Complete Story
12/18/2018
WPS Recent Oncology Related News
Part A, Part B and Part A/B News
ESA Rejections Addressed and Resolved
Problem Reported 10/25/18 - WPS is 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.
11/28/18 - WPS Update:
- As noted previously, the Systems department has been working with the edits for L34633 Erythropoiesis Stimulating Agents (ESAs). There was conflicting information in the current edits, including ICD-10 CM D64.81, which has been corrected. The adjustment of denied claims in J5 and J8 continues to be processed at this point in time. The mass adjustment will occur automatically and your remittance notice will reflect this information within the next 2 weeks.
NOTE: Effective 12/18/18, ALL OUTSTANDING CLAIMS SHOULD HAVE BEEN REPROCESSED BY WPS!
If you have any pending denials from the October, 2018, WPS J0881 and J0885 claims issue - contact WPS. At this point WPS states the denial is likely accurate and you will need to appeal your claim. If you feel you are still being denied in error, contact Michelle Weiss, MSHO Senior Reimbursement Consultant via email at: billing@msho.org ASAP!
WPS Articles From The Past Couple of Weeks that may be of Interest to Oncology:
WPS PART A-Outpatient Hospital Only
Delayed Pass Through Payments and Periodic Interim Payments Due to Christmas Holiday
The bi-weekly pass through payments and periodic interim payments (PIP) that are scheduled to be issued on December 26, 2018, will not be released until Friday, December 28, 2018, due to the Christmas holiday. For those providers who receive their payments via electronic funds transfer (EFT), your payment will be available on December 31, 2018.
WPS PART B-Private Practice Only
Counseling and/or Coordination of Care
Physicians select the level of evaluation and management services based upon the content of the service. The duration of the visit is an ancillary factor and does not control the level of service to be billed unless more than 50 percent of the face-to-face time (for noninpatient services) or more than 50 percent of the floor time (for inpatient services) is spent providing counseling or coordination of care. To learn more, please see our new resource "Selection of Evaluation and Management (E/M) Service Based on Counseling and/or Coordination of Care."
2019 Physician Fee Schedules Available
The 2019 Physician Fee Schedules and Anesthesia Conversion Factors have been published on the WPS GHA website based on the CY 2019 Medicare Physician Fee Schedule (MPFS) Final Rule.
You can access the 2019 Medicare Physician Fee Schedules (MPFS) here. The Anesthesia Conversion Factors can be accessed from the 2019 Specialty Pricing web page.
WPS PART A & PART B
New WPS GHA Portal Eligibility Searches Are Here
There are new elements being displayed for Medicare Secondary Payer (MSP), Medicare Diabetes Prevention Program (MDPP), Managed Care Organization (MCO), and changes to the industry-mandated 2019 HCPCS Codes, if needed.
- Now returning all MSP diagnosis codes related to each Medicare Beneficiary MSP enrollment period(s).
- Now displaying additional MDPP HCPCS codes with actual usage, the Billing Provider NPI and the date of service for each code.
- Modified fields for Managed Care Organization (MCO) Contract and Plan Benefit Package (PBP) information. Each will be displayed on a separate line
- The portal will be prepared for any 2019 industry-mandated changes to the HCPCS codes.
The WPS GHA Portal is no longer displaying an error for the MBI card date not being mailed. All cards have now been mailed.
Physician and Non-physician Signature - CERT Denials
Recent claim reviews performed by the Comprehensive Error Rate Testing (CERT) contractor have noted significant error findings for missing or illegible physician and non-physician signature on medical record documentation. In these cases, the performing physician did not sign their medical record documentation in accordance with Medicare regulations.
MEDICARE HOT LINKS
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 Fact Sheet
Report Broken Links
Have you encountered a problem with a URL (link) on this page not working or displaying an error message? Help us fix it!
