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10/16/2018

WPS Recent Oncology Related News

Part A, Part B and Part A/B News

WPS

WPS PART A-Outpatient Hospital Only

Nothing at this time.

WPS PART B-Private Practice Only

Medicare Secondary Payer (MSP) Calculator Now Available

Check out the new MSP Calculator located in the Claims topic center, under Guides and Resources! The MSP Calculator is intended to provide an approximation of the Medicare Part B payment due for assigned claims. MSP claims are calculated line-by-line. Any billing and/or refunds should be completed based on your remittance advice and not the results of this calculator.

Please let us know what you think about this new feature, as well as your overall website experience, by completing the ForeSee Website Satisfaction survey.

Clerical Error Reopening Expansion Coming Soon

The WPS GHA Portal will soon allow Part B standard and NPI administrator users to perform more advanced Clerical Error Reopenings (CER). Currently, users can only submit one type of change per claim. Based on feedback and a desire to be more efficient, users will be able to modify multiple items on the claim at the same time while submitting the CER. Example: If a user is changing the procedure code, they will also be able to change the billed amount to match that new procedure code chosen. Keep an eye on our eNews for an announcement when this enhancement is available in the WPS GHA Portal.

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).

WPS PART A & PART B

2019 HCPCS Changes

WPS GHA does not provide coding advice and cannot discuss any changes, deletions, or additions to CPT, ICD-10 CM, or HCPCS codes. The American Medical Association (AMA) has responsibility for CPT and CMS has responsibility for HCPCS. Information for 2019 HCPCS changes will be available on the CMS website in early November 2018. You can see the updates on the CMS Alpha-Numeric HCPCS page.

Access the CMS Coverage Database to determine any changes based on ICD-10, CPT, or HCPCS to a Local Coverage Determinations (LCD). One way to do this is to enter the number of an LCD in the Quick Search on the right-hand side of the following web page. Enter a date of service 01/01/2019 and the response will tell you whether there is a future LCD that may have updated codes.

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.

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

 

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