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MSHO Virtual Spring Reimbursement Meeting

Wednesday, April 21, 2021 - REGISTER TODAY!

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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

March 2021

Updates that may be of interest to oncology including these updates/revisions:
• Tumor Markers
• Complex Drug Administration Coding

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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:

• Teleconference - Basics of Medicare Documentation
• Teleconference - Evaluation and Management: History, Exam, and Medical Decision-Making
• On Demand Training -What's New for 2021 Session 2
• On Demand Training for E & M Services
• YouTube Training Available

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Recent Oncology Related Articles

• Biden To Nominate Chiquita Brooks-LaSure To Lead CMS: Reports
• Flu & Pneumococcal Shots: Protect Your Patients
• Improving Accuracy of Medicare Payments
• 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
• 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:

• Kickbacks in the Medicare Advantage Program: $12.5 million Settlement in Whistleblower Case
• No Surprise. It's the Law!

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Recent Oncology Related News

• HCPCS replacement codes established
• Update to Medicare Plus BlueSM PPO Manual coming in April 2021
• Starting in May, additional medical benefit drugs will require prior authorization for some Blue Cross commercial members
• Register today for the March PGIP quarterly meeting
• There's a new information bubble icon in Benefit Explainer related to diagnosis
• 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

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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
• Authorizations coming through are causing claim denials, multiple RHC Issues

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Payer Issue Tracking Page

Last Reviewed/Updated 3/2/21

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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UnitedHealthcare Update

• Oncology supportive care medication sourcing requirement
• Radiation therapy prior authorization update

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Priority Health Update

• IMPORTANT - Telehealth Billing Process and Policy Updates 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: Humana

Tidbits regarding:
• Claim processing edit notifications
• Claim payment inquiry resolution process guide
• Telehealth FAQs

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March 2021, Frequently Asked Questions

Multiple Questions Related to the New E & M Guidelines
• Time or MDM
• What are Social Determinants of Health
• Ordering and Reviewing Tests
• Can't Count a CBC You Bill For in MDM
• Reviewing Labs Ordered by Another Physician in the Group
• Can I Count Time at Tumor Board
• Pre-Charting

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