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like us on facebook connect with us on linkedin follow us on twitter August 18, 2021

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Save The Date - MSHO 12th Annual Payer Update!

Live Event November 10, 2021 - Schoolcraft College, Livonia

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WPS Oncology Related LCD Updates

August 2021

Updates that may be of interest to oncology including:
• Revisions to Complex Drug Administration and many MolDx updates

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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 2021 Final Rules and the WPS Fee Schedules

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Join WPS for a Teleconference, Webinar or Seminar

Check out these upcoming training events:

• Teleconference: ABN: What’s New and What’s Not
• On Demand Training: Appeals - Understanding the Basics
• E & M Services for 2021
• 3 day/1 Day Payment Window
• New YouTube Training Available

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CMS-Medicare

Recent Oncology Related Articles

• CMS Resumes Targeted Probe & Educate Program
• Clinical Diagnostic Laboratories: Private Payor Rate-Based CLFS Resources
• Medicare Secondary Payer Provisions Web-Based Training — Revised
• ICD-10-CM Codes: FY 2022
• Medicare Advance Written Notices of Noncoverage — Revised
• Recent LearnResource & MedLearn Matters Articles

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Michigan RAC Information

Region 1 - Performant Recovery, Inc.

MSHO NOTE: Many MSHO members have reported recent RAC audits related to waste and single dose vials! - MSHO working with the RAC to bring our members education = stay tuned!

Also, 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:

• New, Major Regulations Face Providers
• Yes, Doctors are Required to Use Words

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BCBSM/BCN

Recent Oncology Related News

• Register today for the September PGIP quarterly meeting — in Lansing, Michigan
• Audit vendor HMS is launching an updated provider portal
• August 24, 2021 ICT Webinar: You've submitted a few claims; now what?
• Procedure codes *70554 and *70555 to require prior authorization from AIM starting Sept. 1 for Blue Cross commercial and Medicare Plus BlueSM members
• Four additional drugs to require prior authorization for Blue Cross URMBT non-Medicare members, for dates of service on or after Sept. 7
• RybrevantTM requires prior authorization for dates of service on or after Sept. 27 for most members
• Payment for certain drugs administered by health care provider changing in October
• Additional drugs require prior authorization for Blue Cross URMBT non-Medicare members, starting Nov. 1
• AsparlasTM to require prior authorization for Blue Cross URMBT non-Medicare members, starting Nov. 1
• We're adjusting our systems to pay all rituximab claims for the same diagnostic indications for Blue Cross commercial members

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BCBSM/BCN

Publications

• The Record
• BCN Provider News
• Just Released - Blues Brief for Oncology Providers

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Medicare Plus Blue

Monthly Status Report

Many 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

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Payer Issue Tracking Page

Last Reviewed/Updated 8/18/21

Review the reported payer reimbursement issues including:
• MPB diagnosis loading for biosimilars to match brand drugs, claims being reprocessed
• Aetna denials for initial inpatient codes & need to bill with consultation codes - Aetna's Response

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Medicaid

Recent Oncology Related News

Medicaid Updates Include:
• MSA Bulletin Updates
• Biller "B" Aware Notices

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Newsletters of Interest

• Aetna OfficeLink Updates
• Cigna
• HAP
• Humana YourPractice
• UHC Network Bulletin
• UHC Medical Policy Update
• UHC Reimbursement Policy Update

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Priority Health Update

• Priority Health outperforms industry benchmarks for pharmacy costs, extends partnership with Express Scripts
• New preferred products for Medicare Part B drugs start Oct. 14 (Includes Erythropoietin stimulating agents)

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Managed Care Committee Reimbursement TIDBITS

Featuring this month: Aetna/Cofinity

Tidbits regarding:
• Aetna commercial looking for consultation codes, not initial visit codes
• Aetna bought by CVS
• New research presented at ASCO 2021 reinforces promise of CVS Health’s Transform Oncology Care program

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ASK MSHO

August 2021, Frequently Asked Questions

• Proposed Rule Split/Shared - Bill Under the Provider Which Spent the Most Time
• Overview of Proposed Changes to Split/Shared Visits
• Aetna Still Wants Consultation Codes For Commercial Plans

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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