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State Society Map Slide

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

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Attention MSHO Members

Support Parity for Oral Cancer Treatments: Please Urge Chairman VanderWall to Hold a Hearing on HB4354

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Attention Radiation Oncology MSHO Members

CMS Regional Office Webinar on the Radiation Oncology Model

The Clinical Data Elements and Quality Measures Reporting Requirements webinar will occur on November 16, 2021 from 3:00-4:30 p.m. & access to previous webinar materials

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MSHO 12th Annual Payer Update!

VIRTUAL Event on November 10, 2021

7:00 am - 2:30 pm REGISTER TODAY!

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Certified Hematology and Oncology Coder (CHONC) Workshop & Exam

December 6 - 7, 2021, at the Hilton Garden Inn, Lansing West

Register Today!

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WPS Oncology Related LCD Updates

November 2021

Updates that may be of interest to oncology including:
• Multiple MolDx Revised Policies

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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:

• Learning Center: Content Library Enhancements
• Exploring E/M Documentation for 2021 Office Services
• Teleconference: Prevent Part B Rejections and Denials.
• On Demand Training Including; Appeals - Understanding the Basics, E & M Services for 2021, 3 Day/1 Day Payment Window, and New YouTube Training on Transitional Care Management and more...

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Recent Oncology Related Articles

• New/Modifications to the Place of Service (POS) Codes for Telehealth - Effective January 1, 2022
• CMS Releases 2022 Medicare Advantage and Part D Star Ratings to Help Medicare Beneficiaries Compare Plans
• Pneumococcal Conjugate Vaccine, 20 Valent
• Non-Physician Outpatient Services Provided Before or During Inpatient Stays: Bill Correctly
• January 2022 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files & Revisions to Prior Quarterly Pricing Files
• Recent LearnResource & MedLearn Matters Articles

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Michigan RAC Information

Region 1 - Performant Recovery, Inc.

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 Articles

This edition includes articles on:

• TPE and Prepay Audits: Speak Softly, but Carry a Big Stick
• Medicare Audits: Time is of the Essence

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Recent Oncology Related News

• Additional fee schedules added to our provider portal
• NASCO conducting payment recovery for all accounts, including FEP, MOS and Blue Card HOST
• Important Reminder:  BCBSM and BCN are transitioning to a new Pharmacy Benefit Manager
• How to avoid claim rejections when Medicare is primary
• Darzalex FasproTM, PolivyTM and TrodelvyTM require prior authorization for URMBT members with Blue Cross non-Medicare plans, starting Dec. 3
• Prior authorization requirements expanding for Medicare Plus Blue, BCN commercial and BCN AdvantageSM members on Jan. 1
• Additional drugs require prior authorization for UAW Retiree Medical Benefits Trust members with Blue Cross non-Medicare plans, starting Jan. 3
• Additional drugs require prior authorization for UAW Retiree Medical Benefits Trust members with Blue Cross non-Medicare plans, starting Jan. 27

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• The Record
• BCN Provider News
• Blues Brief for Oncology Providers

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Medicare Plus Blue

Monthly Status Report for November

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 11/2/21

Review the reported payer reimbursement issues including:
• Diagnosis loading for biosimilars to match brand drugs, denied claims being reprocessed

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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

• Update to the denials on the following lab panel codes 80053, 85025 & 84443
• Changes to COVID-19 vaccine and lab testing billing coming Jan. 1, 2022
• Improving provider credentialing and change requests turnaround times

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Managed Care Committee Reimbursement TIDBITS

Featuring this month: UnitedHealthcare

Tidbits regarding:
• 1/1/2022 the Reimbursement Policies for UnitedHealthcare Individual Exchange Plans
• Link transition to the new UnitedHealthcare Provider Portal
• UnitedHealthcare is offering training to learn about the new provider portal

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November 2021, Frequently Asked Questions

• Any changes to the infusion section of CPT for 2022?
• Medicare guidelines for an electronic signature
• Medicare Advantage Step Therapy rules for a patient on treatment

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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