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Spring Reimbursement Meeting - REGISTER TODAY!

Friday, April 29 at the Somerset Inn, Troy

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WPS Oncology Related LCD Updates

April 2022

Updates that may be of interest to oncology including:
• 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
• TPE Reviews on 96365 Reported by Facility MSHO Member!
• 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

• Webinar on Advanced Beneficiary Notice of Noncoverage, on Demand Training, and YouTube Training opportunities!

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CMS-Medicare

Recent Oncology Related Articles

• The Future of Medicare…Medicare Managed Care
• 2023 Medicare Advantage and Part D Rate Announcement
• Physicians, Teaching Hospitals, Physician Assistants, & Advanced Practice Nurses: Register in the Open Payments System
• ICD-10 Diagnosis Codes: Comment by May 9
• April 2022 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
• Complying with Medicare Signature Requirements — Revised
• 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 YOUR CLINIC!

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:

• No Surprise. It's Not Surprising
• Prepayment Review Appeals and their Ramifications

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Important Message from BCBSM to MSHO Members

Neulasta - J2506 - Be Careful Your NDC Units of Measure AND your HCPCS Units are Correct!!!

This is a MUST READ alert for all MSHO members!

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BCBSM/BCN

Recent Oncology Related News

• Welcome to Availity for Blue Cross and BCN
• Use HM in Claim Filing Indicator field for BCN commercial medical claims
• CarvyktiTM and ByoovizTM to require prior authorization for commercial members
• Outpatient Hospital - Use C9399 to bill new drugs and biologicals for first year after FDA approval, for Medicare Advantage
• 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
• DanyelzaTM, Margenza® and SaphneloTM to require prior authorization for URMBT members with Blue Cross non Medicare plans starting June 30
• Inflectra® and Avsola® are the preferred infliximab products for pediatric commercial members starting July 1

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BCBSM/BCN

Publications

• The Record
• BCN Provider News

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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 4/6/22

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

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Medicaid

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
• HAP
• Humana YourPractice
• UHC Network News

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Priority Health Update

• Retacrit supply shortage expected soon
• Some Site of Service Restrictions Started April 1st!

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Recent Oncology Related FDA Approvals/Changes

Kite's Yescarta® (axicabtagene ciloleucel)

Novartis' Vijoice® (alpelisib)

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ASK MSHO

April 2022, Frequently Asked Questions

• Documenting time for telehealth visit
• PHE ends but can we still bill for telehealth visits
• 2023 split/shared visits based only on time, where can we address our complaints
• Sequestration and PAYGO cuts

MSHO MEMBERS - You can access and search previous FAQs! Just use the search field on the bottom right corner of the MSHO website!

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