09/11/12 Ask-the-Contractor Teleconference (ACT ... - WPS Medicare
09/11/12 Ask-the-Contractor Teleconference (ACT ... - WPS Medicare 09/11/12 Ask-the-Contractor Teleconference (ACT ... - WPS Medicare
As you may be aware, providers may submit suggestions or topics on the ACT advance http://www.wpsmedicare.com request form and that’s available on our website. The form should be filled out in its entirety and should include what specific information that you’re looking for. The completed form can then be faxed or e-mailed to WPS Medicare. The fax number and the e-mail address both appear on the form itself. Now the existing form is being updated and will soon reflect a new fax number to which the form may be faxed. Please be certain that you discard any old forms that you may have in your possession. The new fax number will be on the form itself as I previously mentioned. That particular new fax number is (618) 998-5249. Now please keep in mind that if your request is not received by WPS Medicare at least five days prior or in advance of the call date, we may not be able to address your request during the ACT. These five days allow time to consult with subject matter experts here at WPS Medicare and it allows us to research those requests that are complex in nature. Now remember that ACTs are designed for general inquiries, not claim specific information. If you have a claim specific issue, please contact WPS Medicare Customer Service as they are best equipped to help you. To begin today’s ACT, we will address the advance requests that have been received and after that, we’ll ask Angie to open up the lines to our questions from all of you, our participants. We will do our best to answer all of the questions while we are on the telephone call today. However, we may need additional time to research additional questions or issues that are complex in nature. If this occurs, we’ll ask you for your name and your telephone number, and someone will get back to you within the next couple of business days. Today’s teleconference of this ACT is being recorded. If this causes an issue for anyone, you might wish to keep this in mind during the question-andanswer period. You can access a recording and a transcription of this J5 ACT on our J5 On Demand Training web page in approximately two weeks from this call date. Our first advance question today received from Karen states, “Some of our physicians would like to start giving the influenza vaccine to patients. What is the coverage period for this service during flu season For example, is it October through May” The Centers for Medicare & Medicaid Services, or CMS, currently follows the Centers for Disease Control and Prevention, or CDC’s recommendation that the flu season begins as soon as the vaccine is available and continues through the flu season. CMS concurs with the CDC that the beginning and duration of the flu season cannot be precisely determined. Just as one of our current messages on our provider home page states on our website, “We do receive numerous phone calls this time of year asking us 2
for a new pricing on the influenza vaccine.” We will not have that information prior to notification http://www.wpsmedicare.com by CMS. When we receive that information from CMS, we will publish that information or that notice in the WPS Medicare eNews. Please continue to watch eNews for this notification. Once available, the CMS website will actually contain the pricing. It will be posted out on the CMS website. That website location will be included in the eNews that is sent out by WPS Medicare. If you do not subscribe to eNews, we encourage you to sign up. Our listserv subscribers are assured that they receive the most current WPS Medicare information in the most expeditious manner. Now, to sign up for our eNews or to manage your current eNews subscription, simply choose eNews, which appears in the upper right-hand corner of each WPS Medicare web page. Here’s a question we received from Amy: “Can an Advanced Registered Nurse Practitioner, ARNP, supervise a registered nurse performing a stress test This would be reported with CPT code 93015 and bill that service under the ARNP’s or the Advanced Registered Nurse Practitioner’s provider number.” And the answer to that is this, the Code of Federal Regulations requires that diagnostic tests covered by the Social Security Act and payable under the physician fee schedule with certain exceptions that are listed in the regulations has to be performed under the supervision of an individual meeting the definition of a physician as listed in the Social Security Act. It goes on to say that non-physician practitioners cannot act as supervisory physicians under the diagnostic test benefit. You can find this information in the CMS Medicare Benefit Policy Manual. That’s publication 100-02 Chapter 15 Section 80. Remember you can easily access CMS’ Internet-Only Manual by choosing the link labeled Manual. It appears under the top five links heading on the center right portion of the CMS home page. It’s available at www.cms.gov. Our third and last Advance Request for today’s call states, “Recently, a CMS review on a denial suggested that the technical and professional component on a procedure should reflect different dates if they were performed on a different date. The request further states this is not currently the procedure of any practice in any CMS region in the country. Is this a new regulation And if so, please indicate where this can be found in the existing claims manual. Further, the request we received states, it is widely known that a professional component may be performed at a later time when the original technical component of the procedure was performed. The professional component report reflects the date the test was done and the date the test was read. It has always been the understanding of the physician communities that the dates of the technical component and the professional component need to be identical in order to be paid. If this is not correct, then there has been a terrible miscommunication for years because this is the usual practice of all physicians.” 3
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As you may be aware, providers may submit suggestions or topics on <strong>the</strong><br />
<strong>ACT</strong> advance http://www.wpsmedicare.com<br />
request form and that’s available on our website. The form<br />
should be filled out in its entirety and should include what specific information<br />
that you’re looking for. The completed form can <strong>the</strong>n be faxed or e-mailed to<br />
<strong>WPS</strong> <strong>Medicare</strong>. The fax number and <strong>the</strong> e-mail address both appear on <strong>the</strong><br />
form itself.<br />
Now <strong>the</strong> existing form is being updated and will soon reflect a new fax<br />
number to which <strong>the</strong> form may be faxed. Please be certain that you discard<br />
any old forms that you may have in your possession. The new fax number will<br />
be on <strong>the</strong> form itself as I previously mentioned. That particular new fax<br />
number is (618) 998-5249.<br />
Now please keep in mind that if your request is not received by <strong>WPS</strong><br />
<strong>Medicare</strong> at least five days prior or in advance of <strong>the</strong> call date, we may not be<br />
able to address your request during <strong>the</strong> <strong>ACT</strong>. These five days allow time to<br />
consult with subject matter experts here at <strong>WPS</strong> <strong>Medicare</strong> and it allows us to<br />
research those requests that are complex in nature.<br />
Now remember that <strong>ACT</strong>s are designed for general inquiries, not claim<br />
specific information. If you have a claim specific issue, please contact <strong>WPS</strong><br />
<strong>Medicare</strong> Customer Service as <strong>the</strong>y are best equipped to help you.<br />
To begin today’s <strong>ACT</strong>, we will address <strong>the</strong> advance requests that have been<br />
received and after that, we’ll ask Angie to open up <strong>the</strong> lines to our questions<br />
from all of you, our participants. We will do our best to answer all of <strong>the</strong><br />
questions while we are on <strong>the</strong> telephone call today. However, we may need<br />
additional time to research additional questions or issues that are complex in<br />
nature. If this occurs, we’ll ask you for your name and your telephone<br />
number, and someone will get back to you within <strong>the</strong> next couple of business<br />
days.<br />
Today’s teleconference of this <strong>ACT</strong> is being recorded. If this causes an issue<br />
for anyone, you might wish to keep this in mind during <strong>the</strong> question-andanswer<br />
period. You can access a recording and a transcription of this J5 <strong>ACT</strong><br />
on our J5 On Demand Training web page in approximately two weeks from<br />
this call date.<br />
Our first advance question today received from Karen states, “Some of our<br />
physicians would like to start giving <strong>the</strong> influenza vaccine to patients. What is<br />
<strong>the</strong> coverage period for this service during flu season For example, is it<br />
October through May”<br />
The Centers for <strong>Medicare</strong> & Medicaid Services, or CMS, currently follows <strong>the</strong><br />
Centers for Disease Control and Prevention, or CDC’s recommendation that<br />
<strong>the</strong> flu season begins as soon as <strong>the</strong> vaccine is available and continues<br />
through <strong>the</strong> flu season. CMS concurs with <strong>the</strong> CDC that <strong>the</strong> beginning and<br />
duration of <strong>the</strong> flu season cannot be precisely determined.<br />
Just as one of our current messages on our provider home page states on<br />
our website, “We do receive numerous phone calls this time of year asking us<br />
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