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When will
Kansas providers STOP sending claims to Wheatlands? |
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Claims must be received at
Wheatlands by 2:00 on February 28. It is important
to calculate the "hold time" of claims at your
clearinghouse. Claims sent to the clearinghouse on
February 28 would probably not be received at
Wheatlands by the deadline. February 29th will be a
"dark day" when no claims can be sent. |
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If a
claim submitted to Wheatlands prior to the March 1st
transition date is denied by Wheatlands, would it be
resubmitted to WPS? |
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Yes. |
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If, after
the March 1st transition date, a first level appeal
is necessary for a claim processed by Wheatlands,
would the appeal be made to Wheatlands or WPS? |
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The appeal would
be made to WPS. Claims information stored in the
outgoing contractors files will be transferred to
the new contractor. |
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When will
Wheatlands begin forwarding all claims to WPS? |
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Until February 28th paper
claims received by Wheatlands will be scanned into
the processing system by Wheatlands and forwarded to WPS. February 28th is the last day claims will be
processed by Wheatlands. Everything received
electronically by that date but not processed or in
process will be forwarded to WPS for completion. |
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Can I
resend claims to WPS if I have concerns that they
were not received at Wheatlands? |
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Do NOT submit claims to
Wheatlands on February 28th and then resubmit
everything to WPS. This will create duplicate claims
and increased work. The dark day and weekend is
intended to prevent problems. Both Wheatlands and
WPS are on the MCS system. |
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Will
there be any changes in the Medicare fee schedule
when WPS becomes the MAC? |
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No, the Medicare fee schedule
is location specific. The 2008 Medicare fee schedule
will remain the same for Kansas as it was when
Wheatlands was the MAC. |
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If claims
are forwarded from Wheatlands to WPS, will the
14-day payment floor be affected? |
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The payment floor
does NOT start over when claims are forwarded to
WPS. The processing cycle at WPS will begin on March
3rd. |
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An excessive number of
claims have been denied by Wheatlands because of
programming errors. It is unlikely these programming
errors will be fixed between now and the cutover
dates. How does WPS plan to handle these claims
denied incorrectly because of bad programming edits
in the previous carrier's system? Will these claims
be automatically reprocessed? |
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WPS is aware of
multiple and extensive claims processing issues (E&M
and DEXA for example) that will not be fully
resolved by March 1st. WPS has set up a workgroup to
research and identify these issues and prioritize
them based upon their impact to the provider
community. The workgroup will decide which issues to
handle and the order in which they are handled.
Whether mass adjustments can be made will be
evaluated upon a case by case basis. There will
likely be some mass adjustments but this will depend
on system limitations. |
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Will WPS maintain an
"Issues" log on its website as Wheatlands has done? |
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WPS will not
continue the "Issues" log. |
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Will WPS
notify providers when these claims processing issues
are resolved? |
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Yes, notices will
be sent through the list-serve. It is highly advised
for all providers to sign up for the list-serve. |
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The WPS
LCD policy for DEXAs lists no covered V screening
diagnosis for the every-2-year asymptomatic DEXA.
According to information from CMS this is a covered
screen. How do providers code for this service? |
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As of 2/01/08,
this issue has been forwarded to policy staff for
clarification. |
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If Wheatlands has
claims processing issues with DEXAs, for example,
should providers hold these claims to submit to WPS
on March 1st? |
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Claims with dates of service
before March 1st are likely to continue to deny
until WPS has the opportunity to correct the edits
causing the denials. Holding claims may be a valid
strategy, but the programming edits will still have
to be fixed. Basically, WPS is taking over the
existing Wheatlands system on March 1st so claims
with dates of service prior to March 1st will
processed with the edits and LCDs programmed into
that system. Programming errors in that system will
be fixed over time. It is not like flicking a
switch. |
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If, at
the time of the cutover, there are claims in review
without and NPI number, how will WPS identify the
provider on those claims? |
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WPS will have
access to the same information that Wheatlands has
had. WPS can use either the NPI or the legacy number
(PTAN) to identify providers. After March 1st all
claims must be submitted with either an NPI or an
NPI/PTAN pair that matches the crosswalk. |
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How will
the effective dates of the LCDs be coordinated? |
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The effective date of each LCD
is based upon the date of service, not the date of
transmission. Claims with a service date prior to
March 1st will be subject to Wheatlands LCDs. Claims
with a data of service beginning on March 1st will
be subject to the WPS LCDs. |
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It is our
understanding that Wheatlands local coverage
determinations (LCDS) will continue for Kansas
providers after the transition. First, is there a
time limitation on how long these LCDs will be
followed? And second, can the WPS claims processing
system be counted on not to deny these claims? |
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The new, WPS LCDs are posted
on the website and will be implemented into the
claims processing for service dates beginning March
1st. (Review the FAQ above.) The URL address for the
LCDs is:
http://www.wpsmedicare.com/part_b/policy/policy_active.shtml.
There is an option at the URL to submit written
comments on the policies. There are no plans to
suspend any policies currently posted except as they
may need updates and revisions. |
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We
understand that WPS will look at LCDs within J-5 and
go with the least restrictive policy. Has WPS
developed a plan to reconcile the different LCDs? |
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It is correct
that WPS has consolidated the LCD policies from the
previous J-5 carriers. The process is complete and
LCDs are available on the website. (See FAQ above)
These LCDs will not be effective in Kansas until the
March 1st cutover date |
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It is our
understanding that CMS will keep Wheatland's LCD on
its website long after the cutover date. Will CMS
also keep Wheatlands policy memos on its website? |
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CMS will keep the
retired LCDs on its website. The companion articles
(policy memos) should also be retained there, too,
but this will be confirmed after discussing with
CMS. |
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We've
heard that, by policy, WPS dos not allow a primary
care physician to bill a consultation code when a
surgeon has asked the PCP to do an evaluation for
surgical clearance. Is this correct? |
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According to LCD
"CONSULTATIONS" - PHYS-006, preoperative
consultations are payable for new or established
patients performed by any physician or qualified NPP
at the request of a surgeon, as long as all of the
requirements for performing and reporting the
consultation codes are met and the service is
medically necessary and not routine screening. |
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A new NCD effecting
Procrit and Epogen is effective Jan 1st with an
implementation date of April 7th. We have been told
that Wheatlands has no plans to implement this NCD
prior to the cutover. If claims sent to Wheatlands
deny because the NCD change was not implemented,
must the claims be re-filed or can WPS make a mass
adjustment on claims already filed? |
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With an
implementation date of April 7th, Wheatlands would
not be taking any action on this. Since this is an
NCD, WPS will have a plan to address the changes
but at this stage it is in the "systems" area. It
may be that a mass adjustment can be done assuming
the problem is not too complex to resolve in this
manner. |
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Will
providers be able to fax correspondence and
redeterminations to WPS customer service? If so,
what is the fax number? |
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No correspondence
or redetermination can be accepted by fax. |
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Modifier
51 is currently added by the Kansas carrier, will
WPS do the same? |
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Yes. |
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Who can
document HPI? |
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From WPS web sit, page 11 of
the November 2003 Communiqué: "The history
portion refers to the subjective information
obtained by the provider or ancillary staff." In
response to a provider request for clarification,
although ancillary staff can perform the other parts
of the history, that staff cannot perform the
History of Present Illness (HPI) portion of the
patient's history. Only the
provider can perform the HPI. |
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We've
heard that, by policy, WPS does not allow a primary
care physician to bill a consultation code when a
surgeon has asked the PCP to do an evaluation for
surgical clearance. Is this correct? |
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No answer at this
time. Pete will have to check with policy people.
(Added 01/16/2008: According to LCD "CONSULTATIONS"
- PHYS-006, preoperative consultations are payable
for new or established patients performed by any
physician or qualified NPP at the request of a
surgeon, as long as all of the requirements for
performing and reporting the consultation codes are
met and the service is medically necessary and not
routine screening.? |
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Do
providers still need PPTN? If yes, how will that
transaction take place, for example, will providers
have to re-apply with WPS? |
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At the cut over
date, IVR will be the only process available in
Kansas to get claims status. |
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Is WPS
ready with the new ASC Fee Schedule/Regulations? If
not, will it be ready by the transition date? |
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Yes, WPS is
ready. |
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We have heard there
are "specialists" for each problem, i.e.: LCD
questions to Mr. A, coverage questions to Mr. B, and
so on. Will practices receive a direct dial
directory or a single number to customer service? |
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There are subject
matter experts, but the first lines of information
will be the web site and customer service. It is a
customer service function to respond to inquiries.
However, calls can be escalated by customer service
to higher levels. If there is a question beyond the
customer service level "Contact Us" questions
submitted through the web site can be responded to
in 45 days. But it was advised to use the customer
service function first since many questions that
come to the "Contact Us" are better fielded by
customer service. |
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Is there
a limit to the number of questions or issues that
customer service will respond to with each call? |
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Yes, there is a
limit of three issues and/or claims per telephone
call. |
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Will
there continue to be a two week floor time for clean
claims? |
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Yes. |
