Complete Story
04/17/2018
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
Nothing at this time.
WPS PART A & PART B
Local Coverage Determination (LCD) Lookup Now Available
Your suggestion has been put into action! WPS GHA is pleased to announce the availability of the Local Coverage Determination (LCD) Lookup tool. Users can search by Healthcare Common Procedure Coding System (HCPCS) to locate and link to any associated policies or search by LCD number to view a list of HCPCS contained within that policy. Take some time to check out the LCD Lookup tool today!
We're Making a Change!
WPS GHA is implementing changes in our Provider Contact Center (PCC). We are consolidating two 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 May 1, 2018, the EFT and Tax Document calls currently directed to (866) 734-1522 will transition to the PCC. The new numbers will be:
J5: (866) 518-3285
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 2 for EFT/Tax Documents.
Also effective May 1, 2018, the Medicare Secondary Payer (MSP) calls currently directed to (866) 734-1521 will transition to the PCC. The new numbers will be:
J5: (866) 518-3285
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 1 for Medicare Secondary Payer.
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.
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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