08/07/2018

MSHO Reimbursement Alerts

July 31, 2018

Over the last couple of weeks, a number of our MSHO members reported receiving "take backs" and/or denials from WPS Medicare for Treanda, J9033.  When checking with WPS, most were told by WPS that Treanda has not been manufactured since 2016 and was replaced by Bendeka and "should not be billed after 2017."  

While the drug was no longer manufactured, the drug is still being distributed and physicians are able continue utilizing this drug since the expiration date is in 2019. The FDA indicates that "Treanda can still be dispensed until its expiration date."

We immediately contacted WPS and requested they discontinue the denials and take backs and any/all money be refunded or claims paid.  Denying the claim or taking the money back without allowing a practice to show documentation to prove they utilized Treanda and not Bendeka and billed correctly was simply unfair.

GOOD NEWS - We received an update from WPS today, July 31, 2018.  WPS has removed the edit, discontinued the take backs and will do a mass adjustment.  It will take approximately 2 weeks.
THEREFORE - If any MSHO practice does not automatically have their money refunded by mid-August, please notify MSHO via email at: billing@msho.org.  Be sure to include your provider number, ICN Number, and the date of service.  (DO NOT SEND PATIENT NAME.)

July 19, 2018

For the last few weeks, MSHO has been working with WPS Medicare to determine the reasoning for a multitude of denials for ESAs (J0881 & J0885) on outpatient hospital claims for diagnosis  codes which include Chemotherapy Induced Anemia, MDS and Chronic Kidney Disease.  The claims had the proper diagnosis codes, modifiers, HGB/HCT levels, etc., but were still denied.

MSHO was alerted today that WPS has identified the system problem and, as of yesterday (Wednesday, July 18th), it has been corrected.  Claims going forward should be paid correctly.  

WPS identified wrongfully denied claims as far back as October of 2017, and are in the process of doing a mass adjustment.  We have been instructed by WPS to tell our membership "Please don't rebill or appeal anything in the meantime."  They estimate the mass adjustment should take 2 - 3 weeks before outpatient hospital providers will begin to see the corrected payments.

If you have any questions about this alert, please contact Michelle Weiss, Senior Reimbursement Consultant to MSHO via email at billing@msho.org.