Describing Services when Billing Not Otherwise Classified (NOC) Codes

Changes to the Local Coverage Determination (LCD) Process

Information related to the new LCD process is available on our Policies Guides and Resources web page.

Draft Local Coverage Determination (LCD) Open Meeting

WPS GHA Re-awarded CMS J8 Contract 
  
The Centers for Medicare & Medicaid Services (CMS) has announced the re-compete award of MAC Jurisdiction 8 (J8) to WPS GHA. This new contract includes the current J8 A/B MAC workload for the states of Indiana and Michigan. 
 
With this award, WPS GHA will continue to administer the Part A and Part B benefits for the J8 providers in Indiana and Michigan. The contract serves approximately 48,000 physicians, almost 300 hospitals, and 2.1 million Medicare beneficiaries. This jurisdiction represents approximately 5.9% of the overall national Part A and Part B claims volume. As the incumbent contractor for J8, there will be no changes to our operations. This includes no changes to edits, audits, current Local Coverage Determinations (LCDs), or policies. As a result, we anticipate implementation of the new contract will go smoothly, with minimal, if any, disruptions in service for Medicare beneficiaries and providers. 
 
WPS GHA remains committed to delivering outstanding customer service to our J8 provider community.

Contractor Advisory Committee (CAC) Meetings

The Contractor Advisory Committees (CACs) are established according to the Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-08, Medicare Program Integrity Manual, Chapter 13 – Local  Coverage Determinations (LCDs), Section 2.4.3 –Contractor Advisory Committee (CAC), and Change Request (CR) 10901, implementation date January 8, 2019.

WPS GHA hosts CAC meetings in both Jurisdictions J5 and J8 to provide an avenue for healthcare professionals to promote communication between the Medicare Administrative Contractors (MACs) and the healthcare community. The CAC is composed of physicians, beneficiary representatives, and representatives of medical organizations. WPS GHA establishes membership for the CAC for each state in each jurisdiction. During this process, WPS GHA tries to ensure that each specialty that serves on the CAC shall have at least one member and a designated alternate approved by the MAC.

The CAC members’ role is to improve the relations and communication between Medicare and the healthcare community. The CAC is advisory in nature and consults with the MAC, to review and discuss evidence utilized in developing Local Coverage Determinations (LCDs). The summary of recommendations from the CAC members regarding the policy will be included in the Final LCD. 

The MAC shall determine the frequency of the CAC meetings and shall base the meetings on the appropriateness and the volume of LCDs that require CAC consultation as part of the LCD process.

To increase transparency and in accordance with Change Request 10901, the CAC meetings are now open to the general public and/or interested parties to observe via teleconference. Interested parties are generally those who are affected by the proposed LCD including, but not limited to, physicians, providers, beneficiaries, caregivers, vendors, and manufacturers etc. The meetings will include attendance records and recordings which will be maintained on the WPS GHA website. 

WPS GHA requests a RSVP for attendance. Please RSVP no later than one day prior to the CAC meeting. Please register at LCDCAC@wpsic.com.

The CAC Meetings will be held:
Date: 02/18/2019
Time: 6:00 – 8:00 PM ET 
Telephone Conference Call Number: to be provided at least two weeks prior to the scheduled meeting.
Agenda: to be provided at least two weeks prior to the scheduled meeting.