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03/11/14

First Coast to Audit Therapy Claims in Puerto Rico

On July 24, 2012, First Coast Service Options activated a prepayment edit for therapy services rendered by specialty 25 (Physical Medicine and Rehabilitation) in Puerto Rico. This was due to medical review findings that revealed this specialty presents an 88 percent error rate. The purpose of the edit is to prevent the payment of non-covered, incorrectly coded, and inappropriately billed services. Also, with medical review assistance, customer service now advises providers in correcting the billing and documentation errors. Data for October 1 through December 31, 2013, show an error rate of 81 percent. A significant amount of this error rate

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03/10/14

WPS to Host Several Teleconferences

Wisconsin Physician Services (WPS) will be hosting several teleconferences in the month of April. The first will occur on April 9, 2014 and will focus on the Advance Beneficiary Notice of Noncoverage. WPS will also be doing a 2-part teleconference titled “Outpatient Therapy Guidelines” with Part 1 occurring on April 22, 2014 and Part 2 on April 24, 2014.

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03/10/14

Functional Limitation Reporting Processing Issues

First Coast Service Options, National Government Services (NGS) and Novitas Solutions have announced that claims reporting Outpatient Therapy Functional G-codes and modifier information may be incorrectly receiving errors from the Common Working File (CWF) causing incorrect denials. The issues have been referred to CWF system maintainer for research and resolution. CWF has acknowledged an issue that is causing some of the incorrect denials and they are working on a resolution.  However, CWF is also researching other potential issues related to the G-code processing. Further instructions will be provided once CWF has completed their research and any required system corrections. Even

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02/19/14

Upcoming WPS Teleconferences

Wisconsin Physician Services (WPS), Medicare Administrative Contractor for the states of Iowa, Kansas, Missouri, and Nebraska, will be hosting a variety of teleconferences over the next several months pertinent to inpatient and outpatient therapy as well as required documentation for total joint replacements. To access upcoming teleconferences, click HERE.

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02/17/14

NGS Draft LCD on Non-Covered Services

National Government Services has issued a draft local coverage determination (LCD) regarding non-covered services. They are proposing to not reimburse for CPT code 97610 – Low frequency, non-contact, non-thermal ultrasound since it is considered investigational due to methodological limitations and small sample size in the published data. Comments on the proposed LCD will be accepted until March 22, 2014 and applies to all states served by NGS. To access the proposed LCD, click HERE.

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02/17/14

Cahaba GBA Appeal Decision Tree

Cahaba GBA, Medicare Administrative Contractor in the states of Alabama, Georgia, and Tennessee, have developed a tool to assist providers in determining whether they should file an appeal or do a reopening. For non-private practices, click HERE to access the tool. For private practices, click HERE to access the tool.

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02/03/14

WPS Medicare Toll-Free Single Point of Contact Center

On February 3, 2014, WPS Medicare simplified provider contact center phone numbers with a single toll-free number.  All J8 A/B MAC providers will now call (866) 234-7331 when contacting Customer Service, Appeals, Electronic Data Interchange (EDI), Reopenings (Part B) and Provider Enrollment. Please read the following article for examples of the new menu changes.

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01/30/14

WPS to Host Webinar on Medicare Appeals Process

Wisconsin Physician Services, Medicare Administrative Contractor for the states of Indiana and Michigan, will be hosting a webinar on February 3, 2014 on the Medicare Appeals Process. To learn more and to register for the webinar, click HERE.

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