Complete Story
04/03/2018
WPS Recent Oncology Related News
Part A, Part B and Part A/B News
WPS PART A-Outpatient Hospital Only
Nothing at this time.
WPS PART B-Private Practice Only
Special Form Not Required for Billing Not Otherwise Classified (NOC) Codes
Providers should be aware that there is no longer a required form for submitting a claim with an NOC code. Instead, WPS GHA suggests that the provider submit a separate statement in the documentation describing the service or item being billed with the NOC code to assist in review of the claim. Claims where the NOC is not described in sufficient detail may be denied if the reviewer cannot determine if the documentation supports the code billed. Please refer to resource "Not Otherwise Classified (NOC) Billing" for additional information.
If you have already received an Additional Documentation Request (ADR) letter referencing an NOC form, please be sure to include the ADR letter with your documentation as well as a description of the NOC code being billed. A specific NOC form is no longer available for download.
WPS PART A & PART B
IMPORTANT: PLEASE respond to the survey for WPS!!
MSHO Message: We've been notified that VERY FEW have responded to the MAC Satisfaction Indicator Survey. This is YOUR opportunity to tell CMS whether you are satisfied with WPS Medicare and also give suggestions for improvements. Please take the time today to respond!!!
From WPS: There is still time to share your experiences about the services WPS GHA provides. Please complete the MAC Satisfaction Indicator (MSI) survey to share your input directly with CMS about WPS GHA’s performance. Ultimately, these survey results will help CMS and your MAC gain valuable insights and determine process improvements.
Coming Soon to Customer Service - Additional Data Inputs
In the near future, callers to our Customer Service area will be prompted to provide additional claim details after entering the NPI, PTAN, and last 5 digits of their Tax ID. Callers selecting Appeals, Telephone Reopening, or General Inquiries will be prompted to provide either the Internal Control Number (ICN) or the Document Control Number (DCN) before being transferred to a representative. You can find the ICN or DCN on your remit.
Callers selecting Provider Enrollment and then Application Status will be prompted to enter either their Application ID or their Web Tracking ID. Callers who select Provider Enrollment and Revalidation will be prompted to enter either their Enrollment ID, Application ID, or Web Tracking ID.
By providing all of the requested items, your service representative can begin assisting you when your call is transferred.
National Coverage Determination (NCD) 110.21, Erythropoiesis Stimulating Agents (ESAs) in Cancer and Change Request (CR) 10318
Change Request (CR) 10318, Transmittal 2005 titled, "ICD-10 and Other Coding Revisions to National Coverage Determinations (NCDs)," released on January 18, 2018, contains the latest coding instructions to Centers for Medicare & Medicaid Services (CMS) NCDs. Business Requirement 10 specifically addresses coding changes for NCD 110.21, Erythropoiesis Stimulating Agents (ESAs) in Cancer.
CMS is in the process of re-reviewing the coding changes for NCD 110.21. Until this review is complete, and CMS makes a final determination, the A/B Medicare Administrative Contractors (MACs) will not implement the edits contained in CR 10318. The A/B MACs will also reprocess any claims that were processed in error from January 1, 2018, that were processed with the additional codes included in CR 10318 as not payable with the -EC modifier.
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.
Quarterly Provider Update
The Quarterly Provider Update is a comprehensive resource published by the Centers for Medicare & Medicaid Services (CMS) on the first business day of each quarter. It is intended to make it easier for providers, suppliers, and the general public to understand the changes CMS is proposing or making.
CMS publishes this update to inform the public about the following:
- Regulations and major policies completed or cancelled.
- New/Revised manual instructions
The Quarterly Provider Update can be accessed on the CMS website.
We encourage you to bookmark this web page and visit it often for this valuable information. To receive notification when regulations and program instructions are added throughout the quarter, sign up for the Quarterly Provider Update Listserv.
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
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