Wisconsin Physician Services (WPS), Medicare Administrative Contractor for the states of Indiana, Illinois, Kansas, Michigan, Missouri, and Nebraska, will be hosting a webinar on October 22, 2013 from 12:00pm – 1:00PM ET (11:00am – 12:00pm CT) on the Advance Beneficiary Notice of Noncoverage (ABN). Topics will include information on when the ABN is required, completing the ABN, and much more. To sign up for the webinar, click HERE and sign in or create a new user account if new. This is the site WPS is using for registration and is not affiliated with Gawenda Seminars & Consulting, Inc.

The J15 Part A Medical Review department performed a service-specific probe review on Resource Utilization Group Code (RUG) RUB10 in Kentucky from March through May 2013. Based on a 28.8 percent error rate and the percentage of medical necessity denials, this edit will be advanced to a complex edit review. For detailed results of the medical review, click HERE.

Based on Kentucky and Ohio CERT data, J15 Part A Medical Review will implement a service specific probe for 3-Day Inpatient Stays resulting in a SNF Admission. The service specific probe edit for bill type 11X will be implemented in Kentucky and Ohio. What to Send If you receive an Additional Documentation Request (ADR) from CGS, submit the requested medical record information within 30 days. Before you send the requested records, we suggest you double-check the accuracy of your submitted claim. Send the following documentation when responding to the ADRs, along with other supporting documentation. Please note: the documentation you

CMS is committed to ensuring a quality experience for health care providers who participate in the Medicare program. We can’t do this without input from you. If you are a Medicare Fee-For-Service (FFS) provider, practice manager or work on behalf of a Medicare FFS provider (such as a billing agency), please register now for an opportunity to tell CMS about the level of services that your MAC provides. You’ll need your national provider identifier (NPI) and provider transaction access number (PTAN) to sign up. If you work for a medical practice, you can list a group NPI and PTAN. MAC

Please join Wisconsin Physician Services (WPS) Medicare for a webinar on how to register and get recertified for C-SNAP access. C-SNAP is a FREE self-service portal that is a comprehensive, secured website to be used as your primary Medicare information source for patient eligibility, claim status information, and duplicate remittance notices. C-SNAP is available to you 24 hours a day, 7 days a week, with limited functionality outside of normal business hours, at no cost. This applies to providers in the states of Indiana, Iowa, Kansas, Michigan, Missouri, and Nebraska. The webinar will occur on October 8, 2013 from 2:00pm

On July 1, 2013, the Centers for Medicare and Medicaid Services (CMS) issued a revised MLN Matters publication on expedited determinations for provider service terminations. This MLN Matters® Article is intended for Home Health Agencies (HHAs), Comprehensive Outpatient Rehabilitation Facilities (CORFs), Hospices, and Skilled Nursing Facilities (SNFs) providing services to Medicare beneficiaries. This has implications for therapy services reimbursed under both Part A and Part B benefits. Topics discussed include: Health Care Settings in Which the Expedited Determination Process is Available to Beneficiaries, Care Settings in which Notice of Medicare Non-Coverage (NOMNC) Delivery Does Not Apply, NOMNC Preparation and Delivery, Amending

On August 1, 2013, Congresswoman Jackie Speier (D-San Francisco/San Mateo), along with Rep. Jim McDermott (D-WA), Ways and Means Health Subcommittee Ranking Member, and Dina Titus (D-NV), introduced HR 2914, the “Promoting Integrity in Medicare Act of 2013” (PIMA) in the House of Representatives. The bill would cut unnecessary Medicare spending by hundreds of millions annually without reducing the essential care that seniors rely on. The bill has the support of the Alliance for Integrity in Medicare (AIM), a broad coalition of medical societies committed to ending the practice of inappropriate physician self-referral and focused on improving patient care and

On July 10, 2013, the United States Government Accountability Office (GAO) released a report on the implementation of the 2012 manual medical review process for outpatient therapy services. Excerpts from the report can be found below. The Centers for Medicare & Medicaid Services (CMS) implemented two types of manual medical reviews (MMR)–reviews of preapproval requests and reviews of claims submitted without preapproval–for all outpatient therapy services that were above a $3,700 per-beneficiary threshold provided during the last 3 months of 2012. CMS officials estimated that the MACs reviewed an estimated total of 167,000 preapproval requests and claims for outpatient therapy