Complete Story
09/18/2018
WPS Recent Oncology Related News
Part A, Part B and Part A/B News
WPS PART A-Outpatient Hospital Only
Direct Data Entry (DDE) Users - Upcoming Freeze on Online Submission of Requests for New or Modified DDE Access and DDE Submitter IDs
Due to maintenance of WPS GHA internal operating systems there will be a freeze placed on submitting online requests for new or modified DDE access and DDE Submitter IDs during the timeframe of September 28, 2018, (after 6:00 pm CT/7:00 PM ET), through end of day October 3, 2018. We will resume acceptance of online requests on October 4, 2018. As a reminder, faxed or mailed requests are not accepted, so please plan accordingly for the upcoming freeze. If you have questions, please contact our DDE Systems Department at (866) 518-3295 or medicare.dde.analysts@wpsic.com.
J8 Targeted Probe and Educate Round 1 Result
Diagnosis Related Group (DRG) 280-282
Provider Selection
Through complex data analysis, WPS GHA Medical Review identified provider billing practices that pose the greatest financial risk to the Medicare program. Diagnostic Related Group errors were identified as a problem in the J8 jurisdiction.
Provider Education
Each of the 13 providers were notified of their selection for this project prior to the initiation of claim review. Providers were educated on the TPE process and expectations during an initial phone call and in a notification letter. During the probe process, intra-probe education was offered when easily curable errors were discovered and to answer any provider questions. At the end of the probe, providers were sent a results letter and providers were offered a 1:1 educational teleconference to discuss findings of the probe.
Errors Identified
DRG validation was performed using the International Classification of Diseases (ICD)-9 CM/ICD-10 Official Guidelines for Coding and Reporting in place at the time the services were rendered and Centers for Medicare and Medicaid Services (CMS) guidelines. CMS guidelines can be found in the Internet-Only Manual (IOM), Publication 100-08, Chapter 6.
The most common reason for adjustment was the incorrect selection of the principal diagnosis. The principal diagnosis is defined as that diagnosis which after study occasioned the beneficiary's admission.
Additionally, WPS GHA found that some dates for the procedures billed were incorrect. The date of the procedure should be listed as the actual date performed and not the admission date. WPS GHA did not count these as an error, as the procedure code was validated as being performed and changing the date did not affect the DRG payment.
Results of the Probe Reviews
WPS GHA is pleased with the results of the TPE DRG 280-282 round one probes. No providers will be moving to round two.
WPS PART B-Private Practice Only
Why WPS GHA Made Changes to the Timeout and Disabling of Accounts
The CMS security environment is continually changing. Medicare Administrative Contractors (MACs) are required to follow the Acceptable Risk Safeguards (ARS) as it applies to our secure Internet Portal.
On July 31, 2018, WPS GHA made changes to the portal on the 30 Minute Timeout and the 60-day disabling of accounts.
One of the safeguard rules is AC-11 Session Lock (Inactivity). Based on changes to that rule, the inactivity time-out on the WPS GHA Portal was changed to 15 minutes. Once logged into the WPS GHA Portal, the user must remain active in the portal or the user will be logged out.
The second change was on disabling of inactive accounts - AC-2(3) Disable Inactive Accounts. The new ARS security control required us to disable inactive user accounts after 30 days of account inactivity. Users must log in at least once every 30 days to maintain an active account.
For additional information on these changes, please see Change Request (CR) 10216. To prevent any interruption in your portal activities, please be prepared for these changes.
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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