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Warm Holiday wishes from our family to yoursThe MSHO office will be closed December 21st - January 3rd Details >Changes reimbursement for Part B Drugs!The Model begins on Jan. 1, 2021, affects outpatient hospital and private practice, and will operate for seven years. Details >
Presented on December 16thRecording and handouts are available! Details >Presented by ASCO on December 9thRecording and handouts still available! Details >4 Weeks of Michigan Payer Updates Recordings and Handouts AvailableAnswers to questions submitted to Priority Health just released! Details >
TEVA CORE (Comprehensive Oncology Reimbursement Expertise)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 2021 Fee Schedule, 2021 Final Rules, and 2021 Proposed CMS Rules Details >Check out these upcoming training events:• What's New for 2021
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PLUS new on-demand educational opportunities Details >
Recent Oncology Related Articles• Open Payments: Review and Dispute Data by December 31
• Hospital Price Transparency: Requirements Effective January 1
• 2020 MIPS Extreme and Uncontrollable Circumstances Exception Application: Deadline February 1
• Telehealth Services: Bill Correctly
• Advance Care Planning — Revised
• 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 Regulations Herald a Season of Changes
• CMS Finalizes “Historic” Changes to Stark Law Details >
Recent Oncology Related News• Telehealth codes remain billable through the end of the PHE for Medicare Advantage members
• AIM ProviderPortal out of service for maintenance on Dec. 19
• Processing delay for MOS professional medical drug claims
• CMS approves Next Generation Sequencing for certain cancer patients covered by Medicare Advantage plans
• 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
• 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
• 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 12/16/2020Review 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 >• Medicare and Medicaid member engagement and support programs through the end of the year **Financial Navigators - Read This Article!
• Ongoing support for you and your patients in the fight against COVID-19
• 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 > |
