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Includes finalized modifications related to the Radiation Oncology (RO) ModelDetails >Support Parity for Oral Cancer Treatments: Please Urge Chairman VanderWall to Hold a Hearing on HB4354Details >CMS Regional Office Webinar on the Radiation Oncology ModelThe Clinical Data Elements and Quality Measures Reporting Requirements webinar will occur on November 16, 2021 from 3:00-4:30 p.m. & access to previous webinar materials Details >
VIRTUAL Event on November 10, 20217:00 am - 2:30 pm
REGISTER TODAY! Details >December 6 - 7, 2021, at the Hilton Garden Inn, Lansing WestRegister Today! Details >
November 2021Updates that may be of interest to oncology including:
• Multiple MolDx 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
• Exploring E/M Documentation for 2021 Office Services
• Teleconference: Prevent Part B Rejections and Denials.
• 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• New/Modifications to the Place of Service (POS) Codes for Telehealth - Effective January 1, 2022
• CMS Releases 2022 Medicare Advantage and Part D Star Ratings to Help Medicare Beneficiaries Compare Plans
• Pneumococcal Conjugate Vaccine, 20 Valent
• Non-Physician Outpatient Services Provided Before or During Inpatient Stays: Bill Correctly
• January 2022 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files & Revisions to Prior Quarterly Pricing Files
• 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 articles on:• TPE and Prepay Audits: Speak Softly, but Carry a Big Stick
• Medicare Audits: Time is of the Essence Details >
Recent Oncology Related News• Additional fee schedules added to our provider portal
• NASCO conducting payment recovery for all accounts, including FEP, MOS and Blue Card HOST
• Important Reminder: BCBSM and BCN are transitioning to a new Pharmacy Benefit Manager
• How to avoid claim rejections when Medicare is primary
• Darzalex FasproTM, PolivyTM and TrodelvyTM 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 AdvantageSM 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
• Additional drugs require prior authorization for UAW Retiree Medical Benefits Trust members with Blue Cross non-Medicare plans, starting Jan. 27 Details >Publications• The Record
• BCN Provider News
• Blues Brief for Oncology Providers Details >Monthly Status Report for NovemberMany 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 11/2/21Review 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 >• Update to the denials on the following lab panel codes 80053, 85025 & 84443
• Changes to COVID-19 vaccine and lab testing billing coming Jan. 1, 2022
• Improving provider credentialing and change requests turnaround times Details >Featuring this month: UnitedHealthcareTidbits regarding:
• 1/1/2022 the Reimbursement Policies for UnitedHealthcare Individual Exchange Plans
• Link transition to the new UnitedHealthcare Provider Portal
• UnitedHealthcare is offering training to learn about the new provider portal Details >
November 2021, Frequently Asked Questions• Any changes to the infusion section of CPT for 2022?
• Medicare guidelines for an electronic signature
• Medicare Advantage Step Therapy rules for a patient on treatment
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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