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WPS article on on reducing error rates for chemotherapy-related services

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.

WPS eNews

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.

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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:

  1. The original medication order that is signed by the ordering physician. A complete order will include the drug name, the ordered dose, and the ordered frequency.

  2. The flow sheet, which includes the patient's name, dated the same as the date of service billed, shows the name of the medication given, the amount of the medication given, and any wasted amount of the medication.

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/part_b/policy/active/local/l28576_honc010.shtml.

2010 Legislative Update : Presentation at IMOS November Membership Conference

WPS Updates Chemotherapy Drugs and their Adjuncts LCD (HONC-010)

WPS has updated its Medicare policy to include new language referencing compendia as sources for medical necessity and coverage. This policy was effective May 16, 2009.

The following pages and sections are of note:

  • Page 2, section A under “Indications and Limitations of Coverage and/or Medical Necessity"
  • Page 13, section G
  • Page 14, “Utilization Guidelines”
  • Page 19, “Current Compendia.”

 

 

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