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To learn more about Jazz Pharmaceutical's Patient Assistance Program, Jazz Cares, CLICK HERE.

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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

September 2022

Numerous retired and revised policies/articles

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WPS Recent Oncology Related News

Part A, Part B and Part A/B News

• Medicare Hot Links to 2022 Final Rules and the WPS Fee Schedules
• Chronic Care Management (CCM) Survey
• Upcoming System Maintenance Affecting Self-Service Tools
• Claim Timely Filing Exceptions - Issues

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CMS-Medicare

Recent Oncology Related Articles

• CMS 365-day lookback period
• Exceptions to Average Sales Price (ASP) Payment Methodology – Claims Processing Manual Changes
• National Stakeholder Call with the CMS Administrator on Inflation Reduction Act
• Medicare Telehealth Services for 2023 – CMS Proposes Substantial Changes
• 2022 APM Incentive Payment Details
• Seasonal Influenza Vaccines Pricing
• HCPCS Application Summaries & Coding Decisions: Drugs & Biologicals
• Recent LearnResource & MedLearn Matters Articles

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Michigan RAC Information

Region 1 - Performant Recovery, Inc.

Be sure to audit yourself before the RAC audits you!

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Recent RAC Monitor Articles

This edition includes articles on

• Auditors Accusted of Double-Dipping
• Splitting Hairs: “Incident to” or Shared Visit

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BCBSM/BCN

Recent Oncology Related News

• Additional fee change schedules added
• Zynteglo® to require prior authorization for most commercial members starting Sept. 22
• Additional fee change schedules added to our provider portal
• Opdualag to require prior authorization for most members starting Dec. 1
• Next phase of Provider Secured Services and web-DENIS retirement is Sept. 15
• And many more

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BCBSM/BCN

Publications

• The Record
• BCN Provider News

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Reminder: Keep Sending MSHO Your Denials!

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

BCBSM is Manually Processing Denials.

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Payer Issue Tracking Page

Last Reviewed/Updated 9/14/22

Review the reported payer reimbursement issues
• 8/12 Resolution to BCBSM Phesgo Issue and Denials for Auth Exceeds Allowed

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Medicaid

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
• HAP
• Humana YourPractice
• UHC Network News

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Priority Health Update

• Reminder: Save remittance advice files within 90 days
• New clinical edit: Principal or first-listed diagnosis codes
• 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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Recent Oncology Related FDA Approvals and Expanded Indications

• Pharmacyclics IMBRUVICA (ibrutinib)
• Incyte Pemazyre® (pemigatinib)
• AstraZeneca Imfinzi (durvalumab)

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ASK MSHO

Frequently Asked Questions

• Capturing Tumor Board discussions in an E/M outpatient visit

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