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Did You Miss the MSHO Legislative Update: Key Changes for 2022

Presented on December 8, 2021

Handouts, the 2022 Physician Fee Schedule Analyzer, and recording are already available on the MSHO website!

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Did You Miss the MSHO 12th Annual Payer Update

Presented on November 10, 2021

Handouts are still available. Recordings have been released and are located on the MSHO website! ALSO on the website; responses to the questions submitted to WPS Medicare and a Medicaid Health Plan Key Contact List from DHHS!!

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WPS Oncology Related LCD Updates

December 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
• Teleconference - Evaluation and Management Visits in 2022
• On Demand Training Including; Appeals - Understanding the Basics, E & M Services for 2021, 3 Day/1 Day Payment Window, YouTube Training and more...

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Recent Oncology Related Articles

• Impossible to Navigate Price Lists at Cancer Hospitals
• Checking Medicare Eligibility — Revised
• Medicare Provider Compliance Tips
• Quality Payment Program: 2020 Doctors & Clinicians Preview Period Open Until December 14
• New/Modifications to the Place of Service (POS) Codes for Telehealth - Effective January 1, 2022
• 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:

• Medicare Advantage Plans and the Two-Midnight Rule
• What are the Costs and Benefits of Medicare Audits?
• No Surprises Act Features Some Unpleasant Surprises for Providers

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Recent Oncology Related News

• We've improved the commercial Blue Cross and BCN utilization management medical drug list
• Changes to the prior authorization list for medical benefit drugs for Medicare Advantage members
• Blue Cross enhances tools for electronically prescribing medications and submitting prior authorizations
• Mark your calendar – 2022 PGIP Quarterly meeting dates
• 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
• Changes to the medical oncology prior authorization list for URMBT members with Blue Cross non-Medicare plans, starting Feb. 21
• Starting March 1, radiology procedure code *71271 requires prior authorization for most members

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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 December

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 12/7/21

Review the reported payer reimbursement issues including:
• Confusion on the rounding of NDC with BCBSM

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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

• Reminder: THC members newly transferred to Priority Health Choice Medicaid may have benefit changes
• 2022 Commercial Product Updates

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Managed Care Committee Reimbursement TIDBITS

Featuring this month: UnitedHealthcare Community Plan

Tidbits regarding:
• Step Therapy
• Preferred Drugs for Oncology and Non-Chemo Medications
• Denied Drug Codes - Pharmacy Benefit Drugs

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December 2021, Frequently Asked Questions

• New Code for Neulasta in 2022
• Principal Care Management Coding
• Inpatient Hospital E & M Changes for 2022
• How Bad Is the Medicare Cut

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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