WPS PART A ONLY
Inpatient Hospital Admissions: Transferring Medical Review Responsibilities for Short Stay Claims
Starting September 1, 2025, the Medicare Administrative Contractors will assume responsibility for conducting patient status reviews of facilities to determine the appropriateness of Part A payment for short stay inpatient hospital claims. These reviews were previously conducted by the Beneficiary and Family Centered Care Quality Improvement Organization. While this change affects where medical record requests will be sent and the contractor making claim review decisions, the policy for assessing short stay inpatient admissions remains unchanged.
For more information, visit the Inpatient Hospital Reviews webpage.
WPS PART B ONLY
None at this time.
Process Change for Customer Service
To better serve our providers and streamline call handling, the Provider Contact Center (PCC) will accept only one NPI and PTAN combination per phone call, effective August 4, 2025.
This change is being made to improve call efficiency, decrease call wait times, and ensure quicker resolution of your inquiries.
What This Means for You:
Going forward, each call to the PCC must focus on a single NPI/PTAN combination. If you need assistance with multiple combinations, please place separate calls for each one. This allows our team to handle your phone calls more efficiently.
Be Prepared Before Your Call
To help make your call as smooth and efficient as possible, please have the following information ready:
Being prepared upfront will reduce the likelihood of needing to call back.
As a reminder, WPS offers the Secure Net Access Portal (SNAP), as a free and convenient option to check claim status, claim denials, and patient eligibility. SNAP provides quick access to essential information, helping you manage claims without cost. You can enroll here.
CERT Awareness Month: Steps to Take if You Get a CERT Documentation Request
The Part A, Part B, Durable Medical Equipment (DME), Home Health and Hospice, and Railroad Board Medicare Administrative Contractors (MACs) are working together to promote the importance of complying with CERT documentation requests. This is the second of four articles in our CERT Awareness Month.
To be compliant and ensure a timely response to CERT Review Contractor (RC) documentation requests:
1. Review the CERT RC letter request for these important sections
2. Prepare the records for submission
3. Submit the information by the deadline
CERT Resources
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MEDICARE HOT LINKS
Medicare Part B 2024 Fee Schedule Loc 1 (file download)
Effective January 1, 2025
Medicare Part B 2024 Fee Schedule Loc 99 (file download)
Effective January 1, 2025
PFS National Payment Amount File
2025 Ambulatory Surgical Center (ASC) Fee Schedules
Anesthesia Pricing
Clinical Psychologist Pricing
The clinical psychologist is available on the Physician Fee Schedule.
Clinical Social Worker Pricing
The clinical social worker fees are available in the Physician Fee Schedule. To determine the fee, multiply the fee amount by 75%.
Medical Nutrition Therapy Pricing
The medical nutrition therapy fees are available in Physician Fee Schedule. To determine the fee, multiply the fee amount by 85%. (Exception - The 85% calculation does not apply to Codes G0108 and G0109).
Nurse Practitioner/Physician Assistant/Clinical Nurse Specialist Pricing
The NP, PA and CNS fees are available in the Physician Fee Schedule. To determine the fee, multiply the fee amount by 85%. (Exceptions - The 85% calculation does not apply to codes with a TC modifier, Technical Component Only codes, or CPT codes G0108 and G0109).
2025 Final Rules & Fee Schedules