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BeOne - Aug 25 Reimb

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MSHO Featured Corporate Sponsor Assistance Programs

• Coherus Solutions
• Immunocore's Kimmtrak Connect
• Lilly Oncology Support Center

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WPS Oncology Related LCD Updates

• New Policies / Articles
• Revised Policies / Articles
• Proposed LCD Open Meeting
• WPS Wants Your Comments

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WPS Recent Oncology Related News

• Prolonged Care Procedure Codes
• Process Change for Customer Service
• CAR T-Cell Therapy Billing
• Medicare Hot Links
• And More

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WPS Educational Offerings

New training opportunities available

• Live Trainings
• Encore Presentations
• YouTube Videos

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CMS-Medicare

Recent Oncology Related Articles

• Clinical Laboratory Improvement Amendments
• Fee-for-Service Supplemental Improper Payment Data
• Hospice Wage Index & Payment Rate Update
• Federal Register Notice on Requirements for NPPES Data Changes
• MLN Matters

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QPP

• Comment on CY 2026 CMS Proposed Policy Changes for QPP
• Aug 21: 2026 Self-Nomination & QCDR Measure Submission Q&A
• 2025 Qualifying APM Participant Status & Participation Data Available
• Delayed Release of 2024 MIPS Final Scores & Targeted Review
• DAC CY 2023 Preview Period Reopened until Aug 21

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Recent RAC Monitor Article

This edition includes articles on

• Special Alert: Aetna Change Disregards 2-Midnight Rule Obligations
• States & Industry Guiding Healthcare AI Use

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BCBSM/BCN

Recent Oncology Related News

• Aug 1: Updated Fees for Some Codes
• Sept 1: Changes to Managing Self-Administered Hemophilia Products
• Sept 1: Changes to How We Pay for Certain Medications
• Oct. 6: Submission Changes for FEP Members' Prior Auth Requests
• Billing for Non-Covered Services

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BCBSM/BCN

Publications

• The Record
• BCN Provider News

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Current Payer Issue Tracking Page

• Retacrit and Procrit Maintenance Dose Billing

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Resolved Payer Issues

• BCBSM Below Cost Reimbursement

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Aetna

• Level of Severity Inpatient Payment Policy
• August 2025 OfficeLink Update 

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Health Alliance Plan

• HAP CareSource Monthly Updates
• The HAP Pledge
• Monthly Reminders

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Medicaid

• Clinic Overpayments on Excluded Codes 
• 2025 CHAMPS LOCD Reminders
• Upcoming File Transfer Service Downtime

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Molina

Recent Oncology Related News

• Preferred Drug List 

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Priority Health Update

• Aug 21: Medicare & Medicaid Quality Webinar
• August Medical & Billing Policy Updates
• New Vendor Supporting Medical Record Retrieval
• Medicaid Audit Underway
• And More

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United Healthcare

• Medical & Reimbursement Updates
• Commercial Prescription Drug Lis
• Advantage 3-Tier & 4-Tier PDL Updates
• National Gold Card Program Enters 2nd Year  
• And More

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Recent Oncology Related FDA Approvals and Expanded Indications

Boehringer Ingelheim Hernexeos® (zongertinib)
Jazz Pharmaceutical Modeyso™ (dordaviprone)

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Drug Updates

• Discontinuation of Amgen's 120 mg and 320 mg Lumakras® (sotorasib) Tablets

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ASK MSHO

August 2025 Frequently Asked Questions

• Medically Necessary Fluid Replacement
• Hydration vs. Infusion
• Selection of the Primary Code

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