09/11/12 Ask-the-Contractor Teleconference (ACT ... - WPS Medicare

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and then the other ones do not. And so I’m trying to understand, we submit them all the http://www.wpsmedicare.com same and why one gets paid and one doesn’t. Dr. Boren: The question is, are you really submitting them all the same Because a number of times, people think they are the same, my field is emergency medicine. My group complained to me about Medicare denials and they showed me a bunch of denials that they had gotten. I asked them why they have a box open. I forgot which one it was that needed to be filled out and they had left that box open on a number of claims. I just asked them why there were filling out paper claims instead of electronic. That would kind of surprise me. Jennifer Vanwinkle: Well, whenever – I mean, by the same claim is that – if it falls (inaudible) then we use that same code. It can be a diagnosis of the 110.1. Dr. Boren: Brett: You need to let the customer service look up the denial reason. Hey, Dr. Boren, this is Brett, Manager of Medical Review. I believe that’s mycotic nails and there are different exceptions for mycotic nails versus a systemic condition, which requires a professional to trim the nail. So I would advice going back and look because there are different requirements for both. So if you are billing debridement for mycotic nails, there’s a certain way the claim and needs to be submitted. If you are billing routine foot care exception due to a systemic condition with class findings, there are other things that need to be on that billing and again, without claim-specific information, we can’t tell. But those are two separate exceptions, mycotic nails that need certain things and then systemic condition with certain findings which require professionals to do that routine foot care safely. Jennifer Vanwinkle: Thank you so much. Mary Muchow: Operator: Mary Muchow: Kara Lithcum: Beth: You’re welcome. Your next question comes from the line of Kara Lithcum. Hi, Kara. Hi. I have a question regarding LCDs. My question is, we have a service that always gets denied for medical necessity because the diagnosis we’re using is not on the on the LCD. We eventually take this to a judge and our appeals get overturned. So I would like to know how we can transfer that information to get the LCD at least get it considered for a change. Hi, this is Beth from the Policy Department. We do have an e-mail box that will take you – the emails are addressed by the Policy department. It’s policycomments@wpsic.com. If you’d let us know your request in an LCD reconsideration and you’d let us know what policy it is and we have a page on our website that will also explain the type of literature that we like to see included with your LCD reconsideration request. 12
But if you ever see a policy, we really encourage you that you fill this missing coverage and http://www.wpsmedicare.com you have literature to support it, we really encourage you to submit that via the policy comment box. It will save a little work on your end by having to take it through appeals. Kara Lithcum: Beth: Kara Lithcum: Beth: Kara Lithcum: Beth: Mary Muchow: Kara Lithcum: Mary Muchow: Operator: OK. And where is that at on your website Go to the Policy page and then on the left-hand side, you can click on and go to our Draft Policies. And I know there’s an actual link that will bring up an e- mail that says Policy Comments on it. OK, I found it. OK. And then it… And then it lists what we need to include. Right, exactly. I believe there’s an actual article out there for policy reconsideration request, and it includes a very good listing of the information or the type of information that you have to include when sending that information in. OK, yes. Because we do have peer reviewed evidence and I can’t imagine why it wouldn’t change, so. OK, we will do that then. Thank you. Thank you. Your next question comes from the line Kristine Aprenger. Kristine Aprenger: Hi, my question is for Provider Enrollment. I want to see what is the expected timeframe for a provider to become approved with notice of tremendous slowdown and we’ve been told it’s due to other revalidation applications that they’re working. Chere: Hi, this is Chere with Provider Enrollment. That’s probably pretty true. CMS gives us the timeframes of 60 days to process that in a timely manner. If you’re having issues that it’s going over 120 days then we can certainly take a look at them. But the revalidation has really slowed us down. Kristine Aprenger: OK, because I know that we have some that have gone past the 60-day timeframe now. And the odd thing is that we’ve had one provider that we’ve submitted after the rest of them and he, like, went through within a couple of weeks. Chere: So are these new provides or are they revals that you’re sending in Kristine Aprenger: These are new provider applications. Chere: If you have concerns, go ahead and call the hotline, and we can try and pull it out or something. 13
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Page 3 and 4: for a new pricing on the influenza
Page 5 and 6: Mary Muchow: Operator: Mary Muchow:
Page 7 and 8: Dr. Boren: Natalie Murphy: Dr. Bore
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Page 15 and 16: Jenny: Cathy Smith: Jenny: Cathy Sm
Page 17 and 18: code got moved under low vision ser
Page 19 and 20: the internist, because they’re tw
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09/11/12 Ask-the-Contractor Teleconference (ACT ... - WPS Medicare

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