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WPS Oncology Related LCD Updates

June 2020

Including:
• Multiple MolDX policy changes

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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 - Appeals and Overpayments
• New to Medicare - Last Call for 2020
• PLUS many additional on-demand educational opportunities including E & M training opportunities!

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CMS-Medicare

Recent Oncology Related Articles

• Now Available: Fact Sheet for State and Local Governments - CMS Programs & Payment for Care in Hospital Alternate Care Sites
• New COVID-19 FAQs on Medicare Fee-for-Service Billing
• CMS CERT A/B MAC Outreach & Education Task Force
• Telephone Evaluation and Management Visits
• Medicare FFS 2nd Level Appeals: Submission Options
• Telehealth Video: Medicare Coverage and Payment of Virtual Services
• Evaluation and Management Services — Revised
• 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...
• Including - Bone Marrow Transplants, ESAs for Cancer Patients, and Therapeutic Injections!

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Recent RAC Monitor Articles

This edition includes an article on:

• Confusion Remains over Medicare Guidance on Treating Patient Homes as Hospital Departments

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BCBSM/BCN

Recent Oncology Related News

• Temporary relaxation of HIPAA compliance requirements for telehealth visits has been extended until further notice
• CMS expands coverage of telehealth codes
• Blue Cross is changing retrospective audits appeal time frames for Medicare Plus Blue
• UPDATED: More COVID-19-related utilization management changes
• Medical benefit specialty drug prior authorization lists are changing in July and August for Medicare Plus BlueSM PPO, BCN HMOSM and BCN AdvantageSM members
• Blue Cross offering virtual care options for members and convenient ways to get their prescriptions filled

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BCBSM/BCN

Publications

• The Record
• BCN Provider News

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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
• G0463 Incorrect Rejections have been adjusted and issue is being closed
• and more

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Payer Issue Tracking Page

Last Updated 6/2/2020

Review the reported payer reimbursement issues MSHO is currently addressing including the response from BCBSM regarding reimbursement by NDC which is still being investigated! Also, URMBT groups not covering many drugs.

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Medicaid

Recent Oncology Related News

Medicaid Updates Include:
• Proposed policy on Implementation of a Single Preferred Drug List (PDL)
• 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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Priority Health Update

• Financial relief for members and employers in response to COVID-19
• Collecting copays from Medicare Advantage members
• Medical policy updates
• Updated process for peer-to-peer reviews starts July 1
• Commercial formulary changes coming July 1
• Biosimilars preferred over Herceptin, Avastin and Rituxan - July 1

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UnitedHealthcare

• UnitedHealthcare COVID-19 End Date and Billing Guidance
• Cancer Therapy Pathways Program Opportunities

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Meridian Health Plan Update

• Telehealth Claims Being Reprocessed at the Non-Facility Rate

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Managed Care Committee Reimbursement TIDBITS

Featuring this month: Managed Medicaid

Tidbits regarding:
• UHCCP- E-Prescribing Policy On Hold
• Molina/Medicare Claim Recovery Process
• Blue Cross Complete Telehealth Information

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ASK MSHO

June 2020, Frequently Asked Questions

• Who can bill the Telehealth originating site code Q3014?
• Should we prepare for the end of telehealth in a patient's home?
• Billing a consultation without a face to face with patient
• Medicare
• Difference between Copay Accumulator and Copay Maximizer
• CKD Patient and Medicare Primary Timing

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