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Friday, April 29 at the Somerset Inn, TroyDetails >MSHO & WPS Medicare Outpatient Hospital Reimbursement WebinarHandouts and recording are available! Details >
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 >• Teleconference on E/M Services, on Demand Training, and YouTube Training opportunities! Details >
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 Details >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 Details >This edition includes articles on:• Coding Compliance: Some Lessons Learned
• Medicare Inpatient versus Outpatient Status: A Due Process Right! Details >
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 Details >Publications• The Record
• BCN Provider News Details >MSHO alerted BCBSM of the issue and we have a solution!Details >Keep Sending Us Your Denials!BCBSM is Manually Processing Denials QUICKLY! Details >
Last Reviewed/Updated 3/15/22Review the reported payer reimbursement issues including:
• BCBSM issues with Neulasta, Phesgo, and Denials for Auth Exceeds Allowed Details >Recent Oncology Related NewsMedicaid Updates Include:
• MSA Bulletin Updates - Reimbursement for Genetic Counselors!
• Biller "B" Aware Notices 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 - UHC 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 >
AstraZeneca's Lynparza (olaparib)
CTI BioPharma's VONJO™ (pacritinib)
Bristol Myers Squibb's Opdivo® (nivolumab) 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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