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Save The Date - MSHO 12th Annual Payer Update!

Live Event November 10, 2021, Schoolcraft College, Livonia

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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:

• On Demand Training: Appeals - Understanding the Basics
• CMS 1500 Billing Basics
• What's New for 2021 - Session 2
• E & M Services for 2021
• 3 day/1 Day Payment Window
• New YouTube Training Available

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Recent Oncology Related Articles

• Register for the June PGIP Quarterly Meeting Today
• Prepayment Utilization Review can Affect Physicians’ Value-Based Reimbursement
• Lunch and Learn Webinars for Physicians and Coders Focus on Risk Adjustment, Coding
• Clinical Diagnostic Laboratories: Resources about the Private Payor Rate-Based CLFS
• Medicare Pays to Help Patients Plan
• Telehealth Services: Bill Correctly
• 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:

• Significant Shifting Reported in some Office Visits
• MedLearn Media Launches New Incentive Program

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Recent Oncology Related News

• We're using updated utilization management criteria for non-behavioral health services starting Aug. 2, 2021
• For Medicare Advantage inpatient admissions, submit prior authorization requests for CAR-T cell therapy drugs to NovoLogix
• Balance billing members
• Reminder: Check for authorization requirements, not all Blue Cross patients require AIM authorization
• IMPORTANT - ATTENTION MSHO MEMBERS - Additional Update on the BCBSM/AIM Prior Authorization Denials
• Reminder: Using HCPCS code G2212
• We're making changes to drug coverage on Preferred Drug List starting in July
• 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 5/19/21

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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Priority Health Update

• Read These Tips to Ensure Successful Medicaid Billing

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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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