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WPS Oncology Related LCD Updates

August 2020

Including:
• Multiple MolDX Policy Changes, Addition of Reblozyl, Immune Globulins Updated

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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:

• Medicare 3 Day/1 Day Payment Window
• Medicare Advantage - Understanding the Plan Types
• PLUS many additional on-demand educational opportunities including E & M training opportunities!

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CMS-Medicare

Recent Oncology Related Articles

• CMS ABN Form Extension
• CMS and CDC Announce Provider Reimbursement Available for Counseling Patients to Self-Isolate at Time of COVID-19 Testing
• Quarterly Provider Compliance Newsletter, Volume 10, Issue 4
• Physician Compare Preview Period Open through August 20
• Reduce Provider Burden: Participate in Medical Documentation Interoperability Pilot
• ICD-10-CM Diagnosis Codes: FY 2021
• Quality Payment Program: 2020 Resources
• 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 an article on:

• CMS, CDC Announce Available Payments for Counseling on Self-Isolation of COVID-19 Patients  

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BCBSM/BCN

Recent Oncology Related News

• Review August Edition of the BCBSM Record for the Second Quarter HCPCS Changes!
• Review August Edition of the BCBSM Record for MANY Oncology Specific Medical Benefit Policy Changes!
• Medicare Plus Blue expands prior authorization program to include genetic and molecular testing
• eviCore simplifies authorization process for radiation oncology
• The temporary extension of authorization dates on select medical and pharmacy benefit drugs for commercial members concludes Aug. 1, 2020
• Update: McLaren Medicaid erroneous rejection – resubmission required
• Additional fee schedules added to web-DENIS
• August 25, 2020 - ICT Webinar: You've submitted a few claims; now what?
• 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

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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
• System is applying denied authorization to claim in error
• RHC claim issues
• And more

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Payer Issue Tracking Page

Last Reviewed/Updated 8/5/2020

Review the reported payer reimbursement issues including BCBSM UMBRT denials and Mvasi additional coverage request approved.

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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

• Reminder: Complete your D-SNP Model of Care training
• Register today for our new authorization tool webinar training
• Billing reminders for providers treating Qualified Medicare Beneficiaries
• Medicaid Health plans transitioning to Preferred Drug List (PDL)

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ASK MSHO

August 2020, Frequently Asked Questions

• PHE was extended, how long can we bill Medicare for telehealth for patients at home?
• Administration code hierarchy
• Aetna POS requirement for telehealth
• MUE Denials

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