10/02/2018

WPS Recent Oncology Related News

Part A, Part B and Part A/B News

WPS PART A-Outpatient Hospital Only

MLN Connects Special Edition - Wednesday, September 19, 2018
  
New Medicare Card - Progress Updates
 
CMS continues to successfully mail newly-designed Medicare cards with the new Medicare number and we are excited to share important progress updates with you.
 
As of August 31, we mailed nearly 35 million cards and continue to mail more every day. We are processing claims and eligibility requests with the Medicare Beneficiary Identifier (MBI), showing that providers are successfully using the new number.
 
We started mailing new cards to people with Medicare who live in Wave 6 states this week and finished mailing cards to people who live in Waves 1, 2, 3 and 4 states. Because card mailing is progressing so well, we updated the mailing schedule to include an approximate start date for the last wave, and we are on track to finish mailing new cards to all people with Medicare before April 2019. 

With our ongoing focus on fraud and protecting the identities of people with Medicare, we are continuously adjusting and improving our mailing strategy to make sure we are mailing new cards to accurate addresses and using the highest levels of fraud protection throughout the mailing. To do this, we are:

• Using trusted industry tools and standards to verify addresses
• Comparing each address against multiple information sources to ensure we are mailing to the right person and the right address
• Mailing cards to people with Medicare when we have high confidence in their identity and address

If your Medicare patients say they did not get a card after their mailing wave ends, ask them to:

• Call 1-800-MEDICARE (1-800-633-4227) where we can verify their identity, check their address, and help them get their new card
• Continue to use their current card to get health care services until they get their new card

Your Medicare patients should continue to protect their new number to prevent medical identity theft and health care fraud. We will continue to raise awareness about potential scams and how they can prevent fraud through our outreach and launched a national fraud prevention campaign in September before Medicare Open Enrollment.

Direct Data Entry (DDE) Users - Upcoming Freeze on Online Submission of Requests for New or Modified DDE Access and DDE Submitter IDs

WPS PART B-Private Practice Only

Diagnosis Code Reporting on a Part B Claim

Many people ask how many diagnosis codes can be reported on a single Part B claim. The answer is twelve. For more information, please refer to the new resource Reporting Diagnosis Codes on a Part B Claim.

Evaluation and Management Codes - CERT Denials

Recent claim reviews performed by the Comprehensive Error Rate Testing (CERT) contractor have noted significant error findings for evaluation and management (E/M) service procedure codes. In these cases, the performing physician/non-physician practitioner's documentation did not support the level of E/M code billed.
 
Coding and documentation reminders:

• The selection of the CPT code should be based the service provided meeting the required key components of the CPT code.
• Selecting a lower level code when documentation supports a higher level will also result in a CERT error.
• An illegible handwritten note should be accompanied by a typed transcription of the note when requested for a review.
• The exact name of the diagnostic or laboratory service(s) ordered should be listed in the progress note. Listing, "x-ray or lab today" is not acceptable.

For more information, refer to the 2016 Professional Edition Current Procedural Terminology by the American Medical Association and the  CMS Internet-Only Manual, Publication 100-04, Chapter 12, section 30.6  - Evaluation and Management Service Codes-General (Codes 99201-99499).

Hierarchical Condition Categories (HCC) System

Many providers ask WPS GHA for information about the HCC system for reimbursement. Since the HCC system is used for reimbursement by Medicare Advantage (MA) plans, and not traditional Medicare, providers should contact the applicable MA plan directly. For more details, please refer to our Hierarchical Condition Categories resource.

WPS PART A & PART B

Comprehensive Error Rate Testing (CERT) Program - Documentation Requests

A provider can contact the CERT office to verify if there are any outstanding requests. When submitting medical records, please use the enclosed barcoded cover sheet as your only coversheet. For more information about CERT record request and submission requirements, please visit the CERT Provider website.

New Resource: 340B Acquired Drugs and Appeals

When a service is reimbursed in accordance with Medicare's National payment policy for 340B-acquired drugs, the amount paid is final. The method of reimbursement is not an appropriate reason for an appeal and the appeal will be dismissed when submitted to dispute CMS' 340B national payment policy. For more information, please refer to our new resource, 340B Acquired Drugs and Appeals.

Are You Ready for ICD-10-CM Annual Changes?

Any new or revised ICD-10 CM codes will be effective for dates of service October 1, 2018 and after. However, the Medicare processing systems may not be updated until January 1, 2019. Please see the article titled, "October is ICD-10 CM Update Month" for more information. You can find a link to 2019 ICD-10-CM updates, as well as other annual updates, on the CMS ICD-10 web page.

Comprehensive Error Rate Testing (CERT) Program - Documentation Requests

The CERT office has noticed an increase in providers not submitting medical records upon request. The CERT office will send up to four notification letters. The initial letter will be mailed to the correspondence address identified in the Provider Enrollment, Chain, and Ownership System (PECOS). Any additional notification letters needed will be either faxed or mailed based on a follow-up telephone contact with the provider. If the medical records are not received, recoupment action may be initiated. The Medicare Administrative Contractor will attempt to obtain the records prior to recoupment action, however it is ultimately the responsibility of the billing provider to submit records to support services billed to Medicare.
 
A provider can contact the CERT office to verify if there are any outstanding requests. When submitting medical records, please use the enclosed barcoded cover sheet as your only coversheet. For more information about CERT record request and submission requirements, please visit the CERT Provider website.

A55639 Chemotherapy Agents for Non-Oncological Conditions Updated and Reformatted

The article, "Chemotherapy Agents for Non-Oncological Conditions," addresses chemotherapy administration codes which apply to parenteral administration of anti-neoplastic agents provided for treatment of noncancer diagnoses or to substances such as monoclonal antibody agents, and other biologic response modifiers.
 
The article has been updated and reformatted to support Article Guidance on Non-Oncological Conditions. The revision will be viewable October 1, 2018, on the Medicare Coverage Database.

MEDICARE HOT LINKS

Medicare Part B Fee Schedule

Addendum B Update (HOPPS Fee Schedule for Services & Drugs)

Current ASP Drug Pricing Files

Quarterly Updated to CCI Edits

2019 PROPOSED RULES

Physician Fee Schedule

Physician Fee Schedule Fact Sheet

HOPPS

HOPPS Fact Sheet

QPP Fact Sheet

2018 FINAL RULES

Physician Fee Schedule

Physician Fee Schedule Fact Sheet

HOPPS

HOPPS Fact Sheet

QPP

QPP Fact Sheet