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Pharamcyclics 1

To enroll your patients in IMBRUVICA® By Your Side, click here

To view the full prescribing information, click here

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Spring Reimbursement Meeting - REGISTER TODAY!

Friday, April 29 at the Somerset Inn, Troy

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Did You Miss This Webinar?

MSHO & WPS Medicare Outpatient Hospital Reimbursement Webinar

Handouts and recording are available!

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WPS Oncology Related LCD Updates

March 2022

Updates that may be of interest to oncology including:
• Complex Drug Administration Coding and 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 Final Rules and the WPS Fee Schedules

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Join WPS for a Teleconference, Webinar or Seminar

• Teleconference on E/M Services, on Demand Training, and YouTube Training opportunities!

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Recent Oncology Related Articles

• Medicare: Information on Geographic Adjustments to Physician Payments for Physicians' Time, Skills, and Effort
• HCPCS Application Summaries & Coding Decisions: Drugs and Biologicals
• Quality Payment Program: 2020 Performance Information on Care Compare
• Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 28.1, Effective April 1, 2022
• Recent LearnResource & MedLearn Matters Articles

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Michigan RAC Information

Region 1 - Performant Recovery, Inc.

RAC AUDITS CONTINUE - All related to waste - not using the smallest vial available or not using the JW modifier! BE CAREFUL AND DOUBLE CHECK!

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:

• Coding Compliance: Some Lessons Learned
• Medicare Inpatient versus Outpatient Status: A Due Process Right!

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Recent Oncology Related News

• Outpatient Hospital - Use C9399 to bill new drugs and biologicals for first year after FDA approval, for Medicare Advantage
• Claims with telehealth POS 10 are denying incorrectly 
• We're postponing the authorization requirement for *71271 for BCN members
• Enjaymo™ will have prior authorization and site-of-care requirements for commercial members, starting March 17
• 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
• Kimmtrak® and Tivdak® to require prior authorization for most members starting May 23
• Empaveli® and Actemra® to require prior authorization for Blue Cross URMBT non-Medicare members, starting June 1

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• The Record
• BCN Provider News

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Problem with URGENT Prior Authorizations from FEP Blue Cross?

MSHO alerted BCBSM of the issue and we have a solution!

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Erroneous Reimbursement Denials “Exceeds Auth” When All Are Not Used

Keep Sending Us Your Denials!

BCBSM is Manually Processing Denials QUICKLY!

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Payer Issue Tracking Page

Last Reviewed/Updated 3/15/22

Review the reported payer reimbursement issues including:
• BCBSM issues with Neulasta, Phesgo, and Denials for Auth Exceeds Allowed

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Recent Oncology Related News

Medicaid Updates Include:
• MSA Bulletin Updates - Reimbursement for Genetic Counselors!
• Biller "B" Aware Notices

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Newsletters of Interest

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

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Priority Health Update

• 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

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UnitedHealthcare Update

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

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Managed Care Committee Reimbursement TIDBITS

Featuring this month: Humana

Tidbits regarding:
• Telehealth Infomation
• Prior Auth Exception within 72 hours
• New Provider Manual Effective March 15, 2022

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Recent Oncology Related FDA Approvals/Changes

AstraZeneca's Lynparza (olaparib)

CTI BioPharma's VONJO™ (pacritinib)

Bristol Myers Squibb's Opdivo® (nivolumab)

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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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