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05/18/2022

MSHO Reimbursement Alert - May 16, 2022

WPS Requirement to Document Monitoring Every 15 Minutes During Infusions HAS BEEN REMOVED From Their Policy!

WPS recently updated a resource that provides "Documentation Guidance for a Successful Review of Infusion Services.”  This updated policy required "documentation to support frequent monitoring, at a minimum of every 15 minutes, for patients receiving infusions."  WPS had announced this during their infusion services teleconference in February and then had begun reviews by the WPS Medical Review staff as part of the Targeted Probe and Educate (TPE) review process. 

After hearing from many of our members, MSHO reached out to WPS stating that this monitoring at least every 15 minutes documentation requirement is outside of WPS and Medicare authority and in violation of Medicare's "Patients Over Paperwork" initiative as it increases the paperwork burden of documentation and reduces the time a nurse can care for a patient.  MSHO requested that this policy be removed.

Late afternoon on Friday, MSHO received the following announcement from WPS Medicare:


Thank you for your inquiry regarding the timing requirements with infusions. 

Regarding your email: In the past weeks MSHO members have requested MSHO address an issue with WPS Medicare. Recently, WPS updated a resource that provides "Documentation Guidance for a Successful Review of Infusion Services.  This updated policy now requires "documentation to support frequent monitoring, at a minimum of every 15 minutes, for patients receiving infusions." 

The timing requirement of monitoring every 15 minutes has been removed and  already updated on the WPS website/portal. 

Thank you for your time regarding this matter. 

Denise M. Nachodsky, MD
J-5/J-8 Contractor Medical Director
WPS Government Health Administrators


WPS has also agreed to notify all attendees of their February Infusion Services teleconference where they announced this change in policy, and anyone who has received an infusion services TPE review.

If you’ve received a negative TPE review related to this, please check back with WPS since this policy is no longer in effect. 

If you have any questions, please contact MSHO's Senior Reimbursement Consultant, Michelle Weiss at billing@msho.org

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