The following are revised policies. To view the new policies on the WPS Medicare website, use the left hand navigation to go to the Local Policies (LCD). Be sure to note the effective date of the revision, as the revision will not appear in the Active policy until the effective date. Prior to the effective date, the revision can be found by selecting the link"Display Future Effective Documents" within the CMS Medicare Coverage Database
Those of you in radiation therapy most likely have noticed denials when billing 77786 (Brachytherapy
2-12 channels) as part of mammosite for your breast cancer patients. On 2/13/2011 the LCD (DL31510),
Titled, Radiation Therapy for Basal Cell and Squamous Cell Carcinoma was revised, continuing to include
CPT codes 77786 HOWEVER, it deleted breast cancer codes (174.0-). BUT....
I am happy to report, FCSO is currently working to correct editing related to the LCD. They have also
acknowledged providers have been receiving inappropriate denials for appropriate diagnosis related to
the procedure codes listed in this LCD . SO...FCSO will be posting an article related to the above in a day
or so AND...
FCSO WILL BE MAKING THE APPROPRIATE CLAIMS ADJUSTMENTS. PLEASE DO NOT
RESUBMIT YOUR CLAIMS OR REQUEST AN APPEAL FOR REDETERMINATION
PROVENGE: Any claim for Provenge with a diagnosis of 185 (no matter the dos) will be developed on for
medical documentation that supports the FDA label. The medical record should support that the patient has
metastatic hormone resistant prostate cancer (HRPC) with evidence of progressive disease along with other SUPPORTING CRITERIA (FDA) SHOULD BE CLEARLY NOTED IN THE PRE TREATMENT NOTE. In addition, supportive documentation confirming leukopherisis was done three (3) days prior to treatment is required.
All information stated above was obtained via communication with staff responsible for these issues
Posted 2-21-2011 CMS conducting follow-up calls for CERT program The Centers for Medicare & Medicaid Services (CMS) will be conducting follow-up calls to providers for the comprehensive error rate testing (CERT) program. You or your staff may be contacted to obtain all necessary medical record documentation for claims reviewed under the CERT program. Although you may have already received letters and telephone calls from the CERT contractor, these additional efforts by CMS to obtain adequate documentation may change your claim's status from"improper payment" to"proper payment." This will allow CMS to calculate a more accurate Medicare fee-for-service error rate, while also reducing the amount of improper payments.
Payment schedule interruption in March 2011 as a result of HIGLAS transition
On March 11, 2011, First Coast Service Options (FCSO) will be transitioning its Part B financial accounting system to the Healthcare Integrated General Ledger Accounting System (HIGLAS) for Florida, Puerto Rico, and the U.S. Virgin Islands. HIGLAS is a CMS dual-entry accounting system that replaces only the current Medicare financial systems utilized by the Medicare administrative contractors.
To ensure a successful transition of the HIGLAS system, CMS has approved FCSO's waiver request to reduce the payment floor for both paper and electronic media claims (EMC). On March 8-9, the payment floor will be reduced to zero for both electronic and paper claims. This means that during these two cycles, FCSO will release payments for all claims already approved to pay.
This temporary payment floor reduction will result in two higher than normal payments, then lower payments over the next 10-14 days (March 14-25). This may give the appearance that your cash revenues have increased when in fact payments for some of your claims have been issued earlier than normal.
Providers are encouraged to monitor their payments and make adjustments as necessary to prevent cash flow problems during this time period.
Remittance advices impacts
FCSO will not be issuing payments on March 10-11. Electronic Remittance Advices (ERAs) and paper RAs will not be available. FCSO will resume normal payment cycles and issuance of payments on March 14 at which time providers will be able to retrieve their ERAs.
Since the March 8-9 payment cycles will be larger than normal, downloading of remits may take longer than usual. If you use a clearinghouse, please share this information with them.
HIGLAS educational events and resources
To learn about other impacts as a result of the HIGLAS transition click here. Providers can also participate in one of FCSO's upcoming webcasts or seminars. Visit FCSO's Events Calendar page and search for"HIGLAS transition seminar Part B."
Remember to subscribe to FCSO's eNews list Part B HIGLAS Transition to stay informed on all important changes related to the HIGLAS transition.