues

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Payer Issue Tracking Page

Last Reviewed/Updated 1/20/21

Review the reported payer reimbursement issues including clarifications and issues with BCBSM, BCN, Medicare Plus Blue, and UHC Community Plan

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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
• Humana YourPractice
• UHC Network Bulletin
• UHC Medical Policy Update

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Priority Health Update

• New 2021 changes to E/M codes

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Managed Care Committee Reimbursement TIDBITS

Featuring this month: Molina Healthcare of Michigan

Tidbits regarding:
• Use of Biosimilars
• Car-T Coverage
• Telehealth

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January, 2021, Frequently Asked Questions

• Status of MFN Interim Final Rule
• Sequestration
• Fee Schedule Disappearance
• No Specialist Code G2211
• Audio/Video Supervision

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