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National Legislative Updates

• Advancing Education on Biosimilars Act of 2021
• Hearing on Drug Pricing
• Addressing Anticompetitive Conduct and Consolidation in Health Care
• Future of Telehealth
• Reduced Prices for Prescription Drugs
• Bill to Increase Payments for Biosimilar Drugs
• Reimbursement for Pharmacist Services

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Save The Date - MSHO 12th Annual Payer Update!

Live Event November 10, 2021, Schoolcraft College, Livonia

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Did You Miss The MSHO Virtual Spring Reimbursement Meeting

Handouts are available and the recording will be available by the end of the week!

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Important Message from WPS Medicare...

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

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WPS Oncology Related LCD Updates

May 2021

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

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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:

• May 21 - E/M Office Services Questions and Answers
• 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

• Clinical Diagnostic Laboratories: Resources about the Private Payor Rate-Based CLFS
• Coordination of Benefits: Parts A & B Crossover Claims Issue
• SBIRT Services
• Chronic Care Management: Comparative Billing Report in April
• Medicare Billing: Form CMS-1450 and the 837 Institutional — Revised
• OPPS Part B drug payment and status indicator change for HCPCS code Q5122
• 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
• 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 an article on:

• Biden’s Low-Key Healthcare Agenda Emerges after First 100 Days
• Battling the Backlog at the ALJ
• The ALJ Backlog Dissolves – and Supplemental Medical Review Contractor (SMRC) Audits Escalate

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Recent Oncology Related News

• IMPORTANT - ATTENTION MSHO MEMBERS - Additional Update on the BCBSM/AIM Prior Authorization Denials
• Reminder: Using HCPCS code G2212
• Changes to drug coverage on Preferred Drug List starting in July
• 2% sequestration moratorium extended to Dec. 31, 2021
• Some Medicare Supplemental claims rejecting in error
• 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
• Starting in June, we'll use clinical information to validate providers' answers to some questionnaires in the e-referral system

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

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Payer Issue Tracking Page

Last Reviewed/Updated 5/4/21

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

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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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Managed Care Committee Reimbursement TIDBITS

Featuring this month: Medicare Advantage Plans

Tidbits regarding:
• Medicare and You Booklet
• Medicare Advantage Cannot Charge More for Chemo than Traditional Medicare
• Reporting Issues to CMS Regional Office

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May 2021, Frequently Asked Questions

• Documentation requirements for a blood draw
• Time based "incident-to" E & M visit
• Pharmacist billing of E & M visits
• Chemo and CT same day
• Telehealth

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

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