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Michigan's Prior Authorization Bill SB247 Passed and is Headed to the Governor for Signing into Law!Details >
Friday, April 29 at the Somerset Inn, TroyDetails >
Bristol-Myers Squibb Destination AccessDetails >
April 2022Updates 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 • TPE Reviews on 96365 Reported by Facility MSHO Member! • Also, Medicare Hot Links to 2022 Final Rules and the WPS Fee Schedules Details >• Webinar on Advanced Beneficiary Notice of Noncoverage, on Demand Training, and YouTube Training opportunities! Details >
Recent Oncology Related Articles• The Future of Medicare…Medicare Managed Care • 2023 Medicare Advantage and Part D Rate Announcement • Physicians, Teaching Hospitals, Physician Assistants, & Advanced Practice Nurses: Register in the Open Payments System • ICD-10 Diagnosis Codes: Comment by May 9
• April 2022 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files • Complying with Medicare Signature Requirements — Revised • Medicare: Information on Geographic Adjustments to Physician Payments for Physicians' Time, Skills, and Effort • HCPCS Application Summaries & Coding Decisions: Drugs and Biologicals • Quality Payment Program: 2020 Performance Information on Care Compare • Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 28.1, Effective April 1, 2022 • Recent LearnResource & MedLearn Matters Articles Details >Region 1 - Performant Recovery, Inc.RAC AUDITS CONTINUE - All related to waste - not using the smallest vial available or not using the JW modifier! BE CAREFUL AND DOUBLE CHECK YOUR CLINIC!
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:• No Surprise. It's Not Surprising • Prepayment Review Appeals and their Ramifications Details >
Neulasta - J2506 - Be Careful Your NDC Units of Measure AND your HCPCS Units are Correct!!!This is a MUST READ alert for all MSHO members! Details >Recent Oncology Related News• Welcome to Availity for Blue Cross and BCN • Use HM in Claim Filing Indicator field for BCN commercial medical claims • CarvyktiTM and ByoovizTM to require prior authorization for commercial members • Outpatient Hospital - Use C9399 to bill new drugs and biologicals for first year after FDA approval, for Medicare Advantage • Nyvepria™ and Rybrevant™ to require prior authorization for UAW Retiree Medical Benefits Trust members with Blue Cross non-Medicare plans starting May 16 • Kimmtrak® and Tivdak® to require prior authorization for most members starting May 23 • Empaveli® and Actemra® to require prior authorization for Blue Cross URMBT non-Medicare members, starting June 1 • DanyelzaTM, Margenza® and SaphneloTM to require prior authorization for URMBT members with Blue Cross non Medicare plans starting June 30 • Inflectra® and Avsola® are the preferred infliximab products for pediatric commercial members starting July 1 Details >Publications• The Record • BCN Provider News Details >Keep Sending Us Your Denials!BCBSM is Manually Processing Denials QUICKLY! Details >
Last Reviewed/Updated 4/6/22Review the reported payer reimbursement issues including: • BCBSM issues with Neulasta, Phesgo, and Denials for Auth Exceeds Allowed Details >Recent Oncology Related NewsMedicaid Updates Include: • MSA Bulletin Updates - Reimbursement for Genetic Counselors! • Biller "B" Aware Notices Details >• Aetna OfficeLink Updates
• Cigna
• HAP
• Humana YourPractice
• UHC Network News Details >• Retacrit supply shortage expected soon • Some Site of Service Restrictions Started April 1st! Details >
Kite's Yescarta® (axicabtagene ciloleucel) Novartis' Vijoice® (alpelisib) Details >
April 2022, Frequently Asked Questions• Documenting time for telehealth visit • PHE ends but can we still bill for telehealth visits • 2023 split/shared visits based only on time, where can we address our complaints • Sequestration and PAYGO cuts
MSHO MEMBERS - You can access and search previous FAQs! Just use the search field on the bottom right corner of the MSHO website! Details >
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