Michigan Prior Auth SB247 Up for Hearing March 3.
Click here to view hearing details.
Friday, April 29 at the Somerset Inn, TroyDetails >MSHO has worked with BCBSM and we have a solution!Details >BCBSM Erroneous Reimbursement Denials “Exceeds Auth” When All Are Not UsedDetails >
Genentech BioOncology Access SolutionsDetails >
March 2022Updates that may be of interest to oncology including:
• Complex Drug Administration Coding and Multiple MolDx Revised Policies Details >Part A, Part B and Part A/B NewsIncludes articles that may be of interest to oncology released in the past 2 weeks
• Also, Medicare Hot Links to 2022 Final Rules and the WPS Fee Schedules Details >A "CAN'T MISS" TELECONFERENCE FOR MSHO MEMBERS!• Infusion Services: Medical Review Overview and Coverage Criteria -- March 9, just before the MSHO webinar!
• Additional teleconferences, on Demand Training, and YouTube Training opportunities! Details >
Recent Oncology Related Articles• Important CMS Redesigns Accountable Care Organization Model to Provide Better Care for People with Traditional Medicare
• CMS Expands Coverage of Lung Cancer Screening with Low Dose Computed Tomography
• Internet-Only Manual Updates (IOM) for Critical Care, Split/ Shared Evaluation and Management Visits, Teaching Physicians, and Physician Assistants
• Recent LearnResource & MedLearn Matters Articles Details >Region 1 - Performant Recovery, Inc.MORE 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 >This edition includes articles on:• The CMS Appeals System Is Plagued with Appalling Contractor Performance
• Medicare Advantage Issues Making Headlines Details >
Recent Oncology Related News• Claims with telehealth POS 10 are denying incorrectly
• For BCN AdvantageSM members: Don't issue ABNs or bill with ABN modifiers
• Outpatient facilities must bill self-administered medications through Medicare Part D
• Submit prior authorization requests for prescription drugs through an ePA tool to avoid processing delays
• Enjaymo™, Vabysmo™ and Byooviz® to require prior authorization for Medicare Advantage members
• No need to submit new authorization requests for Neulasta® for HCPCS code J2506
• Register today for the March PGIP quarterly meeting
• Optum to perform outpatient facility audits on Blue Cross commercial claims starting in March 2022
• In March, AIM Specialty Health® to update clinical guidelines for prostate cancer imaging starting March 13
• 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.
• Nyvepria™ and Rybrevant™ to require prior authorization for UAW Retiree Medical Benefits Trust members with Blue Cross non-Medicare plans starting May 16 Details >Publications• The Record
• BCN Provider News Details >Monthly Status ReportMany 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
• System is applying a denied authorization to a claim in error
• Claims are denying as duplicates against claims in a deleted status Details >
Last Reviewed/Updated 3/2/22Review the reported payer reimbursement issues including:
• Multiple Blue Cross and BCN Issues - PLEASE be sure to review!!! Details >Recent Oncology Related NewsMedicaid 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 >• Aetna OfficeLink Updates
• Cigna
• HAP
• Humana YourPractice
• UHC Network News Details >• The C-Code billing only applies to the specific brand of Auromedics Cyclophosphamide
• New Provider Enrollment Requires 90 Calendar Days.
• Anatomic Modifiers Required Starting Apr. 1, 2022 Details >MSHO MEMBERS - IMPORTANT INFORMATION!
• Starting April 1st - Exchange Plans: Prior authorization requirements for radiation and chemotherapy services Details >Featuring this month: HumanaTidbits regarding:
• Telehealth Infomation
• Prior Auth Exception within 72 hours
• New Provider Manual Effective March 15, 2022 Details >
Janssen Biotech's CARVYKTI™ (ciltacabtagene autoleucel) a BCMA-Directed CAR-T Immunotherapy for the Treatment of Patients with Relapsed or Refractory Multiple Myeloma. To learn more, click here. Details >
March 2022, Frequently Asked Questions• E & M - Counting time for a prior auth or peer-to-peer
•Split/Shared - NPP provides a more significant service, who are we required to bill under?
• Private Practice and the No Surprise Act
• April 1st Medicare Sequestration
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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