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State Society Map Slide

For more information on The Merck Access Program, please click here.

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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

June 2021

Updates that may be of interest to oncology including:
• Immune Globulins Revised Article and many MolDX Policy 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

• CMS Reweights 2020 MIPS Cost Category; Apply Now for 2021 MIPS Hardship Exceptions; 2018-2019 Cost Measure Benchmark Files Released
• Clinical Diagnostic Laboratories: Private Payor Rate-Based CLFS Resources
• Improper Payment for Intensity-Modulated Radiation Therapy Planning Services
• Collaborative Patient Care is a Provider Partnership
• Complying with Medicare Signature Requirements
• Physician Orders: Provider Minute Video
• Medical Record Maintenance & Access Requirements
• Lunch and Learn Webinars for Physicians and Coders Focus on Risk Adjustment, Coding
• Recent LearnResource & MedLearn Matters Articles

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Michigan RAC Information

Region 1 - Performant Recovery, Inc.

NEW Under Review:
• Positron Emission Tomography for Initial Treatment Strategy in Oncologic Conditions: Medical Necessity
• Documentation Requirements and Positron Emission Tomography for Initial Treatment Strategy in Oncologic Conditions: Medical Necessity and Documentation Requirements

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Recent RAC Monitor Articles

This edition includes an article on:

• The New Reality: Post-COVID RAC Audits
• Making Sense of Shared Visits

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Recent Oncology Related News

• Procedure codes *70554 and *70555 to require prior authorization from AIM starting Sept. 1 for Blue Cross commercial and Medicare Plus BlueSM members
• We're adjusting our systems to pay all rituximab claims for the same diagnostic indications for Blue Cross commercial members
• Revised Participating Hospital Agreement to take effect in July
• Michigan outpatient facilities must bill NDCs with NOCs or commercial claims will reject, starting in August
• Reminder: Check for authorization requirements, not all Blue Cross patients require AIM authorization
• Reimbursement for Lupron Depot® and Eligard® to change on Aug. 1 for all commercial members
• Four additional drugs to require prior authorization for Blue Cross URMBT non-Medicare members, for dates of service on or after Sept. 7
• Optum now identifies, recovers credit balance overpayments, replacing Conduent
• June 24, 2021 ICT Webinar: You've submitted a few claims; now what?
• Remote Patient Monitoring policy – Claims resubmission for procedure codes *99091, *99453, *99454, *99457 and *99458
• JemperliTM and ZynlontaTM require prior authorization for dates of service on or after July 26, 2021, for most members
• Claims Submission access through web-DENIS and Provider Secured Services – SSO001 errors
• We're making changes to drug coverage on Preferred Drug List starting in July

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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 6/9/21

Review the reported payer reimbursement issues including clarifications and issues with Medicare Plus Blue/85025 and BCBSM issues with biosimilars which will now be covered for all diagnosis that was covered by the brand drug

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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
• UHC Reimbursement Policy Update

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Priority Health Update

• Transition of Care for New Priority Health Medicaid Members

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Managed Care Committee Reimbursement TIDBITS

Featuring this month: Managed Medicaid

Tidbits regarding:
• Using the correct Telehealth modifiers
• Denials for infusion claims without a JG or TB modifier
• Aetna Better Health records documentation requirement

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June 2021, Frequently Asked Questions

Clarifications on billing the new E & M Guidelines
• Blood Draws and MDM Data
• New patient visit 2 of 3 or 3 of 3
• Split/Shared overlapping time
• Split/Shared provider times added together
• MDM and prolonged service
• 99213 or 99214

• 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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