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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

July 2021

Updates that may be of interest to oncology including:
• Revisions to Complex Drug Administration and many MolDx 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

• ICD-10-CM Codes: FY 2022
• Medicare Billing: Form CMS-1500 and 837 Professional Web-Based Training — Revised
• Medicare Billing: Form CMS-1450 and 837 Institutional Web-Based Training — Revised
• COVID-19 Accelerated and Advance Payment (CAAP): New Frequently Asked Questions (FAQs) Now Available
• Quality Payment Program: 2021 APM Incentive Payments
• 2019 Quality Payment Program: Performance Information on Care Compare
• Medicare Secondary Payer
• Importance of Proper Documentation: Provider Minute Video
• Medicare Quarterly Provider Compliance Newsletter
• CMS Reweights 2020 MIPS Cost Category; Apply Now for 2021 MIPS Hardship Exceptions; 2018-2019 Cost Measure Benchmark Files Released
• Recent LearnResource & MedLearn Matters Articles

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Michigan RAC Information

Region 1 - Performant Recovery, Inc.

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

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Recent RAC Monitor Articles

This edition includes articles on:

• OIG Telehealth Audits Ramping Up
• Are Doctors Required to Use Words Rather than Codes?

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Recent Oncology Related News

• IMPORTANT - Payment for certain drugs administered by health care provider no longer a benefit in October
• 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
• 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
• 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

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• The Record
• BCN Provider News
• Just Released - Blues Brief for Oncology Providers

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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 7/20/21

Review the reported payer reimbursement issues including:
• MPB diagnosis loading for biosimilars to match brand drugs
• Aetna denials for initial inpatient codes & need to bill with consultation codes

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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

• Are you a new provider to Priority Health?
• Transition of Care for New Priority Health Medicaid Members

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Managed Care Committee Reimbursement TIDBITS

Featuring this month: Meridian Health Plan of Michigan

Tidbits regarding:
• Provider Network Management Representatives
• CMS Regional Office Representative
• Meridian PBM

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Medical Economics - July

How to keep getting paid for telehealth in 2021

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July 2021, Frequently Asked Questions

• Billing Administration with Free Drug
• NCCN Update Request
• Who Can Perform Advanced Care Planning

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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