June 2016

Haven’t joined PGIP yet? Here’s your chance!
Blue Cross Blue Shield of Michigan health care practitioners can help change the face of health care in Michigan — and earn higher levels of reimbursement — by participating in our Physician Group Incentive Program.
Read more.

Inside this issue for you

• Physician Group Incentive Program to accept applications for new organized systems of care
• Here’s what you need to know about the Hospital Blue^SM product and referral process

See all the articles in this issue, grouped by category, below. For tips on navigating the electronic Record,
click here.

• Haven’t joined PGIP yet? Here’s your chance!
• Physician Group Incentive Program to accept applications for new organized systems of care
• Here’s what you need to know about the Hospital Blue^SM product and referral process
• New Medicare star ratings measure: Hospitalization for potentially preventable complications
• Select procedures no longer need preauthorization
• Reminder: New standardized paper prior authorization form for prescription drugs, coming July 1
• Automated Medicare recovery process being updated
• We’ve simplified language in reimbursement addendums for our network agreements
• Ensure that patients with diabetes have regular screenings for eye and kidney disease
• Coding corner: Best practices for documenting diabetes
• BlueCard^® connection: Why am I being contacted to provide referring provider information on my claim?
• Reminder: Depo^®-Testosterone requires prior authorization
• Subscribe to email version of The Record to get information more quickly, easily
• Billing chart: Blues highlight medical, benefit policy changes

• Let patients know that Blue Cross doesn’t cover digital breast tomosynthesis
• Here are more tips on correct billing for medical drugs
• Reminder: Update your Provider Authorization form when changes occur
• Reporting correct frequency code can prevent your claim from rejecting
• We’re changing the categorization process for physical therapy
• Here’s what you need to know about the Private Duty Nursing Program
• Home infusion therapy benefit increases length of time subcutaneous immune globulin can be delivered
• Specialty drug to be added to Medical Drug Prior Authorization program June 1
• Reminder: What to do when home infusion therapy catheter care coverage goes on hold
• Bill FEP dental anesthesia codes on one line
• Home Infusion Therapy claims for FEP Basic Option members need separate lines
• Reminder: Provider informational forums set for Upper Peninsula
• Reminder: Provider informational forums coming to a city near you

• Specialty drug to be added to Medical Drug Prior Authorization program June 1

• Let patients know that Blue Cross doesn’t cover digital breast tomosynthesis
• Reporting correct frequency code can prevent your claim from rejecting
• Reminder: Provider informational forums set for Upper Peninsula
• Reminder: Supporting documentation must meet criteria for consideration during audit appeals
• Here’s how to handle reporting on claims when Medicare benefits are exhausted

• Reminder: Medicare Plus Blue^SM post-acute care prior authorization process changing June 1
• Here are guidelines for treating patients with rheumatoid arthritis
• Chronic Condition Management Program has new remote monitoring services vendor

• Update: Coverage of home blood glucose monitors
• Reminder: Documentation requirements for recurring durable medical equipment, prosthetic, orthotics and medical supply needs

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2015 American Medical Association. All rights reserved.