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BCBSM Erroneous Reimbursement Denials “Exceeds Auth” When All Are Not Used

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Spring Reimbursement Meeting - SAVE THE DATE!

Friday, April 29 at the Somerset Inn, Troy

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Did You Miss the February 2nd Webinar?

Now That The Dust Has Settled: Billing & Coding in 2022

Handouts are available and recording is coming soon!

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WPS Oncology Related LCD Updates

February 2022

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

• Infusion Services: Medical Review Overview and Coverage Criteria on March 9, Just before the MSHO webinar!

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

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Recent Oncology Related Articles

• Provider Compliance Virtual Focus Group — February 24
• Important Reminder of Clinical Trial (NCT) Number Reporting Requirement
• Internet-Only Manual Updates (IOM) for Critical Care, Split/ Shared Evaluation and Management Visits, Teaching Physicians, and Physician Assistants
• Recent LearnResource & MedLearn Matters Articles

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Michigan RAC Information

Region 1 - Performant Recovery, Inc.

MANY RAC AUDITS REPORTED!!! All related to waste - not using the smallest vial available or not using the JW modifier! Be Careful!!

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 Articles

This edition includes articles on:

• Medicare Auditors Caught Double-Dipping
• Who Owns the Chart?

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Recent Oncology Related News

• Resubmit rejected claims to Medicare for patients with Medicare Supplemental coverage from group 71736, UAW Retirees of The Budd Company Health and Welfare Trust.
• No need to submit new authorization requests for Neulasta® for HCPCS code J2506
• Register today for the March PGIP quarterly meeting
• Changes to the medical oncology prior authorization list for URMBT members with Blue Cross non-Medicare plans, starting Feb. 21
• Optum to perform outpatient facility audits on Blue Cross commercial claims starting in March 2022
• NovoLogix user interface update: Old version of authorization screen to be deactivated March 1
• 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 starting March 13
• 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.
• Nyvepria™ and Rybrevant™ to require prior authorization for UAW Retiree Medical Benefits Trust members with Blue Cross non-Medicare plans starting May 16

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• The Record
• BCN Provider News
• 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
• System is applying a denied authorization to a claim in error
• Claims are denying as duplicates against claims in a deleted status

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Payer Issue Tracking Page

Last Reviewed/Updated 2/16/22

Review the reported payer reimbursement issues including:
• Multiple Blue Cross issues, BCN and Medicaid issues - PLEASE be sure to read the section!!!

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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

• The C-Code billing only applies to the specific brand of Auromedics Cyclophosphamide
• New Provider Enrollment Requires 90 Calendar Days.
• Anatomic Modifiers Required Starting Apr. 1, 2022
• Submitting Claims for Medicaid Members with Other Insurance

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UnitedHealthcare Update

• Starting April 1st - Exchange Plans: Prior authorization requirements for radiation and chemotherapy services

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Managed Care Committee Reimbursement TIDBITS

Featuring this month: Cigna

Tidbits regarding:
• Electronic Tools
• Policy Updates
• General News

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February 2022, Frequently Asked Questions

• Face to Face Requirement for Split/Shared Changed
• Deductible/Copay for Telephone Visits
• High Deductible Plans Now Owe Copay/Deductible for Telehealth Visits
• Billing Hydration for an Open Line
• Timing of Signature Requirement for Verbal Orders

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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