like us on facebook connect with us on linkedin follow us on twitter December 02, 2020

Takeda Oncology Here2 Assist RgbTo learn more about Takeda Oncology Here2Assist, click here

Section Header

CMS Released 2021 Physician Fee Schedule Final Rule

NOTE: At the time of this publication, we are still awaiting release of the Hospital Outpatient Prospective Payment Rules

Details >

CMS Released Most Favored Nation (MFN) Model Interim Final Rule

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 >

COA “Most Favored Nation” Comments

Opposes Dangerous, Misguided “Most Favored Nation” Experiment Policy Will Harm Patients and Cancer Providers’ Ability to Access Lifesaving Drugs

Details >

ASCO “Most Favored Nation” Comments

Misguided and Will Decrease Access to Cancer Care

Details >

ASCO New Rules on Physician Self-Referrals and Incentives Comments

Offer Clarity and Flexibility Amid Shift to Value-Based Care

Details >
Section Header

Prepare for 2021 Evaluation & Management Changes

Presented by ASCO

Wednesday, December 9
12:00 - 1:00 pm

Details >

Legislative Update: Key Changes for 2021

Wednesday, December 16
12:00 - 1:00 pm

Details >

MSHO 11th Annual Payer Update - A Webinar Series

4 Weeks of Michigan Payer Updates

Blue 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 >
Section Header Section Header

WPS Oncology Related LCD Updates

December 2020

Updates that may be of interest to oncology Including:
• Billing and Coding: Complex Drug Administration Coding – Effective January 10, 2021 and MolDX Updates

Details >

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

Details >

Join WPS for a Teleconference, Webinar or Seminar

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 >
Section Header

CMS-Medicare

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 >

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

Details >

Recent RAC Monitor Articles

This edition includes articles on:

• NEWS ALERT: CMS Finalizes “Historic” Changes to Stark Law
• Medicare Improper Payment Rate Continues Multi-Year Decline

Details >
Section Header

BCBSM/BCN

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 >

BCBSM/BCN

Publications

• The Record
• BCN Provider News
• Blues Brief for Oncology Providers

Details >

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
• Authorizations coming through are causing claim denials, multiple RHC Issues

Details >
Section Header

Payer Issue Tracking Page

Last Reviewed/Updated 12/2/2020

Review the reported payer reimbursement issues including clarifications and issues with WPS Medicare, BCBSM, BCN, Medicare Plus Blue, Priority Health and UHC.

Details >

Medicaid

Recent Oncology Related News

Medicaid Updates Include:
• MSA Bulletin Updates
• Biller "B" Aware Notices

Details >

Newsletters of Interest

• Aetna OfficeLink Updates
• Cigna
• HAP
• Humana YourPractice
• UHC Network Bulletin
• UHC Medical Policy Update

Details >

UnitedHealthcare Commercial

ATTENTION MSHO MEMBERS - IMPORTANT UPDATE

• Copay Accumulator Program Begins January 1, 2021

Details >

Priority Health Update

• 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 >

Managed Care Committee Reimbursement TIDBITS

Featuring this month: UnitedHealthcare Community Plan

Tidbits regarding:
• “Inappropriate Primary Diagnosis Policy”
• Requirements to follow the Michigan Fee-For-Service Preferred Drug List (PDL)
• Monthly Prior Auth Requirements

Details >
Section Header Section Header Section Header

ASK MSHO

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 >