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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

• Medicare Secondary Payer (MSP) — Tips to Avoid Claim Issues; On Demand Training, How to Upload ADR Documentation to the Website Portal YouTube Training and SO much MORE!

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Recent Oncology Related Articles

• Medicare Telehealth Services for 2023 – CMS Proposes Substantial Changes
• Now Available: 2022 APM Incentive Payment Details
• Claims Processing Instructions for the New Hepatitis B Vaccine Code 90759
• HCPCS Application Summaries & Coding Decisions: Drugs & Biologicals
• Teaching Physicians, Interns, & Residents Guidelines — Revised
• 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:

• Understanding the Medicare Case-By-Case Exception
• Medicare Advantage Plans: More but Not Less
• RAC Audits Under Scrutiny

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Recent Oncology Related News

• We use clinical information to validate providers’ answers to some questionnaires in the e-referral system
• Reminder: Check for authorization requirements; not all Blue Cross patients require AIM authorization
• 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 7/20/22

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

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Newsletters of Interest

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

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Priority Health Update

• Legacy THC providers must wrap up claims, appeals by Dec. 31, 2022
• New clinical edits for facility claims going into effect on Sept. 15, 2022

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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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