AMA House of Delegates Approves ASCO-Backed Resolution Opposing Medicare Sequestration Cuts

Congress Must Protect Patient Access to Radiation Oncology

Build Back Better (BBB) Act Passes in the House, Moves to Senate

PASSED! Mandatory Medicaid Coverage of Routine Patient Costs for Qualifying Clinical Trials

MSHO joins ASCO and other organizations urging Congress to extend the 3.75% adjustment through at least CY 2022

Did You Miss the MSHO 12th Annual Payer Update

Presented on November 10, 2021

Handouts are still available. Recordings have been released and are located on the MSHO website! ALSO on the website; responses to the questions submitted to WPS Medicare and a Medicaid Health Plan Key Contact List from DHHS!!

MSHO Featured Corporate Sponsor Assistance Program

Novartis Patient Assistance Foundation

WPS Oncology Related LCD Updates

December 2021

Updates that may be of interest to oncology including:
• Multiple MolDx Revised Policies

Join WPS for a Teleconference, Webinar or Seminar

Check out these upcoming training events:

• Learning Center: Content Library Enhancements
• Teleconference - Evaluation and Management Visits in 2022
• On Demand Training Including; Appeals - Understanding the Basics, E & M Services for 2021, 3 Day/1 Day Payment Window, YouTube Training and more...

HCPCS Code Update for 2022

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

BCBSM/BCN

Recent Oncology Related News

• We've improved the commercial Blue Cross and BCN utilization management medical drug list
• Changes to the prior authorization list for medical benefit drugs for Medicare Advantage members
• Blue Cross enhances tools for electronically prescribing medications and submitting prior authorizations
• Mark your calendar – 2022 PGIP Quarterly meeting dates
• 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
• Changes to the medical oncology prior authorization list for URMBT members with Blue Cross non-Medicare plans, starting Feb. 21
• Starting March 1, radiology procedure code *71271 requires prior authorization for most members

Medicare Plus Blue

Monthly Status Report for December

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

Payer Issue Tracking Page

Last Reviewed/Updated 12/7/21

Review the reported payer reimbursement issues including:
• Confusion on the rounding of NDC with BCBSM

Newsletters of Interest

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

Managed Care Committee Reimbursement TIDBITS

Featuring this month: UnitedHealthcare Community Plan

Tidbits regarding:
• Step Therapy
• Preferred Drugs for Oncology and Non-Chemo Medications
• Denied Drug Codes - Pharmacy Benefit Drugs

Recent Oncology Related FDA Approvals/Changes

With No Replacement for OCM on Horizon, Oncology Practices Ask: What Now?

ASK MSHO

December 2021, Frequently Asked Questions

• New Code for Neulasta in 2022
• Principal Care Management Coding
• Inpatient Hospital E & M Changes for 2022
• How Bad Is the Medicare Cut

MSHO MEMBERS - You can access and search previous FAQs! Scroll to the bottom of the Q & As to find out how!