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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

September 2021

Updates that may be of interest to oncology including:
• MolDX: Molecular Diagnostic Tests

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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 2022 Proposed Rules, 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:

• Teleconference: ABN: What’s New and What’s Not
• On Demand Training: Appeals - Understanding the Basics
• E & M Services for 2021
• 3 day/1 Day Payment Window
• New YouTube Training Available

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Recent Oncology Related Articles

• Impact of the PHE on Telehealth: Comparative Billing Report in August
• CMS Resumes Targeted Probe & Educate Program
• Clinical Diagnostic Laboratories: Private Payor Rate-Based CLFS Resources
• Recent LearnResource & MedLearn Matters Articles

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Michigan RAC Information

Region 1 - Performant Recovery, Inc.

MSHO NOTE: Many MSHO members have reported recent RAC audits related to waste and single dose vials! - MSHO working with the RAC to bring our members education - Be sure to click the details button below and read our 8/30/21 update!

Also, newest approved issues listed on RAC website:
• 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 Article

This edition includes an article on:

• More Money for CMS Means More Medicare Audits

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Recent Oncology Related News

• Internet Claim Tool taxonomy code edit error
• How to submit prior authorization requests for drugs that are managed by AIM when the drugs are prescribed for non-oncology diagnoses
• We’re updating our policy for non-chemotherapy drug administration coding
• Register today for the September PGIP quarterly meeting — in Lansing, Michigan
• Audit vendor HMS is launching an updated provider portal
• Four additional drugs to require prior authorization for Blue Cross URMBT non-Medicare members, for dates of service on or after Sept. 7
• RybrevantTM requires prior authorization for dates of service on or after Sept. 27 for most members
• Payment for certain drugs administered by health care provider changing in October
• Additional drugs require prior authorization for Blue Cross URMBT non-Medicare members, starting Nov. 1
• AsparlasTM to require prior authorization for Blue Cross URMBT non-Medicare members, starting Nov. 1

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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 8/31/21

Review the reported payer reimbursement issues including:
• MPB diagnosis loading for biosimilars to match brand drugs, claims being reprocessed
• Confusion and clarification non-oncology Colony Stimulating Factor prior authorization

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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

• Prism Launches this September
• A Member Programs Catalog Now Available
• New preferred products for Medicare Part B drugs start Oct. 14 (Includes Erythropoietin stimulating agents)

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Managed Care Committee Reimbursement TIDBITS

Featuring this month: HAP

Tidbits regarding:
• Easier Access to the Provider Portal Coming Soon!
• Billing Guidelines for COVID-19 Were Updated August 20
• Important Contact Information for Providers

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September 2021, Frequently Asked Questions

• NPP Billing for Genetic Counseling
• Billing and Infusion as a Push
• Utilize the Smallest Available Vial
• Billing for "Chemo Teach"

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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