Complete Story
11/20/2018
WPS Recent Oncology Related News
Part A, Part B and Part A/B News
ESA Rejections Addressed and Partially Resolved
NOTE: WPS has been wrongfully rejecting claims for ESAs J0881 and J0885 when members are following the diagnosis, modifier and submission requirements within the WPS LCD. MSHO sent examples to WPS and asked for the system to be corrected.
11/5/18 - WPS Response:
Thank you for your inquiry regarding LCD L34633 Erythropoiesis Stimulating Agents (ESAs) and reporting denials for payment.
I contacted our Systems department regarding the October revision/update. It was brought to our attention there was conflicting information in the current edit. The edits have been revised to support the appropriate ICD-10 CM Codes for Group 8 Paragraph: 3. Myelodysplastic Syndromes (MDS) for J0881 or J0885.
An adjustment of denied claims in J5 and J8 is being processed over a 2 - 3 week time frame to verify claims within the system have been cleared and included in the mass adjustment.
The mass adjustment will occur automatically and your remittance notice will reflect this information.
MCS Claims Processing Alerts (for Part B) will be published on 11/05/2018:
https://www.wpsgha.com/wps/portal/mac/site/claims/guides-and-resources/mcs-system-alerts/
It is important to point out that claims can deny for a multitude of reasons. All services must be reasonable and necessary, documents must be properly signed, and other documentation requirements must be met. If you believe the providers need further information regarding this notification or if they find that their claim(s) meeting this criteria haven’t been appropriately adjusted by 12/01/2018 please feel free to have them contact our Customer Service Center.
NOTE: MSHO feels this is progress, however, it seems there are still issues with claims for chemotherapy induced anemia and MSHO will continue to address this with WPS.
WPS Articles From The Past Couple of Weeks:
WPS PART A-Outpatient Hospital Only
Cost Report Filing Reminder
Medicare cost reports with a fiscal year end of June 30, 2018, are due November 30, 2018. This means the cost report must be postmarked by November 30, 2018. Order your PS&Rs now to ensure timely filing of your report. We are encouraging providers to mail their cost reports in advance of the November 30, 2018, due date. A provider that submits a late cost report will have their payments suspended until we accept the report, which could be several days after receipt. See "Cost Report Submission Guidelines" to learn what is required for an acceptable submission.
WPS PART B-Private Practice Only
2019 Physician Fee Schedules Available
The 2019 Physician Fee Schedules and Anesthesia Conversion Factors have been published on the WPS GHA website based on the CY 2019 Medicare Physician Fee Schedule (MPFS) Final Rule.
You can access the 2019 Medicare Physician Fee Schedules (MPFS) here. The Anesthesia Conversion Factors can be accessed from the 2019 Specialty Pricing web page.
WPS PART A & PART B
We Want Your Comments - Draft Local Coverage Determinations (LCDs)
The following DRAFT LCDs are open for comment. Comments will be accepted until November 23, 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 and a list of the draft LCDs, see the full 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 FINAL RULES
Physician Fee Schedule Fact Sheet
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