05/14/2018
WPS Recent Oncology Related News
Part A, Part B and Part A/B News
WPS PART A-Outpatient Hospital Only
Attention Direct Data Entry Users - Direct Data Entry Claims Display Error
A Message from CMS:
Claims that were originally submitted for processing with a Health Insurance Claim Number (HICN) as the beneficiary identifier are being incorrectly displayed in Direct Data Entry (DDE) with the Medicare Beneficiary Identifier (MBI). Claims should be displaying in DDE with the original identifier submitted on the claim (either the HICN or MBI). We will resolve this issue no later than May 29, 2018.
If you use the MBI returned through this display error on claims, the beneficiary will receive a Medicare Summary Notice with the MBI on it, possibly before they receive their new Medicare card containing their MBI.
To avoid confusion, please do not use a beneficiary's MBI until one of these occur:
- They present their new Medicare card (which will contain their MBI)
- The MBI is available through your Medicare Administrative Contractor's secure portal
- Their MBI is shared through the remittance advice starting in October 2018
For More Information
- Transition to New Medicare Numbers and Cards Medicare Learning Network® Fact Sheet
- New Medicare Card webpage
WPS PART B-Private Practice Only
Fast, Easy, Secure - Use the WPS GHA Portal to Submit Reopening Requests
Do you need to make a minor change to a previously filed claim? Save time and money by using the WPS GHA Portal to submit your Clerical Error Reopen (CER) request.
Advantages of Using the Portal
- Submit your request on your schedule, not ours (the WPS GHA Portal is available 24 hours a day, 7 days a week).
- No form to print and complete.
- No need to go to the post office, or even the fax machine!
- Receive immediate notification when your claim adjustment has been accepted.
- Receive immediate notification if your request is not a valid CER submission.
- After submission, use the portal to track your adjustment, determine when it is finalized, and find payment information.
More information about using the portal to submit a CER is available in "How to Submit Your Clerical Error Reopening (CER) via the WPS GHA Portal."
Not a current portal user? Register for an account and begin taking advantage of this, and other portal features, today.
WPS PART A & PART B
Frequently Asked Questions (FAQs) and Questions and Answers (Q/As)
WPS GHA publishes FAQs, based on data analysis of inquiries received by customer service staff. Searchable FAQs are available on the WPS GHA Portal. WPS GHA also publishes Questions and Answers; however, because these are based on questions received during or after various education events created by provider outreach and education (POE) staff, Q/As are available in the WPS GHA Learning Center.
Time and Procedure Codes
Ever wonder exactly how much time you need to document to submit specific services? The A/B Medicare Administrative Contractor (MAC) collaboration team has developed a resource concerning time and the requirements as it relates to certain procedure codes. This resource will help you determine the appropriate code to use based on the amount of time you have documented in the medical records. For more information, see, Professional Services Where Time is a Primary Factor.
You Asked, We Listened! New Features in the WPS GHA Portal
When portal users complete our surveys to tell us what they are looking for in the WPS GHA portal, we listen to those comments and use them to improve your experience when you visit our site. We are always working on ways to make the portal easier to use and to provide the most value to our users. Here are some new features we recently added:
- Remit Lookup is Now Easier!We listened when users asked us to streamline the Remittance Advice search. Now you only need to select your NPI and enter the information to identify the remittance notice(s) you want to view. When you login to your account and select Remittance Advice, you no longer need to enter your PTAN and last five digits of your TIN to perform the search.
- Eligibility Printing has been Enhanced! We listened when providers asked for an easier way to print eligibility information and to use less paper. When you login to your account to verify patient eligibility, you now have a Print button on the Eligibility Check page. It will print a summary of the information for all eligibility tabs at one time. You can still use your browser print feature if you only want to print certain tabs.
- Finding your NPI Administrator is Now Easier!There are two ways to easily locate your NPI Admin for assistance with your account:
If you are not able to login to the portal and need assistance with a password reset, new user account approval, etc., there is an NPI Administrator Search located on the Login page. Enter your NPI, PTAN and Tax ID to find your admin.
The second option is available if you can login to your account. When you are on your dashboard, go to My Service Locations. Find the line with your NPI and press the Find My Admin button. A box will display with the Administrator name, phone number, and email address. Make sure you have pop ups enabled for the WPS GHA portal to use this new feature.
Read all about it! Upcoming Changes to Provider Contact Center!
WPS GHA is implementing changes in our Provider Contact Center (PCC). We are consolidating three more of our toll-free lines with the PCC lines. This enhancement will provide additional services in our PCC, allowing you access to more information in one phone call, instead of having to call multiple lines.
Effective June 1, 2018, the Overpayment calls currently directed to (866) 734-9444, (866) 345-0275 and (866) 503-9694 will transition to the PCC. The new numbers will be: J8: (866) 234-7331
At the main menu select General Inquiries, then enter your NPI, PTAN, and the last 5 digits of your tax identification number when requested. Then choose Option 3 for Overpayment Recovery.
It's Here! - The New Medicare Beneficiary Identifier (MBI) Lookup Tool
WPS GHA Portal users will soon have access to an MBI Lookup tool. Users must be a registered portal user and be logged in to access the MBI lookup Tool.
This tool is to be used only when a Medicare patient doesn't or can't give you his/her Medicare Beneficiary Identifier (MBI). The patient's first name, last name, date of birth, and social security number are required to get a unique match. The MBI is confidential so you'll have to protect it as Personally Identifiable Information and use it only for Medicare-related business.
June 4, 2018, Draft Local Coverage Determination (LCD) Open Meeting
Wisconsin Physicians Service (WPS) Government Health Administrators (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. The next Draft LCD Open Meeting will be held Monday, June 4, 2018, at 1:00 pm CT (2:00 pm ET). See full article for further information.
Medicare Patient Signature Requirements
The CMS Internet-Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 1, Section 50, includes signature requirements for Medicare patients. These apply to both assigned and non-assigned claims and are applicable when submitting paper or electronic claims to Medicare. Providers and suppliers must retain these signature authorizations, in the event of an audit.
Payment for Medical Records for CERT Claim Reviews
Recent claim reviews performed by the Comprehensive Error Rate Testing (CERT) contractor have noted significant error findings because there was no response received from the provider after the fourth request for medical records. Upon further examination, some providers or their third-party storage contractors are requesting payment for medical records before they will submit them.
Neither WPS GHA nor the CERT contractor will reimburse for the cost of submitting medical record documentation for a Medicare claim review. It is the responsibility of the health care provider to furnish sufficient information to determine whether payment is due on a claim for federal funds reimbursement. Any cost the provider incurs by making this information available to Medicare is considered part of the health care provider's administrative costs.
You can find additional information on the CMS website in the Internet-Only Manual (IOM) Publication 100-08, Chapter 3, Section 3.2.3.6. Please share this information with your Medical Records Staff or independent records contractor.
MEDICARE HOT LINKS
Addendum B Update (HOPPS Fee Schedule for Services & Drugs)
Current ASP Drug Pricing Files
Quarterly Updated to CCI Edits
2018 FINAL RULES
Physician Fee Schedule Fact Sheet
2017 FINAL RULES