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WPS Oncology Related LCD Updates

September 2020

Including:
• Multiple MolDX Policy Changes, Bisphosphonate Drug Therapy Update

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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, 2021 Proposed Rules, and 2020 Final CMS Rules

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Join WPS for a Teleconference, Webinar or Seminar!

Check out these upcoming training events:

• Medicare Advantage - Understanding the Plan Types
• Part B Claim Review
• Part B Rejections and Denials
• PLUS many additional on-demand educational opportunities including E & M training opportunities!

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CMS-Medicare

Recent Oncology Related Articles

• CMS Care Compare Empowers Patients When Making Important Health Care Decisions
• Open Payments: Adding 5 Provider Types in 2021
• Office Visits by Nurse Practitioners: Comparative Billing Report
• CMS Extends AUC Program Educational + Operational Testing Period to 2021
• COVID-19: Waive Cost-Sharing for These HCPCS Codes
• Physician Fee Schedule Listening Session: Audio Recording and Transcript
• Reduce Provider Burden: Electronic Medical Documentation Interoperability Pilot Program
• Medicare Secondary Payer (MSP) Provision
• Renewed ABN: Deadline Extended to January 1
• ICD-10-CM Diagnosis Codes: FY 2021
• Recent LearnResource & MedLearn Matters Articles

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Michigan RAC Information

Region 1 - Performant Recovery, Inc.

No New Oncology Related Issues Since March:
• Latest under review at that time included: - Bone Marrow Transplants, ESAs for Cancer Patients, and Therapeutic Injections

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Recent RAC Monitor Articles

This edition includes articles on:

• New Challenges to Organizations that Compensate Physicians on Productivity
• Telehealth and Medicaid Expansion during COVID

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BCBSM/BCN

Recent Oncology Related News

• NASCO conducting payment recovery for URMBT claims - Reprocessing Denied Drug Claims
• BCBSM:  Changes to Inquiry and Appeal Process
• BCBSM/BCN:  New, Secure Provider Website in 2021
• Register for the September 25th PGIP quarterly meeting today
• Starting Dec. 1, some drugs covered under the medical benefit will require authorization for Blue Cross and Blue Shield Federal Employee
• Medicare Plus BlueSM PPO is not expanding prior authorization program for genetic, molecular testing
•AllianceRx Walgreens Prime specialty pharmacy program starts Jan. 1 for certain Blue Cross PPO commercial members
• IVIG dosing strategy is changing for the Medicare Part B medical specialty drug program, starting Dec. 7
• TecartusTM will require authorization for commercial members effective August and September 2020
• Blue Cross and BCN further extend authorization end dates on select medical and pharmacy benefit
• During the COVID-19 emergency, we're extending global referrals through at least Dec. 31 for BCN HMOSM members
• Medical specialty drug prior authorization lists are changing in September for BCN HMO, Medicare Plus Blue PPO and BCN Advantage members
• Effective Oct. 1, Nivestym® and Zarxio® are the preferred filgrastim products for all Blue Cross and BCN commercial and Medicare Advantage members
• Medicare Part B medical specialty drug prior authorization list is changing Aug. 21 and Sept. 28

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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
• 835 CARC 210 sanction amount is incorrect
• NEW - System is applying denied authorization to claim in error
• Authorizations coming through are causing claim denials
• RHC claim issues
• NEW - CMS procedure cods are denying incorrectly
• And more

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Payer Issue Tracking Page

Last Reviewed/Updated 9/15/2020

MSHO MEMBERS:
• Please remember to report any reimbursement issues you are having with a Michigan Payer that you feel is a system issue that should be addressed by MSHO.
• Review the reported payer reimbursement issues including another BIG update on the BCBSM UMBRT denial issue.

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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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Priority Health Update

• Alert message displaying in error for PriorityMedicare Edge PPO  members in GuidingCare
• Cost Estimator available to all providers
• New authorization tool launches September 14
• We're reviewing the 2021 changes to E/M codes.
• Non-Medicare outpatient services moving to 90-day window for retro authorizations
• Medicaid Health plans transitioning to Preferred Drug List (PDL)

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Managed Care Committee Reimbursement TIDBITS

Featuring this month: HAP

Tidbits regarding:
• Online Prior Auths
• Procedure Reference List
• Claims Access Online

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ASK MSHO

September 2020, Frequently Asked Questions

• Billing for Coumadin Management
• 2021 Conversion Factor Decrease
• Proposed 2021 Drug Reimbursement Changes
• The Future of Reimbursement for Telehealth in the Home Setting

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