 
For more information on GSK Oncology, CLICK HERE.
Expert witnesses call for strong consumer protection, federal regulationDetails >
WPS Requirement to Document Monitoring Every 15 Minutes During Infusions HAS BEEN REMOVED From Their Policy!Details >Live Event November 9, 2022 - Schoolcraft College, LivoniaDetails >
May 2022Updates that may be of interest to oncology including:
• Multiple MolDx Revised Policies Details >Part A, Part B and Part A/B NewsIncludes articles that may be of interest to oncology released in the past 2 weeks
• Good News - MSHO UPDATE the TPE Reviews on 96365 & 96413 Reported by MSHO Members!
• Also, Medicare Hot Links to 2022 Final Rules and the WPS Fee Schedules Details >• Evaluation and Management (E/M) Services Ask-the-Contractor Teleconference (ACT) Recording Available
• On Demand Training
• YouTube Training Opportunities! Details >
Recent Oncology Related Articles• Comprehensive Error Rate Testing Documentation Center Moved on April 13
• Medicare Cards Without Full Names
• Medical Record Maintenance & Access Requirements — Revised
• Recent LearnResource & MedLearn Matters Articles Details >Region 1 - Performant Recovery, Inc.RAC AUDITS CONTINUE - All related to waste - not using the smallest vial available or not using the JW modifier!
Be Careful and Double Check To Be Sure You Are Doing It Correctly!
Also, Newest approved issues listed on RAC website Details >This edition includes articles on:• A Telehealth Checkup
•
Making the Case for Clean Claims Details >
Recent Oncology Related News• Additional medical benefit drugs to have site-of-care requirements for BCN commercial members starting Sept. 1
• Meridian Health Plan commercial Claims Edited in Error
• Important news about submitting medical benefit drug prior authorization requests for Medicare Advantage members
• Register today for the June PGIP quarterly meeting
• Kimmtrak® and Tivdak® to require prior authorization for most members starting May 23
• Fusilev® will no longer require prior authorization, starting May 31
• Empaveli® and Actemra® to require prior authorization for Blue Cross URMBT non-Medicare members, starting June 1
• DanyelzaTM, Margenza® and SaphneloTM to require prior authorization for URMBT members with Blue Cross non Medicare plans starting June 30
• Inflectra® and Avsola® are the preferred infliximab products for pediatric commercial members starting July 1
• We’re designating preferred and nonpreferred IV iron therapy replacement drugs for Medicare Advantage members starting August 8 Details >Publications• The Record
• BCN Provider News Details >BCBSM System Still Not Fixed - Keep Sending Us Your Denials!BCBSM is Manually Processing Denials QUICKLY! Details >
Last Reviewed/Updated 5/18/22Review the reported payer reimbursement issues including:
• Resolution - WPS Medicare requirement for infusion monitoring documentation every 15 minutes
• BCBSM issues with Pemfexy, Phesgo, and Denials for Auth Exceeds Allowed Details >Recent Oncology Related NewsMedicaid Updates Include:
• MSA Bulletin Updates - Coverage of Routine Patient Costs for Items and Services Associated with Participation in a Qualifying Clinical Trial
• Biller "B" Aware Notices including a webinar on dealing with other insurances, update on the outpatient hospital changes related to attending/ordering/referring provider's on claims and a record keeping reminder! Details >• Aetna OfficeLink Updates
• Cigna
• HAP
• Humana YourPractice
• UHC Network News Details >• We're working to resolve Medicaid claims being rejected incorrectly
• New billing guidance for follow-up colon cancer screenings Details >Featuring this month: Medicare Advantage PlansDetails >
Daiichi Sankyo's Enhertu® (fam-trastuzumab deruxtecan-nxki) Details > 
May 2022, Frequently Asked Questions• Physician Orders and Nursing Compliance
• Hydration for 31 Minutes
• E/M 95/97 Guidelines vs 2021 Guidelines
• Concurrent Coding Confusion
MSHO MEMBERS - You can access and search previous FAQs! Just use the search field on the bottom right corner of the MSHO website! Details > |
