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Supports hospital pricing transparency, 340B rebalancing and is opposed to mandatory CMMI models Details >
NOW A VIRTUAL Event on November 10, 2021Sadly, due to payer restrictions on travel to any live event, we have to switch the format to a virtual event. We will still have a full day of speakers and updates from our Michigan payers! Register today! Details >
October 2021Updates that may be of interest to oncology including:
• Multiple 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 Proposed Rules, 2021 Final Rules and the WPS Fee Schedules Details >Check out these upcoming training events:• Learning Center: Content Library Enhancements • Teleconference: Last Chance: Exploring E/M Documentation for 2021 Office Services • On Demand Training Including; Appeals - Understanding the Basics, E & M Services for 2021, 3 Day/1 Day Payment Window, and New YouTube Training on Transitional Care Management and more... Details >
Recent Oncology Related Articles• HCPCs and HOPPS Changes for 10/1/2021 • Proposals to cap Medicare Part B payments will limit outpatient access to CAR-T • Clinical Laboratory Fee Schedule Updates • Part C Organization Determination, Appeals, & Grievances — Revised • Transitional Care Management Services — Revised • Medicare Quarterly Provider Compliance Newsletter • Outpatient Clinic Visit Services at Excepted Off-Campus Provider-Based Departments: Payment Update • Recent LearnResource & MedLearn Matters Articles Details >Region 1 - Performant Recovery, Inc.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 an article on:• Medicare Provider Appeals: “Get Thee to an ALJ!” • Medicare Advantage and TPE Audits Surge • Medicare ABN Manual Changes Made - Are you Aware? Details >
Recent Oncology Related News• Medical oncology prior authorization list for UAW Retiree Medical Benefits Trust PPO non-Medicare members • How to submit prior authorization requests for drugs that are managed by AIM when the drugs are prescribed for non-oncology diagnoses • We’re updating our policy for non-chemotherapy drug administration coding • Payment for certain drugs administered by health care provider changing in October • October 29, 2021 ICT Webinar: You’ve submitted a few claims; now what? • Additional drugs require prior authorization for Blue Cross URMBT non-Medicare members, starting Nov. 1 • Asparlas to require prior authorization for Blue Cross URMBT non-Medicare members, starting Nov. 1 • Darzalex Faspro, Polivy and Trodelvy require prior authorization for URMBT members with Blue Cross non-Medicare plans, starting Dec. 3 • Prior authorization requirements expanding for Medicare Plus Blue, BCN commercial and BCN Advantage members on Jan. 1 • Additional drugs require prior authorization for UAW Retiree Medical Benefits Trust members with Blue Cross non-Medicare plans, starting Jan. 3 Details >Publications• The Record • BCN Provider News • Just Released - Blues Brief for Oncology Providers 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 10/6/21Review the reported payer reimbursement issues including: • Diagnosis loading for biosimilars to match brand drugs, denied claims being reprocessed 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 >• Denials on the following lab panel codes 80053, 85025 & 84443 • Priority Health provider onboarding and training for Total Health Care provider is available on demand • Assist members newly transferred from THC products with updating their medications • New preferred products for Medicare Part B drugs start Oct. 14 (Includes erythropoietin stimulating agents) Details >Featuring this month: McLaren Health PlanTidbits regarding: • Physician Administered Drugs and NCD Reporting • Where to find the Site of Care Injectable/Infusible Required Drug list • Genetic Testing Pre-authorization Requirements can be found on their website Details >
October 2021, Frequently Asked Questions• Updated ABN Form Rules • Pass-through and Non Pass-through Drugs • Transitional Care Management • AMA CPT and Inpatient Hospital E & M Changes
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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