06/19/2018

WPS Recent Oncology Related News

Part A, Part B and Part A/B News

WPS PART A-Outpatient Hospital Only

Medicare Cost Report e-Filing (MCReF) System is Now Available

The WPS GHA Audit department has started to receive cost reports submitted via the new CMS Medicare Cost Report e-Filing system (MCReF) for electronic transmission (e-filing) of a Medicare cost report package. We encourage providers to take advantage of this new technology to file cost reports with fiscal year ends on or after December 31, 2017. See the full article on our website for helpful tips on using the system.

WPS PART B-Private Practice Only

WPS PART A & PART B

CERT Error Findings - Prolonged Care Procedure Codes (CPT 99354-99359)

Recent claim reviews performed by the Comprehensive Error Rate Testing (CERT) contractor have noted significant error findings for prolonged care procedure codes (CPT 99354-99359), due to insufficient documentation. Upon further examination, the documentation submitted did not adequately describe the duration of the visit. In order to support prolonged care codes, the start and end times of the visit must be present. Documentation such as "75+ minutes spent with the patient," or no time listed, are not acceptable.
 
You can find additional information in the CMS Internet-Only Manual (IOM) Publication 100-04, Chapter 12, section 30.6.15, and the WPS GHA article "Clarification on the Use of Prolonged Care Procedure Codes."

Two Changes Coming to the WPS GHA Portal on July 31, 2018 

The CMS security environment is continually changing. The Medicare Administrative Contractors (MACs) are required to follow the Acceptable Risk Safeguards (ARS) as it applies to our secure Internet Portal. For further information regarding upcoming changes in security to the WPS GHA Portal, please see the full article.

We Want Your Comments - June 2018 Draft LCD Open Meeting 

Draft Local Coverage Determinations (LCDs) are open for comment. Comments will be accepted until July 22, 2018, and can be sent to policycomments@wpsic.com. Please include the topic of the LCD on the email subject line. Please include published scientific studies and/or literature to support additional coverage.
 
For more information, see the full article on our website.

Medicare Secondary Payer Claims

Medicare Secondary Payer (MSP) claims has seen an increase in the level of development due to MSP records not existing. Before you submit a claim where Medicare is the secondary payer, make sure to verify the patient's eligibility MSP file. If the patient does not have an MSP record or the MSP record is not active, then work with the Benefit Coordination & Recovery Contractor at (855) 798-2627 to update the file before submitting the claim. Remember your first step is to go back to the patient or follow the guidance in the MLN Matters article SE1416, "Updating Beneficiary Information with the Benefits Coordination & Recovery Center." 

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