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September 2020Including:
• Multiple MolDX Policy Changes, Bisphosphonate Drug Therapy Update Details >Part A, Part B and Part A/B NewsIncludes 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 Details >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! Details >
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 Details >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 Details >This edition includes articles on:• New Challenges to Organizations that Compensate Physicians on Productivity • Telehealth and Medicaid Expansion during COVID Details >
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 Details >Publications• The Record • BCN Provider News • Blues Brief for Oncology Providers Details >Monthly Status ReportMany 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 Details >
Last Reviewed/Updated 9/15/2020MSHO 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. Details >Recent Oncology Related NewsMedicaid Updates Include: • MSA Bulletin Updates • Biller "B" Aware Notices Details >• Aetna OfficeLink Updates
• Cigna
• HAP
• Humana YourPractice
• UHC Network Bulletin
• UHC Medical Policy Update
Details >• 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) Details >Featuring this month: HAPTidbits regarding: • Online Prior Auths • Procedure Reference List • Claims Access Online Details >
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 Details >
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