High Dollar Claims - Reducing Provider Burden 
 
WPS GHA is excited to announce that providers and practitioners have done a great job in providing documentation to support high-dollar claims. Based on analysis performed, we allowed more than 95% of the services reviewed. Therefore, we will no longer require documentation on a standard basis. Your offices will not need to alert us to having documentation available on your claim and will no longer have to submit documentation for each high-dollar claim unless we send you an Additional Documentation Request (ADR) letter. No longer submitting this documentation will reduce the burden on your offices in gathering the documentation, save you money in submitting the documentation, and allow for faster processing. Great job, we appreciate your assistance.

2019 MAC Satisfaction Indicator (MSI): Coming in March 2019!
  
The 2019 MAC Satisfaction Indicator (MSI), a survey administered by the Centers for Medicare & Medicaid Services (CMS), is coming in March. The MSI measures your satisfaction with our processes and service delivery so we can gain valuable insights and determine process improvements. Thanks for your feedback in 2018. We used your feedback to make improvements to our services, and here are examples of improvements we made:

1. Provider Enrollment and Provider Outreach and Education developed additional educational tools and resources to help providers submit an accurate and complete application upon initial submission.
2. To reduce callbacks, Customer Service implemented a live transfer process for escalated calls. Enhanced technology enables the customer service representative (CSR) to converse about the inquiry with the second level CSR and provide the case record prior to transfer.
3. Provider Outreach and Education developed a handout format combining PowerPoint slides, outline notes, and other references to enable participants to follow the presentation with ease through a single, comprehensive document.

Watch for the survey on our website to participate in the 2019 survey.

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Draft Local Coverage Determination (LCD): We Want Your Comments

The following DRAFT LCDs are open for comment. Comments will be accepted until April 8, 2019, and can be sent to policycomments@wpsic.com. Please include the topic of the LCD on the e-mail subject line. Please include published scientific studies and/or literature to support additional coverage.

LCD Database ID Number	Draft LCD Title	CMD
DL38018	MolDX: DecisionDX - Melanoma	Dr. Ella Noel

Individual responses to the comments will not be sent. Responses will be available in a Comment and Response document that is posted with the Final LCD.
 
Additional information is located on the WPS GHA Proposed/Draft Local Coverage Determinations (LCD) page.

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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.

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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.

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