WPS Medicare has noted an increase in the number of Comprehensive Error Rate Testing (CERT) errors related to CPT codes 85025 and 85027. Based on review of documentation, either the test administered or the physician order did not support the service billed to Medicare. These codes are defined in CPT® 2009 as: 85025 - Complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and...
5010 is an electronic data interchange version of the ANSI X12 formats for all HIPAA financial and administrative transactions for claims, remittance advice, eligibility, and claim status query and response transaction, plan enrollment, and referral authorization transactions. 5010 is for all covered entities (health care provider that conducts certain electronic transactions, clearinghouse or...
WPS Medicare has noted an increase in the number of Comprehensive Error Rate Testing (CERT) errors related to CPT codes 85025 and 85027. Based on review of documentation, either the test administered or the physician order did not support the service billed to Medicare. These codes are defined in CPT® 2009 as: 85025 - Complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and...
Recently, WPS Medicare began seeing a dramatic increase in the number of providers experiencing claim denials when the provider submits claims past the timely filing limit for submitting claims. Although WPS Medicare recognizes that many providers must submit claims after Medicare's timely filing limit due to circumstances beyond their control, WPS Medicare must deny any claim submitted after the...
WPS Medicare – Carrier/FI for Iowa, Illinois, Kansas, Minnesota, Michigan, Missouri, Nebraska and Wisconsin. Recently, WPS Medicare received the following question and statement, "Do initials satisfy Medicare's documentation requirements? Our physician feels that providing a full "signature" to each medical record is not efficient and is time consuming." A valid signature (electronic or...
WPS Medicare is aware that the CERT Review Contractor (CRC) may assess an error when medical record documentation does not include a legible identifier of the author. The CRC confirmed that the Office of Inspector General has made it clear that the signature must be legible. To avoid potential assessment of CERT errors for this reason, WPS Medicare recommends that providers make certain their...
As the Medicare contractor, it is WPS responsibility to ensure that Medicare claims are submitted and processed correctly. Through close monitoring, WPS has identified the following areas of concern for Part B. Diagnostic Service Issues Missing signed physician order or progress note showing intent for performance of diagnostic services (ex. laboratory, radiology services...
Effective for claims submitted with dates of service on or after October 1, 2004, Wisconsin Physician Services (WPS) will cover the new 2005 ICD-9-CM codes for Diagnostic Pap Smears. Policy Name/Number Policy Procedure Codes 2005 Added ICD-9-CM GU-003 88141-88155, 88164-88167, 88174, 88175 622.10, 622.11, 622.12, 795.03...