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Industry News: Wps

Are You Preparing For 5010?
Monday, May 03, 2010

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 health plan). 5010 is not just for Medicare.

CERT Errors Regarding Complete Blood Count (CBC) Services
Monday, May 03, 2010

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.

Diagnostic Pap Smears
Thursday, February 04, 2010

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

CERT Alert - WPS Commitment to Error Rate Reductions
Tuesday, January 26, 2010

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.

CERT Alert - Legible Identifier of the Author of Medical Record Documentation
Tuesday, January 26, 2010

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 signature is legible, and include a signature sample when responding to CERT Documentation Contractor (CDC) requests for medical records.

CERT Errors Regarding Complete Blood Count (CBC) Services
Thursday, January 07, 2010

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 automated differential WBC count.
  • 85027 - Complete (CBC) automated (Hgb, Hct, RBC, WBC and platelet count)

Timely Filing of Claims - Important Notice About Claim Denials
Thursday, January 07, 2010

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 time limit for filing the claim expires.

Use of Initials in Medical Documentation
Wednesday, December 02, 2009

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 hand written) is always the best practice. Initials could be more work in the long run, depending on the type of documentation and scenario.