Medicare
WPS seeks input on local policies
WPS will accept comments on the following DRAFT Local Coverage Determinations (LCD) until March 19, 2012, and can be sent to This e-mail address is being protected from spambots. You need JavaScript enabled to view it Please include the topic of the LCD on the e-mail subject line and include any published scientific studies and/or literature to support additional coverage.
Individual responses to the comments will not be sent. Responses will be available in a Comment and Response document that is posted with the final LCD.
If you have any questions or concerns please contact This e-mail address is being protected from spambots. You need JavaScript enabled to view it at 785.235.2383
Medicare to perform prepay audits
WPS has announced they will implement edits to identify claims on which to perform prepayment complex medical reviews on Established Patient Office Visit - CPT code 99214. The edit will focus on the following provider specialties: Cardiology, Family Practice and Internal Medicine in Jurisdiction 5 (Iowa, Kansas, Missouri, and Nebraska). Claims submitted for CPT 99214 will be randomly selected to determine if the service(s) was documented, coded correctly and the medical necessity supports the level of service billed.
WPS has not indicated the size or duration of this audit but point to, high utilization of the code, increased error rates found in the initial and subsequent prepayment service specific probes and significant errors identified through the Comprehensive Error Rate Test (CERT) program, as the reason.
If your claim(s) is selected, WPS will send an Additional Documentation Request (ADR) letter requesting medical records. It is important to respond, within 30-days, to the ADR letters, submitting ALL requested documentation necessary to support the medical necessity for each billed service, and to substantiate the appropriate use of each billed procedure.
Additional resources
If you have questions or concerns, please contact This e-mail address is being protected from spambots. You need JavaScript enabled to view it , KMS Director of Health Care Finance at 785.235.2383.
