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)
It is crucial that providers in their jurisdictions comply with CERT requests for medical records in a timely manner and submit documentation that supports all services billed to Medicare, including the level of care and medical necessity. WPS encourages all providers to perform a self-audit on their medical record documentation to ensure completeness. WPS also encourages providers to examine your billing practices. If you utilize a billing service, we recommend sharing educational information to assist with the preparation and submission of your Medicare claims.