Complete Story
09/05/2018
WPS Recent Oncology Related News
Part A, Part B and Part A/B News
WPS PART A-Outpatient Hospital Only
Notice of Erroneous Additional Documentation Request (ADR) Letters
WPS PART B-Private Practice Only
Diagnosis Code Reporting on a Part B Claim
Many people ask how many diagnosis codes can be reported on a single Part B claim. The answer is twelve. For more information, please refer to the new resource Reporting Diagnosis Codes on a Part B Claim.
Evaluation and Management Codes - CERT Denials
Recent claim reviews performed by the Comprehensive Error Rate Testing (CERT) contractor have noted significant error findings for evaluation and management (E/M) service procedure codes. In these cases, the performing physician/non-physician practitioner's documentation did not support the level of E/M code billed.
Coding and documentation reminders:
- The selection of the CPT code should be based the service provided meeting the required key components of the CPT code.
- Selecting a lower level code when documentation supports a higher level will also result in a CERT error.
- An illegible handwritten note should be accompanied by a typed transcription of the note when requested for a review.
- The exact name of the diagnostic or laboratory service(s) ordered should be listed in the progress note. Listing, "x-ray or lab today" is not acceptable.
For more information, refer to the 2016 Professional Edition Current Procedural Terminology by the American Medical Association and the CMS Internet-Only Manual, Publication 100-04, Chapter 12, section 30.6 - Evaluation and Management Service Codes-General (Codes 99201-99499).
Hierarchical Condition Categories (HCC) System
Many providers ask WPS GHA for information about the HCC system for reimbursement. Since the HCC system is used for reimbursement by Medicare Advantage (MA) plans, and not traditional Medicare, providers should contact the applicable MA plan directly. For more details, please refer to our Hierarchical Condition Categories resource.
WPS PART A & PART B
Eligibility Searches Now Allowed up to Four Years in the Past!
Coming September 8, 2018, the WPS GHA Portal and the IVR system will be modified to allow eligibility searches up to four years in the past instead of one year. The portal will allow you to search one year at a time by date span or a single date up to four years in the past. The IVR system only allows a single date, however, you can search up to four years back.
Feedback Results in Portal Improvements - New "By Specialty/Service" Tab for Locating Information
Help make the WPS GHA Portal the best it can be by giving us your suggestions!
October 1, 2018, Draft Local Coverage Determination (LCD) Open Meeting
WPS GHA will hold Draft LCD Open Meetings for persons wishing to provide input concerning LCDs that are currently in the development process. The next Draft LCD Open Meetings will be held Monday, October 1, 2018, at 1:00 pm CT (2:00 pm ET). See the full article for more information.
A55639 Chemotherapy Agents for Non-Oncological Conditions Updated and Reformatted
The article, "Chemotherapy Agents for Non-Oncological Conditions," addresses chemotherapy administration codes which apply to parenteral administration of anti-neoplastic agents provided for treatment of noncancer diagnoses or to substances such as monoclonal antibody agents, and other biologic response modifiers.
The article has been updated and reformatted to support Article Guidance on Non-Oncological Conditions. The revision will be viewable October 1, 2018, on the Medicare Coverage Database.
For more information, see the full news article on our website.
MEDICARE HOT LINKS
Addendum B Update (HOPPS Fee Schedule for Services & Drugs)
Current ASP Drug Pricing Files
Quarterly Updated to CCI Edits
2019 PROPOSED FINAL RULES
Physician Fee Schedule Fact Sheet
2018 FINAL RULES
Physician Fee Schedule Fact Sheet
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