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Welcome to the Reimbursement Bulletin

MSHO Confidentiality Statement

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Changes to Billing of Telehealth Services

MSHO Telehealth Coverage Updates

MSHO is supporting our members by creating payer resources, clarifying coding and billing requirements, inquiring with and tracking payer policies and creating a Telehealth FAQ

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A Message From Your E-bulletin Sponsor

AstraZeneca

• Enhertu (fam-trastuzumab deruxtecan-nxki) Access and Support

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Spring Reimbursement Meeting

Moving to a Virtual Fomat - Details coming soon!

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Did you miss the MSHO & WPS Outpatient Hospital Webinar

Held March 11, 2020 - Handouts are still available!

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MSHO Featured Corporate Sponsor Assistance Program

Genomic Access Program: Oncotype DX Reimbursement Assistance

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WPS Oncology Related LCD Updates

March 2020

Including:
• Multiple MolDX Updates and Retiring Clinical Social Worker Policy

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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 Fee Schedules and 2020 Final CMS Rules

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Join WPS for a Teleconference, Webinar or Seminar!

Check out these upcoming training events:

• New to Medicare - Policy, Documentation and Medical Review
• Care Management Services
• PLUS many additional on-demand educational opportunities including E & M training opportunities!

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CMS-Medicare

Recent Oncology Related Articles

• HHS Finalizes Historic Rules to Provide Patients More Control of Their Health Data
• COVID-19: Test Pricing; Diagnostic Lab Tests, Pricing & Codes; and EHB Coverage
• Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment MLN Matters® Article
• Essential Health Benefits (EHB) Coverage
• CMS Sends More Detailed Guidance to Providers about COVID-19
• Administrative Simplification: Claim Status Basics
• Quality Payment Program: MIPS 2019 Data Submission Period Open through March 31
• Quality Payment Program: Updated Explore Measures Tool
• Medicare Part B Immunization Billing: Seasonal Influenza Virus, Pneumococcal, and Hepatitis B
• Quality Payment Program: 2019 Data Submission Videos
• Quality Payment Program: 2020 Resources
• Recent LearnResource & MedLearn Matters Articles

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Michigan RAC Information

Region 1 - Performant Recovery, Inc.

Latest Issues Under Review That May be Significant to Oncology...
• BE READY - NEW ISSUES including - Bone Marrow Transplants, ESAs for Cancer Patients, and Therapeutic Injections!

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BCBSM/BCN

Recent Oncology Related News

• Blue Cross and 14 health organizations will share financial risk for patient care, quality and health outcomes
• Medicare Part B medical specialty drug prior authorization list is changing in June
• Blue Cross Blue Shield of Michigan and Blue Care Network will waive member copays and deductibles for COVID-19 tests
• Update to Medicare Plus BlueSM PPO Manual coming in April
• Medicare Part B medical specialty drug prior authorization list is changing in April
• We're removing zoledronic acid drugs from the Medicare Part B medical specialty drug prior authorization list in March
• Radiation therapy services for A9590 require authorization starting April 1 for all Blue Cross and BCN members
• Sign up for upcoming training webinars
• Radiation therapy services for A9590 require prior authorization for all Blue Cross, BCN members starting April 1
• Important information about peer-to-peer reviews and appeals
• Two medical drugs going on commercial site-of-care program, starting April 1
• We're adding site-of-care requirements for Lemtrada and Tysabri for commercial members, starting May 1

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BCBSM/BCN

Publications

• 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
• J0881 and J0885 claims are being denied incorrectly
• RHC claim issues
• and more

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Payer Issue Tracking Page

Last Updated 3/17/2020

Review the reported payer reimbursement issues MSHO is currently addressing including the response from BCBSM regarding reimbursement by NDC and problems with payments below the minimum fee schedule!

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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 Bulletin
• UHC Medical Policy Update

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Managed Care Committee Reimbursement TIDBITS

Featuring this month: Humana

Tidbits regarding:
• Education opportunities
• How to obtain faster approvals
• Mandatory fraud and abuse training

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Priority Health Update

• New process for submitting post-claim appeals and medical records effective Mar. 19, 2020
• Get smarter access to the information you need
• Stay up to date on the latest Priority Health provider news

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ASK MSHO

March 2020, Frequently Asked Questions

• Treating a VA Patient
• CMS Step Edit Letter
• New Single Chronic Care Management Code

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