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MSHO Virtual Spring Reimbursement Meeting

SAVE THE DATE - Wednesday, April 21, 2021

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Webinar - 2021 Changes to E & M Guidelines: It Really is Easier! Let me Show You!

Presented on February 16, 2021

Did you miss this? It was amazing! The handouts are available!

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WPS Oncology Related LCD Updates

February 2021

Updates that may be of interest to oncology including these updates/revisions:
• 2021 CPT/HCPCS Code Updates
• Complex Drug Administration Coding
• Immune Globulins

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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:

• New On Demand Training -What's New for 2021 Session 2
• New On Demand Training for E & M Services
• New YouTube Training Available

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Recent Oncology Related Articles

• Flu & Pneumococcal Shots: Protect Your Patients
• PFS Payment for Office & Outpatient E/M Visits
• Improving Accuracy of Medicare Payments
• HCPCS Code G2211 is a Bundled Service and Not Separately Paid
• Care Compare: 2019 Preview Period Open through March 25
• Open Payments Data
• Payment for Outpatient Clinic Visit Services at Excepted Off-Campus Provider-Based Departments
• Importance of Proper Documentation: Provider Minute Video
• 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 Article

This edition includes articles on:

• No Surprise. It's the Law!

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Recent Oncology Related News

• There's a new information bubble icon in Benefit Explainer related to diagnosis
• Breyanzi® to require prior authorization for Medicare Advantage members starting Feb. 11
• Commercial payer Meridian Health Plan of Michigan Denied in Error
• COVID-19 telehealth code chart changes
• Changes in coverage decisions for some 2021 CPT codes
• February 26, 2021 ICT Webinar: You've submitted a few claims; now what?
• Medical benefit specialty drug prior authorization list changing in April for most members
• Some drugs not payable when administered by a health care professional to Blue Cross and BCN commercial members, starting April 1, 2021
• Changes coming to preferred products for drugs covered under the medical benefit for most members, starting April 1, 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 2/16/21

Review the reported payer reimbursement issues including clarifications and issues with WPS Medicare, BCBSM, Medicare Plus Blue, BCN Advantage, 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

• IMPORTANT - Telehealth Billing Process and Policy Updates Coming March 1
• Post-Claims Appeals and Medical Records
• Changes to our preferred biosimilars for pegfilgrastim effective April 1

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Managed Care Committee Reimbursement TIDBITS

Featuring this month: Cigna

Tidbits regarding:
• Medical necessity review related to site of care for some drugs
• Accredo, Cigna specialty pharmacy is making the Prior authorizations easier
• Cigna updated their Precertification list effective 1/1/2021-Read more!

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February 2021, Frequently Asked Questions

• Bundled Specialist Code G2211
• OCM and OCF, When Do They End/Start?
• Medicare Timely Filing for Medicaid Takeback
• Is MFN Gone For Good?
• Transitional Care Management

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