Complete Story
 

06/18/2019

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."

WPS PART B-Private Practice Only

Nothing at this time.

WPS PART A & PART B

CERT Documentation Office Contact Information and Reminders

When responding to the Comprehensive Error Report Testing (CERT) documentation office, here are a few reminders: 

  • Submit the page with the barcode with your documentation.
  • The fax number is (804) 261-8100.
  • The mailing address is 1510 East Parham Road, Henrico, VA 23228.
  • The telephone number is (888) 779-7477 or (443) 663-2699.
  • For initial requests, submit documentation within 75 days of the request.
  • For additional requests, submit documentation within 15 days of the request.
  • Providers do not need to obtain patient authorization to release medical information.
  • The CERT contractor does not reimburse for copying costs. 

For further information, refer to our article, "CERT Record Requests, Responses, and Review Results." 

Medicare EDI Gateway (MEG) - Discontinued July 1, 2019

Effective July 1, 2019, WPS will discontinue the Medicare EDI Gateway (MEG). All trading partners must transition to WPS Community Manager and transmit/receive files using WPS Gateway Express.  
 
If you currently submit/receive transmissions via MEG, you will need to change how you connect.
 
Visit the EDI website to begin the transition process to WPS Gateway Express.

IMPORTANT: After you receive your campaign email and complete the registration process, we recommend you submit a test claim file. Although we do not require testing, it will help ensure you understand the upload/download process (for claim files and associated acknowledgments) prior to submitting production files.
 
Once you complete testing prior to July 1, 2019, you are ready to complete your transition to the WPS Gateway Express. Please contact the EDI Help Desk at (800) 782-2680 (option 1) and request to have your access to the Medicare EDI Gateway shut-off. This will ensure we route your outbound files to the WPS Gateway Express correctly.

Multijurisdictional Draft LCD Contractor Advisory Committee (CAC) Meeting - June 26, 2019

WPS GHA will participate in a Multi-Jurisdictional Draft Local Coverage Determinations (LCD) CAC meeting on Wednesday, June 26, 2019, at 12:00 PM CT (1:00 PM ET). This meeting is for anyone wishing to provide input about LCDs currently in development.
 
Medicare Administrative Contractors (MACs) will present the following proposed/draft policies at this CAC meeting:
 
Draft LCD Title: MolDX: Pharmacogenomics
CMD: Dr. Earl Berman (MAC: CGS)
 
For more information about this meeting, see the full article on our website.

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 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

 

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