02/01/2019
WPS Recent Oncology Related News
Part A, Part B and Part A/B News
WPS Articles From The Past Couple of Weeks that may be of Interest to Oncology:
WPS PART A-Outpatient Hospital Only
Non-Excepted Outpatient Services
Medicare will soon be validating service facility location when non-excepted outpatient professional claims are submitted. Review "Provider-Based Attestations - General Guidance" for instructions on how to properly file the claim form 1500, Box 32 Service Facility Location Information.
WPS PART B-Private Practice Only
Describing Services when Billing Not Otherwise Classified (NOC) Codes
WPS GHA has found that a large number of claims for NOC codes are being submitted with missing or inadequate descriptions of the service provided.
In order for WPS GHA to correctly reimburse NOC services, drugs and biologicals, providers must indicate the following in the 2400/SV101-7 data element (this field holds up to 80 characters), or Item 19 of the CMS 1500 form:
- A complete description of the service performed with enough information so that the reviewer can adequately determine coverage and compare the service to similar work for pricing.
- The name of the drug/biologic, the total dosage (plus strength of dosage, if appropriate), and the method of administration.
For more information, including examples of good and inadequate descriptions, see the
full news article on our website.
WPS PART A & PART B
Agenda for the Contractor Advisory Committee (CAC) Meeting is Available
The agenda for the next Contractor Advisory Committee (CAC) Meeting has been posted to the "Contractor Advisory Committee (CAC) Meetings" web page.
Please RSVP to LCDCAC@wpsic.com if you wish to observe via teleconference. Please indicate the jurisdiction and/or date of the CAC you plan to attend.
Changes to the Local Coverage Determination (LCD) Process
Recent changes to the LCD process include new LCD requests, new LCD Reconsideration process, Informal meetings, and changes to the Contractor Advisory Committee meetings and Open meetings. CMS issued
Change Request (CR) 10901, transmittal 829 which gives a detailed explanation of the changes to the 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 will hold Draft LCD Open Meetings for persons wishing to provide input concerning LCDs that are currently in the development process. The next Draft LCD Open Meeting will be held Tuesday, February 19, 2019, at 1:00 PM CT (2:00 PM ET). For more information, see the
full news article on our website.
Future Article for Human Granulocyte/Macrophage Colony Stimulating Factors Billing and Coding Guidelines
A future Coverage Article for Human Granulocyte/Macrophage Colony Stimulating Factors Billing and Coding Guidelines is replacing LCD
L34699 Human Granulocyte/Macrophage Colony Stimulating Factors, which has an anticipated retirement date of March 18, 2019.
The new article supports human granulocyte colony-stimulating factors drugs that are produced by recombinant DNA technology with the use of bacteria and a human G-CSF gene. G-CSF regulates the production of neutrophils (a WBC) within the bone marrow (where blood cells are manufactured naturally in the body). Neutrophils are an essential in the body's fight against infections.
The new article will efficiently support the billing and coding guidance that was in L34699. A lapse in coverage will not occur.
The future article will be viewable February 1, 2019, on the
Medicare Coverage Database and on the WPS GHA
Local Coverage Determination (LCDs) and Coverage Articles web page.
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
