Do you need help understanding Medicare? Would you like to learn the basics of Medicare or refresh your memory about Medicare billing? WPS Medicare is pleased to offer an all-day session in Johnston, Iowa, on July 25, 2012, (and Overland Park, Kansas, on June 20, 2012) for those who want to learn the basic fundamentals of the Medicare program. This full-day program, designed for coders, billers, and health care providers, will provide each participant with a basic knowledge of the Medicare program. Participants will learn the fundamentals of the Medicare program including assistance in understanding claim submissions, reading the remittance advice, Medicare reimbursement, medical documentation, as well as exploring the WPS Medicare and CMS websites and more. For a full description of the seminar and to register to attend, click here.
WPS Medicare announced that the following drugs are covered for the following indications:
New Medicare policies effective March 17, 2012, include: Acute Inpatient Services versus Observation (Outpatient) Services and Proton Beam Therapy. Revised policies include: Chemotherapy Drugs and their Adjuncts - Effective 02/01/2012; Circulating Tumor Cell Marker Assays - Effective 02/15/2012; Independent Diagnostic Testing Facilities (IDTFs) - Appendix A - Effective 01/01/2012; Magnetic Resonance Imaging - Effective 01/01/2012.
View details about these policy updates on the WPS website.
Would you like to learn more about billing claims when Medicare is the secondary payer, rather than primary? Would you like a better understanding of the various MSP plans? New for 2012, WPS Medicare is pleased to offer a three-hour session designed specifically for those who wish to increase their skill level of billing MSP claims.
Come join our face-to-face, half-day program scheduled for providers and their staff in Iowa, Kansas, Missouri, and Nebraska. To view the course description, event details, and for easy-access registration, please refer to our website for the schedule.
WPS Medicare has noted a recent increase in errors assessed for chemotherapy-related services. These services have the potential to have a large impact on Comprehensive Error Rate Testing (CERT) error rates for WPS Medicare and on a national level. To assist its providers and combat potential future errors, WPS has asked us to let our state society members know about an educational article written specifically for those who perform and bill chemotherapy-related services.
Wisconsin Physician Services (WPS) Medicare Jurisdictions 5 and 6 has issued a positive local coverage determination for CellSearch® Circulating Tumor Cell test. This policy will become effective 2/15/12. This coverage policy is for the CellSearch® (Veridex) Circulating Tumor Cell (CTC) assay utilizing CPT codes 0279T and 0280T. The policy clearly states that all other methods for circulating tumor cell detection, including PCR (RTPCR) assays, are non-covered as they are considered investigational.
Circulating tumor cells represent the point in the metastatic process of solid tumors when cells from a primary tumor invade, detach, disseminate, colonize and proliferate in a distant site. Detection of elevated CTCs during therapy is an accurate indication of subsequent rapid disease progression and mortality in breast, colorectal and prostate cancer. Therefore, CTC testing will be limited to metastatic breast, colorectal and prostate cancer. CTC testing for all other malignant diagnoses will be denied as not reasonable and necessary. The WPS policy can be found in its entirety at www.wpsmedicare.com, Circulating Tumor Cells Assays – L-32218.
IOS has been active in highlighting the increasingly urgent drug shortage issue in local and national press. Read articles relating to the issue, below.
Letters to the Editor on the drug shortage issue from IOS Board Members:
Ames Tribune, November 5, 2011
Dubuque Telegraph Herald, November 9, 2011
Quad-City Times, November 14, 2011
Mason City Globe Gazette, November 14, 2011
Editorial by the Des Moines Register on the shortage of cancer drugs, November 2, 2011
Guest essay by the IOS Board of Directors about the drug shortage issue in the Des Moines Register, October 28, 2011
Dr. Merchant interviewed in Proto article highlighting drug shortage issue, Summer 2011
Read the information provided by WPS on this issue.
In January 2011, Dr. Merchant wrote to the leaders of several pharmaceutical manufacturers, the FDA, and Iowa congressional representatives to raise their awareness of the drug shortage issue. Read this letter and two responses that were received.
In Section V of its eNews for Monday, October 17, 2011, Wisconsin Physicians Services (WPS) provided instructions to providers on the documentation to be submitted to get high dollar drug claims paid in a timely fashion. The instructions read:
What documentation do I have to submit to get my high dollar drug claims paid timely?
To expedite your payment and to avoid CERT errors submit at least:
The information also is available on the WPS website in the news scroll.
Please note that the "Medicare Tip of the Week," also contained in the October 17th issue, is a link to specific policy requirements for certain chemotherapy drugs and their adjuncts. To view this policy, go to: www.wpsmedicare.com/j5macpartb/policy/active/local/l28576_honc010.shtml
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