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MSHO 12th Annual Payer Update!

NOW A VIRTUAL Event on November 10, 2021

Sadly, 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!

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WPS Oncology Related LCD Updates

October 2021

Updates that may be of interest to oncology including:
• Multiple 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
• Also, Medicare Hot Links to 2022 Proposed Rules, 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:

• 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...

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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

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Michigan RAC Information

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

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Recent RAC Monitor Article

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?

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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

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• 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 10/6/21

Review the reported payer reimbursement issues including:
• Diagnosis loading for biosimilars to match brand drugs, denied claims being reprocessed

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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
• Humana YourPractice
• UHC Network Bulletin
• UHC Medical Policy Update
• UHC Reimbursement Policy Update

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Priority Health Update

• 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)

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Managed Care Committee Reimbursement TIDBITS

Featuring this month: McLaren Health Plan

Tidbits 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

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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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