like us on facebook connect with us on linkedin follow us on twitter April 21, 2021


Make sure your clinical team registers today!

Section Header Section Header

Save The Date - MSHO 12th Annual Payer Update!

Live Event November 10, 2021, Schoolcraft College, Livonia

Details >

Did You Miss The MSHO Virtual Spring Reimbursement Meeting

Recordings And Handouts Will Be Available By The End of Next Week!

Details >

Changes to E & M Guidelines: It Really is Easier! Let Me Show You!

Be sure to share this recorded webinar with your physicians and staff!

Details >
Section Header Section Header

Important Message from WPS Medicare...

Education to Enhance Provider Awareness of the Depression Screening Benefit for Medicare Patients

Details >

WPS Oncology Related LCD Updates

April 2021

Updates that may be of interest to oncology including these updates/revisions:
• Many MolDX Policy Changes/Updates

Details >

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

Details >

Join WPS for a Teleconference, Webinar or Seminar

Check out these upcoming training events:

• Ask-the-Contractor Teleconferences (ACT)
• On Demand Training -What's New for 2021 Session 2
• On Demand Training for E & M Services
• YouTube Training Available

Details >
Section Header


Recent Oncology Related Articles

• Medicare Pays to Help Patients Plan - Advanced Care Planning
• Telehealth Services: Bill Correctly
• Diagnosis Coding: Using the ICD-10-CM Web-Based Training — Revised
• How to Use the Medicaid NCCI Tools
• Update to the Manual for Telephone Services, Physician Assistant (PA) Supervision, and Medical Record Documentation for Part B Services
• Non-Physician Outpatient Services Provided Before or During Inpatient Stays: Bill Correctly
• Average Sales Price Files: April 2021
• April 2021 HCPCS Code Update
• Recent LearnResource & MedLearn Matters Articles

Details >

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

Details >

Recent RAC Monitor Articles

This edition includes an article on:

•The ALJ Backlog Dissolves – and Supplemental Medical Review Contractor (SMRC) Audits Escalate

Details >
Section Header


Recent Oncology Related News

• Abecma® to require prior authorization for commercial members starting April and May
• Some Medicare Supplemental claims rejecting in error
• Duplicate Crossover claims
• Spravato® and Panzyga® to require prior authorization starting July 12 for URMBT PPO non-Medicare members
• Additional medications will require prior authorization for most members starting May 24
• Starting in June, additional medical benefit drugs will require prior authorization for some Blue Cross commercial members
• Michigan outpatient facilities must bill NDCs with NOCs or commercial claims will reject, starting in August
• Additional medications will require prior authorization for Medicare Advantage members, starting June 22
• 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
• Starting in May, additional medical benefit drugs will require prior authorization for some Blue Cross commercial members

Details >



• The Record
• BCN Provider News

Details >

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
• The system is applying a denied authorization to a claim in error
• Multiple RHC Issues

Details >
Section Header

Payer Issue Tracking Page

Last Reviewed/Updated 4/20/21

Review the reported payer reimbursement issues including clarifications and issues with BCBSM and BCN Advantage

Details >


Recent Oncology Related News

Medicaid Updates Include:
• MSA Bulletin Updates
• Biller "B" Aware Notices

Details >

Newsletters of Interest

• Aetna OfficeLink Updates
• Cigna
• Humana YourPractice
• UHC Network Bulletin
• UHC Medical Policy Update

Details >

Managed Care Committee Reimbursement TIDBITS

Featuring this month: Priority Health

Tidbits regarding:
• Alliance with Cigna
• Changes to Preferred Biosimilars
• New Portal Coming Soon

Details >
Section Header Section Header Section Header


April 2021, Frequently Asked Questions

• Prolonged visits - 99417 vs G2212
• ICD10 History Of Cancer Adjuvant Breast Cancer Therapy
• Counting CBC in E & M MDM
• Billing "Chemo Teaches" as E & M Visit

•MSHO MEMBERS - You can access and search previous FAQs! Scroll to the bottom of the Q & As to find out how!

Details >