04/02/2019
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
Improper Payment for Intensity-Modulated Radiation Therapy Planning Services
In a recent report, the Office of Inspector General (OIG) determined that payments for outpatient IntensityModulated Radiation Therapy (IMRT) did not comply with Medicare billing requirements. Specifically, hospitals billed separately for complex stimulations when they were performed as part of IMRT planning. Overpayments occurred because hospitals are unfamiliar with or misinterpreted CMS guidance.
Use the following resources to bill correctly:
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 submitted with missing or inadequate descriptions of the service(s) 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.
WPS PART A & PART B
EDI Ask-the-Contractor Teleconference (ACT) Reminder
WPS GHA will be hosting an EDI Ask-the-Contractor Teleconference on April 11, 2019, from 1:00 PM-2:30 PM (2:00 PM-3:30 PM ET) for Medicare providers, billers, clearinghouses, and trading partners. During the session, EDI team members will provide education, give program updates, answer questions, and take feedback.
Additional information is available on our
EDI website. The call is an open forum, and advance registration is not required for this teleconference. To participate, please call (800) 305-2862 and use passcode 2466416.
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: DL38018
Draft LCD Title: MolDX: DecisionDX - Melanoma
CMD: 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.
Updated Medicare Companion Guides now Available
At CMS' direction, WPS has made updated versions of the 837 Institutional, 837 Professional, 835 Electronic Remittance Advice, and 276/277 Claim Status Request/Response Companion Guides available on the
WPS Health Insurance website.
If you have any questions, please contact the EDI hotline at:
J5 Providers - (866) 518-3285
J8 Providers - (866) 234-7331
MSI: Evaluate Our Services!
The MAC Satisfaction Indicator (MSI) is the best way to share your opinions directly with the Centers for Medicare & Medicaid Services (CMS) about your experience with us. These survey results will help us gain valuable insights and determine process improvements.
https://www.surveygizmo.com/s3/4826847/?MAC_BRNC=15&MAC=J8-WPS
Thank you for your feedback.
Self Service Denial Assistance is Available
Are you using the Self-Service Denial Assistance that is available to you with the More Info button? We have added some new denial categories recently.
Some denial categories have additional information available. Examples are eligibility, claim history, or links to useful webpages. Please visit the resource, "Self Service Denial Assistance is Available with the More Info Button." You can view the denial categories and see the additional information available for each.
If you would like to suggest a denial category for the enhanced denial information, please let us know! Suggestions can be emailed to MedicareAdmin@wpsic.com. We are updating the denials often and would like to provide information that will help you.
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