Complete Story
 

11/06/2018

WPS Recent Oncology Related News

Part A, Part B and Part A/B News

WPS

NOTE:  WPS has been wrongfully rejecting claims for ESAs J0881 and J0885 when members are following the diagnosis, modifier and submission requirements within the WPS LCD.  MSHO sent examples to WPS and asked for the system to be corrected.

11/5/18 - WPS Response:

Thank you for your inquiry regarding LCD L34633 Erythropoiesis Stimulating Agents (ESAs) and reporting denials for payment.

I contacted our Systems department regarding the October revision/update.  It was brought to our attention there was conflicting information in the current edit. The edits have been revised to support the appropriate ICD-10 CM Codes for Group 8 Paragraph:  3. Myelodysplastic Syndromes (MDS) for J0881 or J0885.

An adjustment of denied claims in J5 and J8 is being processed over a 2 - 3 week time frame to verify claims within the system have been cleared and included in the mass adjustment.
The mass adjustment will occur automatically and your remittance notice will reflect this information. 
 
MCS Claims Processing Alerts (for Part B) will be published on 11/05/2018: 
https://www.wpsgha.com/wps/portal/mac/site/claims/guides-and-resources/mcs-system-alerts/
 
It is important to point out that claims can deny for a multitude of reasons.  All services must be reasonable and necessary, documents must be properly signed, and other documentation requirements must be met. If you believe the providers need further information regarding this notification or if they find that their claim(s) meeting this criteria haven’t been appropriately adjusted by 12/01/2018 please feel free to have them contact our Customer Service Center.

 

NOTE:  MSHO feels this is progress, however, it seems there are still issues with claims for chemotherapy induced anemia and MSHO will continue to address this with WPS.

WPS Articles From The Past Couple of Weeks:

 

WPS PART A-Outpatient Hospital Only

Appeal Rights for Part A CERT Denials

Claims that have been adjusted based on Comprehensive Error Rate Testing (CERT) reviews are subject to the same appeal rights as any other claim. When the CERT Contractor instructs the MAC to adjust a claim based on a CERT finding, the date the adjustment finalizes is considered to be the Initial Determination Date. Affected providers have 120 days from the Initial Determination Date to file a request for an appeal of the CERT determination.
 
Please Note: Part A Appeals does not accept requests via the WPS GHA Portal or Facsimile (Fax). Part A Appeals will only accept compact disc (CD) records if they are in addition to a hardcopy appeal request and are properly secured. Appeal requests that are submitted via CD only will not be accepted even if properly secured.
 
Part A Appeals encourages the use of electronic submission of medical documentation (ESMD) as an alternative to the WPS GHA Portal and fax submissions.
 
For more information on how to file an appeal, please refer to Filing an Appeal.

WPS PART B-Private Practice Only

Changes Made for Submitting Clerical Error Reopening (CER) via the WPS GHA Portal

Effective Friday, November 2, 2018, CERs can be performed for multiple component changes per claim. This can be done on a paid or denied claim and you will receive immediate notification that the claim adjustment has been accepted. For more details, please see, "How to Submit Your Clerical Error Reopening (CER) via the WPS GHA Portal."
 
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. 
Appeal Rights for Part B CERT Denials
 
Claims that have been adjusted based on Comprehensive Error Rate Testing (CERT) reviews are subject to the same appeal rights as any other claim. When the CERT Contractor instructs the MAC to adjust a claim based on a CERT finding, the date the adjustment finalizes is considered to be the Initial Determination Date. Affected providers have 120 days from the Initial Determination Date to file a request for an appeal of the CERT determination.
 
WPS GHA accepts Part B Appeal request via the  WPS GHA Portal, via fax, and in writing.
 
For more information on how to file an appeal, please refer to How to Appeal a Claim Determination.
Appropriate Date of Service for Part B
 
The A/B Medicare Administrative Contractors (MACs) collaborated to provide a single resource to identify the appropriate date of service in various situations. The resource titled Correct Date of Service for Specific Services covers items from surgery and post-surgical services, Chronic Care Management (CCM), Transition Care Management (TCM), to services that may happen over more than one day. Please take advantage of this information to confirm you are submitting the correct date of service for your services.
Coming Soon: 2019 Medicare Physician Fee Schedules

The 2019 Medicare Physician Fee Schedules (MPFS) will be published on the WPS GHA website as soon as possible after the calendar year (CY) 2019 physician fee schedule regulation is put on display.
 
Once published, you will be able to access the 2019 MPFS from our Fee Schedules and Reimbursement Guides and Resources web page. In addition, we will publish a news article with a direct link to the 2019 Medicare Physician Fee Schedules (MPFS) web page when it becomes available. 

Please continue to read eNews, watch the Medicare News section of our home page, and follow us on Facebook to receive this important news as soon as it is published.

WPS PART A & PART B

Upload Documents in PECOS

When using Internet-based PECOS for your application submission we highly recommend also using the upload feature in PECOS. If you choose not to electronically sign your Internet-based PECOS application, you can now upload the certification statements directly in PECOS. We would suggest uploading all other supporting documents as well. This is the most efficient method of providing us the information necessary for processing of your application.
 
Please refer to the CMS MLN Matters article, Update to Chapter 15, Pub. 100-08, Certification Statement Policies (Revised MM 10845), for more information. 
WPS GHA Portal NPI Administrator Responsibilities
 
Recent customer feedback indicates there is some confusion regarding the role of an NPI Administrator. We have published a news article on our website with reminders to help explain the responsibilities of NPI Administrators. Please see the full news article for more information.
New Enhancement: Eligibility Searches Now Allowed up to Four Years in the Past
 
The WPS GHA Portal and IVR have been enhanced to allow eligibility searches up to four years in the past instead of one year. The portal will allow you to search one year at a time by date span or single date up to four years in the past. The IVR only allows a single date, however, you can search up to four years back.
 
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.
On-Demand: Targeted Probe and Educate (TPE)
 
The Medicare Medical Review program went through one of the biggest changes in 2017-2018. The TPE changes who or what services Medicare reviews. Listen to the Question and Answer session or the follow-up Ask-The-Contractor Teleconference for full details.
 
Audience: Compliance officers, office managers, medical professionals

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 FINAL RULES

Physician Fee Schedule

Physician Fee Schedule Fact Sheet

HOPPS

HOPPS Fact Sheet

QPP Fact Sheet

E/M Payment Amounts Charts

 

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