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Together With Gsk Oncology

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More Changes to 2021 E & M Outpatient Visit Guidelines Announced!

Now you can count CBCs as MDM Data even if you bill for them!

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The Health Policy Committee voted to move HB 4353 out of committee 18 - 0, with 1 pass

House Bill 4353 Supports Patient Access to Critical Treatments by Banning Discriminatory Copay Accumulator Adjustment Programs

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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

The handouts are available & a new recording will be available soon!

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MSHO & WPS Outpatient Hospital Webinar

Presented on March 10, 2021

Handouts and recording now available!

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MSHO Featured Corporate Sponsor Assistance Program

TEVA CORE (Comprehensive Oncology Reimbursement Expertise)

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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
• 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-Harris Administration Increases Medicare Payment for Life-Saving COVID-19 Vaccine
• Open Payments & You Call — March 25
• Average Sales Price Files: April 2021
• April 2021 HCPCS Code Update
• Intravenous Immune Globulin Demonstration
• 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:

• DOJ Announces 15-Year Term for Provider CEO Convicted of “Barbaric” Fraud Scheme
• 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

• AIM Specialty Health® technical issues are resolved
• Additional medications will require prior authorization for Medicare Advantage members, starting June 22
• Some Meijer Inc plans have wrong alpha prefix on web-DENIS ID card
• Easier access to RC Claim Assist
• Starting in June, we'll use clinical information to validate providers' answers to some questionnaires in the e-referral system
• Medicare Advantage Claims Processed in Error
• Deductible, out-of-pocket maximums for Medicare Plus Blue groups showing incorrectly in web-DENIS
• 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
• 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 3/17/21

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

• New Provider Portal Coming This Year
• 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 - UPDATED 3/17/21
• Reviewing Labs Ordered by Another Physician in the Group
• Can I Count Time at Tumor Board
• Pre-Charting

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