like us on facebook connect with us on linkedin follow us on twitter July 06, 2022

Board Review

For more information, CLICK HERE.

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CMS Innovation Center Announces Successor to the Oncology Care Model

The Enhancing Oncology Model will focus on certain cancers and health disparities

Apply by September 30th - set to launch next summer!

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Save The Date - MSHO 13th Annual Payer Update!

Live Event November 9, 2022 - Schoolcraft College, Livonia

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WPS Oncology Related LCD Updates

July 2022

Updates that may be of interest to oncology including:
• Self-Administered Drug Exclusion List

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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 Final Rules and the WPS Fee Schedules

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Join WPS for a Teleconference, Webinar or Seminar

• July 19th CAR-T Therapy Event! Also, Medicare Secondary Payer (MSP) — Tips to Avoid Claim Issues; On Demand Training, YouTube Training and SO much MORE!

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Recent Oncology Related Articles

• Internet-Only Manual Update to Publication 100-04, Chapter 16, Sections 70.5, 70.8, and 70.9 to Remove References to the Clinical Laboratory Improvement Amendments (CLIA) Files
• Medical Records Correspondence Address
• Quarterly Update to the National Correct Coding Initiative [NCCI] Procedure-to-Procedure [PTP] Edits, Version 28.2, Effective July 1, 2022
• July 2022 Quarterly Average Sales Price [ASP] Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
• ICD-10-CM Diagnosis Codes: Fiscal Year 2023
• Recent LearnResource & MedLearn Matters Articles

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Michigan RAC Information

Region 1 - Performant Recovery, Inc.

RAC Audits Continue - However, No New Oncology Related Issues Posted Since May, 2021

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Recent RAC Monitor Articles

This edition includes articles on:

• Notes on Notes on Notes on Notes
• The Challenges of Billing Observation Correctly

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Recent Oncology Related News

• July 2022 quarterly Medicare pricer update 
• New collections vendor for Federal Employee Program claims
• Provider Secured Services, including web-DENIS, end date extended for some functions
• BCN AdvantageSM to review reimbursement of claims
• Benefits and out-of-pocket costs for Collaborative Care members from another Blue plan
• We’re designating preferred and nonpreferred IV iron therapy replacement drugs for Medicare Advantage members starting August 8
• Additional medical benefit drugs to have site-of-care requirements for BCN commercial members starting Sept. 1

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• The Record
• BCN Provider News

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

BCBSM System Still Not Fixed - Keep Sending Us Your Denials!

BCBSM is Manually Processing Denials QUICKLY.

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Payer Issue Tracking Page

Last Reviewed/Updated 7/5/22

Review the reported payer reimbursement issues including:
• BCBSM Phesgo Issue and Denials for Auth Exceeds Allowed still pending

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Physicians Health Plan (PHP) Update

Zelis ePayments Postponed to July 26, 2022 and New Mailing Address Reminder

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Recent Oncology Related News

Medicaid Updates Include:
• MSA Bulletin Updates
• Biller "B" Aware Notices
• MSMS - Medicaid - COVID-19 Public Health Emergency Ending Resources

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Newsletters of Interest

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

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Priority Health Update

• How to ensure quicker, more accurate Elective Inpatient Admission authorization reviews
• New clinical edits announced in June 2022

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Recent Oncology Related FDA Approvals and Expanded Indications

Novartis' Tafinlar® (dabrafenib) + Mekinist® (trametinib)

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July 2022, Frequently Asked Questions

• New E/M Changes For Hospital Same as Office?
• Comparison of Oncology Models
• Appropriate Telehealth Location Codes

MSHO MEMBERS - You can access and search previous FAQs. Just use the search field on the bottom right corner of the MSHO website.

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