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WPS Oncology Related LCD Updates

January 2022

Updates that may be of interest to oncology including:
• Multiple MolDx Revised Policies, HCPCS and CPT updates and revisions to the Complex Drug Administration Coding

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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 - Evaluation and Management Visits in 2022
• On Demand Training Including; Appeals - Understanding the Basics, E & M Services for 2021,ABN Basics, YouTube Training and more...

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Recent Oncology Related Articles

• Medicare FFS Claims: 2% Payment Adjustment (Sequestration) Changes
• National Correct Coding Initiative Medicare Policy Manual: Annual Update
• 2022 Medicare & You Handbook
• Checking Medicare Eligibility — Revised
• Medicare Provider Compliance Tips
• New/Modifications to the Place of Service (POS) Codes for Telehealth - Effective January 1, 2022
• 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:

• Taking a Proactive Approach to Audit Defense

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Recent Oncology Related News

• Coding Advisor’s procedure coding and E/M educational mailings start in January
• Telehealth services require place of service code 10 beginning February 1 for services provided in the patient's home
• Transforming Care for Patients with Cancer: POEM celebrates first anniversary
• Update to Medicare Plus BlueSM PPO Manual coming in January 2022
• 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
• Ryplazim® to require prior authorization for Medicare Advantage members, starting Jan. 17
• 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
• Additional drugs to require prior authorization for Blue Cross URMBT non-Medicare members, starting March 10
• In March, AIM Specialty Health® to update clinical guidelines for prostate cancer imaging

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• The Record
• BCN Provider News
• Blues Brief for Oncology Providers

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Payer Issue Tracking Page

Last Reviewed/Updated 1/5/22

Review the reported payer reimbursement issues including:
• multiple issues with BCBSM, Medicaid Not Recognizing a NDC for Zoladex

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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 News

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Priority Health Update

• What Makes a Good Appeal?  Tips From Our Reimbursement Team
• 2022 Commercial Product Updates

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UnitedHealthcare Update

MSHO MEMBERS - IMPORTANT!!! Exchange plans: Prior authorization requirements for radiation and chemotherapy services

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Managed Care Committee Reimbursement TIDBITS

Featuring this month: Molina Healthcare of Michigan

Tidbits regarding:
• Retrospective Authorization
• Quick Reference Guide
• 4 Medicare Plans in 2022

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January 2022, Frequently Asked Questions

• New J-code for Neulasta and Authorization Requirements
• Split/Shared Visit Changes for 2022
• Telehealth Visits and Medicare
• Billing for Blood Draw from a Port Same Day as an Office Visit

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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