05/01/2018

WPS Recent Oncology Related News

Part A, Part B and Part A/B News

WPS PART A-Outpatient Hospital Only

WPS PART B-Private Practice Only

WPS PART A & PART B

Breaking News: 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. 

Coming Soon - 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

Medicare Part B Fee Schedule

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

Physician Fee Schedule Fact Sheet

HOPPS

HOPPS Fact Sheet

QPP

QPP Fact Sheet

2017 FINAL RULES

Physician Fee Schedule

Physician Fee Schedule Fact Sheet

HOPPS

HOPPS Fact Sheet