Complete Story
 

05/21/2019

WPS Recent Oncology Related News

Part A, Part B and Part A/B News

WPS

WPS Articles From The Past Couple of Weeks that may be of Interest to Oncology:

 

WPS PART A-Outpatient Hospital Only

System Edits Will Be Activated for OPPS Providers with Multiple Service Locations

On July 1, 2019, CMS will begin enforcing edit requirements for Outpatient Prospective Payment System (OPPS) providers with multiple service locations submitting claims to Medicare. These are not new requirements. CMS discussed these requirements in Change Requests (CRs) 9613 and 9907, both of which were effective on January 1, 2017.  
 
Claims will Return-to-Provider (RTP) if:
  • The service location and information in the Provider Enrollment, Chain and Ownership System (PECOS) do not match exactly, and/or
  • The correct modifier is not reported on the claim.
For more information about this edit, see the full article on our website.

2-Midnight Rule - CERT Denials

The Comprehensive Error Rate Testing (CERT) contractor continues to assess errors for inpatient claims billed by hospitals, long-term care hospitals and inpatient psychiatric facilities submitting short-stay, due lack of medical necessity per the Medicare 2-midnight benchmark. Their decision is based on the medical record documentation indicating the beneficiary's clinical presentation, prognosis and expected treatment did not support the expectation of the need for hospital care spanning two or more midnights.
 
For more information, refer to CMS Internet-Only Manual, Publication 100-08, Chapter 6, Section 6.5.2, "Conducting Patient Status Reviews of Claims for Medicare Part A Payment for Inpatient Hospital Admissions."

Cost Report Filing and PS&R Ordering Reminder

All Medicare cost reports with a fiscal year end of December 31, 2018, must be postmarked by May 31, 2019. Order your PS&Rs now to ensure timely filing of your report.

WPS PART B-Private Practice Only

Nothing at this time.

WPS PART A & PART B

MAY 2019 Draft LCDs: WE WANT YOUR COMMENTS

The comment period for our current draft LCDs is now open. We will accept comments until June 9, 2019. Interested parties can send their comments to policycomments@wpsic.com. Please include the topic of the LCD on the email subject line. Please include published scientific studies and/or literature to support additional coverage. For a list of draft LCDs open for comment, see the full article on our website.
 
We will not send individual responses to the comments. Responses will be available in a Comment and Response document posted with the Final LCD.
 
You can find additional information on the Proposed/Draft Local Coverage Determinations (LCD) page and the Open Meetings page.

June Draft LCD Open Meeting 

WPS GHA will hold Draft Local Coverage Determinations (LCD) Open Meetings for persons wishing to provide input concerning LCDs that are currently in the development process. There will be a Draft LCD Open Meeting Tuesday, June 18, 2019, at 1:00 PM CT (2:00 PM ET).
 
Addresses for the meeting locations are:
 
WPS Health Solutions
1707 W Broadway
Madison, WI 53713 (Nordby Rooms LL7 & LL8; Check in Nordby security desk)
 
WPS Health Solutions
2525 No. 117th Avenue, Suite 200
Omaha, NE. 68164
 
Interested parties may attend in person at one of the WPS sites listed above. Photo identification is required at the time of check-in. Please RSVP in-person attendance to LCDCAC@wpsic.com.
 
Interested parties may also call in to the following teleconference number:
 
(866) 685-4589, (conference ID 9388564).
 
Additional information is located on the Open Meetings page.
 
Comments related to the draft policies can be sent to policycomments@wpsic.com.
 
Note: This meeting is not the official Contractor Advisory Committee meeting.

Draft LCD Open Meeting and Open Comment Period; We Want Your Comments: May 30, 2019 through July 14, 2019

On Tuesday, June 18, 2019, at 1:00 p.m. CST (2:00 p.m. EST), WPS GHA will hold Draft Local Coverage Determinations (LCD) Open Meetings for persons wishing to provide input concerning LCDs that are currently in the development process.
 
We will post the Draft LCDs to the Proposed/Draft Local Coverage Determination (LCD) page on May 30, 2019. The Open Comment period will begin on that date. We will accept comments until July 14, 2019.
 
For more information about the meeting and the comment period, see the full article on our website.
 
Note: This meeting is not the official Contractor Advisory Committee meeting.

Medicare Appeals - Do I Really Need to Appeal?

WPS GHA receives appeal requests where physicians and facilities question a claim determination. Depending on the reason for denial and rejection, providers can resubmit the original claim making necessary changes, or some denials will qualify for a Clerical Error Reopening. Using these other methods when appropriate, allows for faster processing of the claim.
 
Resources:
 
CMS - Medicare Part A and B Appeals Process
 
WPS GHA Learning Center - We have two On-Demand courses: On-Demand - Appeal Tips to Avoid Decision Dismissals and Duplicates and On-Demand - New to Medicare - Appeals Overview.
 
WPS GHA Portal - Appeals Guides and Resources

Medicare EDI Gateway (MEG) - Discontinued July 1, 2019
 
Effective July 1, 2019, the Medicare EDI Gateway will be discontinued. All trading partners will need to be transitioned to WPS Community Manager and transmit/receive files using WPS Gateway Express.

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

 

Printer-Friendly Version


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! 
Report Broken Link