Industry News: Illinois

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

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:

Administers the Medicare Part A contract for the states of Connecticut, Illinois, Indiana, Kentucky, Michigan, New York, Ohio, Virginia, West Virginia, and Wisconsin. They also administer the Medicare Part B contract for the states of Connecticut, Indiana, Kentucky, and New York.

The National Government Services Connex online inquiry application offers providers and suppliers the ability to:
• receive claim status;
• receive beneficiary eligibility information;
• view provider demographics;
• view financial data, and
• order duplicate remittances.

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.