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Industry News: WPS Medicare

APPEALS FOR GLYCATED HEMOGLOBIN A1C TESTS - PROCEDURE CODE 83036
Monday, January 16, 2012

When submitting appeals for A1C tests (83036) you must describe the patient's condition and include documentation, such as the A1C test results, to support the medical necessity for providing this service more frequently than once every three months. Also note that the Multi-Carrier System (MCS) begins the three-month count the day after the date of service billed. For example, if the date of service is December 15, 2011, then count day one as December 16, 2011.

CERT Error Summary 3rd Qtr 2011
Thursday, December 15, 2011

The below findings for laboratory billing are reported based on the type of documentation, coding, or billing error assessed by the CERT Contractor. WPS Medicare received error findings in the following categories during the third quarter of 2011.

Insufficient Documentation - 70% of total errors
• Missing valid physician order/notes documenting intent and/or medical necessity for diagnostic services
• Illegible or missing provider signature on physician order or progress notes

Medically Unnecessary Service or Treatment - 4% of total errors

Clinical Laboratory CERT errors
Monday, October 17, 2011

The following Comprehensive Error Rate Testing (CERT) errors occurred during the most recent reporting period within the states of Illinois, Michigan, Minnesota, and Wisconsin. The CERT Error Analysis web page details the errors found for Clinical Laboratory - Specialty 69.

Insufficient Documentation: Missing acceptable physician order (illegible signature) and progress notes (no beneficiary name, illegible signature) to support medical necessity for the laboratory tests billed.

CERT Error Summary /April 2011 - June 2011
Wednesday, September 21, 2011

The below findings are reported based on the type of documentation or coding error assessed by the CERT Contractor. WPS Medicare received error findings in the following categories during the second quarter of 2011.

Insufficient Documentation - 65% of total errors

Reasons for Errors:
• Missing valid physician order or notes documenting intent for diagnostic services
• Illegible or missing provider signature on physician order or progress notes

Medically Unnecessary Service or Treatment - 5% of total errors

Reasons for Errors:

CHANGES TO THE FREQUENCY AUDITING FOR A1C PROCEDURES
Friday, July 29, 2011

CMS has a Lab National Coverage Determination (NCD) policy for glycated hemoglobin/glycated protein, NCD 190.21. This NCD provides information on both the coverage and frequency limitations of these tests. The coverage determination is based on the diagnosis codes as listed in the NCD and the frequency shows Medicare will make payment once every three months. Any additional services must show medical necessity through the appeals process.

WPS MEDICARE PART B APPEAL FAX INITIATIVE
Friday, June 25, 2010

Effective June 14, 2010, WPS Medicare is able to accept redetermination and reopening requests from all J5 Part B providers in Iowa, Missouri, Kansas and Nebraska by Fax.

NOTE: The Part B Appeal Fax forms and Fax numbers are distinct from the Fax forms and Fax numbers for Claims Development Resolution. Only submit appeal (redetermination or reopening) requests to the Appeal Fax lines. See below for appropriate Fax numbers.

State

Provider Signature Attestation Statement
Thursday, May 27, 2010

WPS Medicare has received questions from providers regarding the information a provider signature attestation statement should contain. In response to these inquiries we have developed an example of a signature attestation statement to provide further guidance. While not a Medicare mandated form, for your convenience it can be completed and submitted as an attestation statement if required. Any similar statement is acceptable provided it is signed, dated, and contains sufficient information to identify the patient and date of service.