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NOTE: At the time of this publication, we are still awaiting release of the Hospital Outpatient Prospective Payment Rules Details >Changes reimbursement for Part B Drugs!The Model begins on Jan. 1, 2021, affects outpatient hosptial and private practice, and will operate for seven years. Details >Opposes Dangerous, Misguided “Most Favored Nation” Experiment Policy Will Harm Patients and Cancer Providers’ Ability to Access Lifesaving Drugs Details >Misguided and Will Decrease Access to Cancer Care Details >Offer Clarity and Flexibility Amid Shift to Value-Based Care Details >
Presented by ASCOWednesday, December 9 12:00 - 1:00 pm Details >Wednesday, December 16 12:00 - 1:00 pm Details >4 Weeks of Michigan Payer UpdatesBlue Cross, Michigan Medicaid, WPS Medicare and Priority Health webinars have completed however, if you missed them, you can still download the handouts and listen to the recordings. • Medicare and Blue cross released the responses to questions submitted! Note: some responses by BCBSM are incorrect and we will be publishing an additional clarification update by our next Reimbursement Newsletter!
• The response the questions submitted to Medicaid is also available. • Questions submitted to Priority Health are still pending. Details >
December 2020Updates that may be of interest to oncology Including:
• Billing and Coding: Complex Drug Administration Coding – Effective January 10, 2021 and MolDX Updates 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:• E/M Office and Outpatient Services for 2021 Q and A Teleconference •
PLUS on-demand educational opportunity on the 3 Day/1Day Payment Window Part B Details >
Recent Oncology Related Articles• Hospital Price Transparency Webcast — December 8 • Advance Care Planning — Revised • Reminder: Upcoming MIPS Important Dates and Deadlines • COVID-19 Vaccine: Find Out How to Prepare • 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:• NEWS ALERT: CMS Finalizes “Historic” Changes to Stark Law • Medicare Improper Payment Rate Continues Multi-Year Decline Details >
Recent Oncology Related News• Update: Oncology management program for Blue Cross commercial members will not include use of S codes (S0353 and S0354) • Enhanced Blue Cross Blue Shield Michigan NASCO 835 electronic remittance advice information • We're expanding High Technology Radiology Prior Authorization program with AIM to Michigan FEP members • CMS 2021 HCPCS codes delayed • December 15, 2020 ICT Webinar: You've submitted a few claims; now what? • Medical specialty drug prior authorization list will change in January for Blue Cross commercial fully insured groups • Prior authorization requests for outpatient CAR-T therapy drugs for Medicare Advantage members • AllianceRx Walgreens Prime specialty pharmacy program starts Jan. 1 for certain Blue Cross PPO • BCBSM/BCN: New, Secure Provider Website in 2021 • IVIG dosing strategy is changing for the Medicare Part B medical specialty drug program, starting Dec. 7 • During the COVID-19 emergency, we're extending global referrals through at least Dec. 31 for BCN HMOSM members 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 • System is applying denied authorization to claim in error • Authorizations coming through are causing claim denials, multiple RHC Issues Details >
Last Reviewed/Updated 12/2/2020Review the reported payer reimbursement issues including clarifications and issues with WPS Medicare, BCBSM, BCN, Medicare Plus Blue, Priority Health and UHC. 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 >ATTENTION MSHO MEMBERS - IMPORTANT UPDATE• Copay Accumulator Program Begins January 1, 2021 Details >• Medicare and Medicaid member engagement and support programs through the end of the year • Ongoing support for you and your patients in the fight against COVID-19 • ePA for pharmacy now available through the Surescripts portal • 2021 commercial fee schedules now available • Jan.1, 2021 Commercial and Medicare formulary changes Details >Featuring this month: UnitedHealthcare Community PlanTidbits regarding: • “Inappropriate Primary Diagnosis Policy” • Requirements to follow the Michigan Fee-For-Service Preferred Drug List (PDL) • Monthly Prior Auth Requirements Details >
December 2020, Frequently Asked Questions• 2021 E & M Guideline Questions • Do We Need to Meet 3 Out of 3 For a New Patient? • Billing on Time Includes Record Review • Time Reviewing Notes From a previousDday • What Would Be 3 Unique Lab Tests • Which to Choose - Time or MDM? Details >
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