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For more information on The Merck Access Program, please click here.
Would require Medicare Advantage plans to report approval and denial ratesDetails >
Live Event November 10, 2021, Schoolcraft College, LivoniaDetails >
June 2021Updates that may be of interest to oncology including:
• Immune Globulins Revised Article and many MolDX Policy Updates 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 2021 Final Rules and the WPS Fee Schedules Details >Check out these upcoming training events:• On Demand Training: Appeals - Understanding the Basics
• CMS 1500 Billing Basics
• What's New for 2021 - Session 2
• E & M Services for 2021
• 3 day/1 Day Payment Window
• New YouTube Training Available Details >
Recent Oncology Related Articles• CMS Reweights 2020 MIPS Cost Category; Apply Now for 2021 MIPS Hardship Exceptions; 2018-2019 Cost Measure Benchmark Files Released
• Clinical Diagnostic Laboratories: Private Payor Rate-Based CLFS Resources
• Improper Payment for Intensity-Modulated Radiation Therapy Planning Services
• Collaborative Patient Care is a Provider Partnership
• Complying with Medicare Signature Requirements
• Physician Orders: Provider Minute Video
• Medical Record Maintenance & Access Requirements
• Lunch and Learn Webinars for Physicians and Coders Focus on Risk Adjustment, Coding
• Recent LearnResource & MedLearn Matters Articles Details >Region 1 - Performant Recovery, Inc.NEW Under Review:
• Positron Emission Tomography for Initial Treatment Strategy in Oncologic Conditions: Medical Necessity
• Documentation Requirements and Positron Emission Tomography for Initial Treatment Strategy in Oncologic Conditions: Medical Necessity and Documentation Requirements Details >This edition includes an article on:• The New Reality: Post-COVID RAC Audits
• Making Sense of Shared Visits Details >
Recent Oncology Related News• Procedure codes *70554 and *70555 to require prior authorization from AIM starting Sept. 1 for Blue Cross commercial and Medicare Plus BlueSM members
• We're adjusting our systems to pay all rituximab claims for the same diagnostic indications for Blue Cross commercial members
• Revised Participating Hospital Agreement to take effect in July
• Michigan outpatient facilities must bill NDCs with NOCs or commercial claims will reject, starting in August
• Reminder: Check for authorization requirements, not all Blue Cross patients require AIM authorization
• Reimbursement for Lupron Depot® and Eligard® to change on Aug. 1 for all commercial members
• Four additional drugs to require prior authorization for Blue Cross URMBT non-Medicare members, for dates of service on or after Sept. 7
• Optum now identifies, recovers credit balance overpayments, replacing Conduent
• June 24, 2021 ICT Webinar: You've submitted a few claims; now what?
• Remote Patient Monitoring policy – Claims resubmission for procedure codes *99091, *99453, *99454, *99457 and *99458
• JemperliTM and ZynlontaTM require prior authorization for dates of service on or after July 26, 2021, for most members
• Claims Submission access through web-DENIS and Provider Secured Services – SSO001 errors
• We're making changes to drug coverage on Preferred Drug List starting in July 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
• The system is applying a denied authorization to a claim in error
• Multiple RHC Issues Details >
Last Reviewed/Updated 6/9/21Review the reported payer reimbursement issues including clarifications and issues with Medicare Plus Blue/85025 and BCBSM issues with biosimilars which will now be covered for all diagnosis that was covered by the brand drug Details >Recent Oncology Related NewsMedicaid Updates Include:
• MSA Bulletin Updates
• Biller "B" Aware Notices Details >• Aetna OfficeLink Updates
• Cigna
• HAP
• Humana YourPractice
• UHC Network Bulletin
• UHC Medical Policy Update
• UHC Reimbursement Policy Update
Details >• Transition of Care for New Priority Health Medicaid Members Details >Featuring this month: Managed MedicaidTidbits regarding:
• Using the correct Telehealth modifiers
• Denials for infusion claims without a JG or TB modifier
• Aetna Better Health records documentation requirement Details >
Telemedicine in Oncology and Payer PoliciesDetails >
June 2021, Frequently Asked QuestionsClarifications on billing the new E & M Guidelines
• Blood Draws and MDM Data
• New patient visit 2 of 3 or 3 of 3
• Split/Shared overlapping time
• Split/Shared provider times added together
• MDM and prolonged service
• 99213 or 99214
• MSHO MEMBERS - You can access and search previous FAQs! Scroll to the bottom of the Q & As to find out how! Details > |
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