WPS PART A-Outpatient Hospital Only
System Edits Will Be Activated for OPPS Providers with Multiple Service Locations
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
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:
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
MEDICARE HOT LINKS
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 Fact Sheet