like us on facebook connect with us on linkedin follow us on twitter February 02, 2022

Rigel 1

To learn more about Rigel, click here.

Section Header Section Header

Spring Reimbursement Meeting - SAVE THE DATE!

Friday, April 29 at the Somerset Inn, Troy

Details >

Did You Miss the February 2nd Webinar?

Now That The Dust Has Settled: Billing & Coding in 2022

Handouts are available and recording is coming soon!

Details >
Section Header Section Header

WPS Oncology Related LCD Updates

February 2022

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

Details >

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

Details >

Join WPS for a Teleconference, Webinar or Seminar

Check out these upcoming training events:

• Teleconferences including; Claim Denials Relating to Provider Enrollment and Infusion Documentation
• On Demand Training Including; Appeals - Understanding the Basics, ABN Basics, YouTube Training and more...

Details >
Section Header


Recent Oncology Related Articles

• Important Reminder of Clinical Trial (NCT) Number Reporting Requirement
• Internet-Only Manual Updates (IOM) for Critical Care, Split/ Shared Evaluation and Management Visits, Teaching Physicians, and Physician Assistants
• CY2022 Telehealth Update Medicare Physician Fee Schedule
• Calendar Year (CY) 2022 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment — Revised
• Original Medicare vs. Medicare Advantage
• Recent LearnResource & MedLearn Matters Articles

Details >

Michigan RAC Information

Region 1 - Performant Recovery, Inc.

MANY RAC AUDITS REPORTED!!! All related to waste - not using the smallest vial available or not using the JW modifier! Be Careful!!

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

Details >

Recent RAC Monitor Articles

This edition includes articles on:

• Medicare Auditors Caught Double-Dipping
• Who Owns the Chart?

Details >
Section Header


Recent Oncology Related News

• HCPCS replacement codes, effective Jan. 1, 2022, established
• Changes to the medical oncology prior authorization list for URMBT members with Blue Cross non-Medicare plans, starting Feb. 21
• NovoLogix user interface update: Old version of authorization screen to be deactivated March 1
• Starting March 1, radiology procedure code *71271 requires prior authorization for most members
• Additional drugs to require prior authorization for Blue Cross URMBT non-Medicare members, starting March 10
• In March, AIM Specialty Health® to update clinical guidelines for prostate cancer imaging
• Changes coming to preferred products for infliximab (reference product Remicade®) for Medicare Advantage members, starting April 1
• Changes coming to preferred products for pegfilgrastim (reference product Neulasta®) for commercial and Medicare Advantage members, starting April 1

Details >



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

Details >
Section Header

Payer Issue Tracking Page

Last Reviewed/Updated 2/1/22

Review the reported payer reimbursement issues including:
• Multiple issues TOO MANY TO MENTION HERE - PLEASE be sure to read the section!!!

Details >


Recent Oncology Related News

Medicaid Updates Include:
• MSA Bulletin Updates
• Biller "B" Aware Notices
• No Zoladex Coverage for Michigan Medicaid Patients - NDC Not Rebate Eligible Here is What You Should Do For Your Patient

Details >

Newsletters of Interest

• Aetna OfficeLink Updates
• Cigna
• Humana YourPractice
• UHC Network News

Details >

Priority Health Update

• Anatomic Modifiers Required Starting Apr. 1, 2022
• Submitting Claims for Medicaid Members with Other Insurance

Details >

UnitedHealthcare Update

• Starting April 1st - Exchange Plans: Prior authorization requirements for radiation and chemotherapy services

Details >

Managed Care Committee Reimbursement TIDBITS

Featuring this month: Cigna

Tidbits regarding:
• Electronic Tools
• Policy Updates
• General News

Details >
Section Header Section Header Section Header


February 2022, Frequently Asked Questions

• Face to Face Requirement for Split/Shared Changed
• Deductible/Copay for Telephone Visits
• High Deductible Plans Now Owe Copay/Deductible for Telehealth Visits
• Billing Hydration for an Open Line
• Timing of Signature Requirement for Verbal Orders

MSHO MEMBERS - You can access and search previous FAQs! Scroll to the bottom of the Q & As to find out how!

Details >