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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
• On Demand Training Including; Appeals - Understanding the Basics, ABN Basics, YouTube Training and more...

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Recent Oncology Related Articles

• Original Medicare vs. Medicare Advantage
• 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

• Advantages of using the e-referral system for prior authorization requests instead of calling or faxing
• Telehealth services require place of service code 10 beginning February 1 for services provided in the patient's home
• 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
• Changes coming to preferred products for infliximab (reference product Remicade®) for Medicare Advantage members, starting April 1
• Changes coming to preferred products for pegfilgrastim (reference product Neulasta®) for commercial and Medicare Advantage members, starting April 1

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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 1/18/22

Review the reported payer reimbursement issues including:
• multiple issues with BCBSM, Medicaid Not Recognizing a NDC for Zoladex, NDC issue with Treanda Resolved & Thank you to Sara Gouin from Ascension!

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Recent Oncology Related News

Medicaid Updates Include:
• MSA Bulletin Updates
• Biller "B" Aware Notices
• No Zoladex Coverage for Michigan Medicaid Patients - NDC Not Rebate Eligible Here is What You Should Do For Your Patient

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Newsletters of Interest

• Aetna OfficeLink Updates
• Cigna
• Humana YourPractice
• UHC Network News

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Priority Health Update

• Our Clinical Pharmacists are Calling Some of Your Patients About Medication Adherence
• Use Place of Service Code 10 for Virtual Services Provided in the Patient's Home
• Appeals Tips for Medicare Non-Contracted Providers
• 2022 Commercial Product Update

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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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