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Medicare eligible medical services must occur in the USA or it's territories. Providers outside the USA or it's territories do not need to enroll or opt out of Medicare.

Glad it was helpful! Thanks for the feedback.

We're glad we could help.

If your appeal is at level 4, you will need to reach out to the Departmental Appeals Board. CMS offers information on their website at www.hhs.gov/about/agencies/dab/index.html If you need general help or information on a level 1 appeal, contact our customer service area. This link will take you to our contact page. You can use the drop-down to locate the contact information. med.wpsgha.com/contact

A medical professional use the provider enrollment process. The process involves completing an application. For more information, view the CMS web page Become a Medicare Provider or Supplier at www.cms.gov/medicare/enrollment-renewal/providers-suppliers.

All ambulance claims require the Point of Pickup (POP) ZIP Code. The denial CO 284 is related to prior authorization. You will want to contact customer service for assistance with your claim.

Yes. The swing bed in considered part of a hospital not a skilled nursing facility.

CMS instructions are silent on whether time spent in gathering the patient consent would or would not be part of the monthly chronic care management (CCM) time-based billing. This would be a business decision as to whether you would include this in the initiating visit, the comprehensive assessment and care planning (if provided), or in the monthly CCM service.

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Welcome!

You can send a email to wps.gha.education@wpsic.com and request a copy of the power point.

The practitioner can develop the care plan. The practitioner can also work with the clinical staff to develop the care plan. You can find additional information in the resource we have available on our website. Chronic Care Management: med.wpsgha.com/guides-resources/view/856

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We are not the contractor handling second level appeals. We recommend checking the CMS Website for more information. www.cms.gov/medicare/appeals-grievances/fee-for-service/second-level-appeal The website provides a list of the contractors handling this level of an appeal.

The condition code 02 shows the claim is related to employment. The lack of condition code 02 should indicate the claim is not related. For specifics on your claim, contact our customer service area.

The condition code 02 shows the claim is related to employment. The lack of condition code 02 should indicate the claim is not related. For specifics on your claim, contact our customer service area.

Hello. You will need to complete the 855I to enroll the LLC and the 460. The new 460 is required because you are no longed under a group. You will also need to complete the CMS 588 for electronic funds transfer.

@@wpsghaeducationThanks - this is very helpful. When I fill out 588, should I also delete the group I am leaving in the reassignment section or should I assume that the group will update the 588 on their end. and remove me when I leave the group?

@@mrt3511 Yes, that is the best practice.

@@wpsghaeducationAonther question- do I need to fill out the 460 BOTH for myself (provider) as well as my LLC ?

@@mrt3511 You will one. The form will cover your practice locations.

Hi, you can select Medicare Nutrition Therapist or Technician. If you do no have these options, you would report "other" on the drop-down. There will be a free-text field, and you enter your specialty.

You will need to enroll with electronically in Medicare Provider Enrollment, Chain, and Ownership System (PECOS) at pecos.cms.hhs.gov/pecos/login.do#headingLv1. You may also complete the paper enrollment form and send the form to the Home Health and Hospice MAC for Texas. To view the MAC, visit CMS's web page www.cms.gov/medicare/medicare-contracting/medicare-administrative-contractors/who-are-the-macs-a-b-mac-jurisdiction-m-jm for JM.

You are so welcome

Hello, to answer your question I need to confirm if the information showing incorrectly in Provider Enrollment Chain and Ownership System (PECOS) with a Provider Transaction Access Number (PTAN) assigned or the National Plan and Enumeration System (NPPES)? If it is in NPPES it can be changed inside the providers NPPES record. If the provider has a Sole Owner PTAN that is no longer needed an application would need to be submitted to deactivate either through PECOS or on paper using a CMS 855I.

Hello. Thanks for the suggestion. We will look into this.

Billing will depend on the units of service as described by the procedure code. For example, the procedure code indicates one unit of service is 50 units. In the example, you would have one line with the procedure code, and 11 units of service with Modifier JZ. You would then have one line of service with one unit with Modifier JW. Another example, the procedure code indicates the units of service is 100 units. In the example given, you would have one line of service with six units and Modifier JZ.

Hello. Yes, this type of bill is possible. The transport must be medically necessary and the patient cannot be inpatient in either hospital for Medicare to consider the claim.

The unit of service is .09 mg. Use Modifier JZ. The amount available in the single-dose package does not show an additional unit of service.

Good afternoon. Thank you for the comments. I am not sure which source documents you may be referring to. Note that there are several URLs included in the PowerPoint to the various CRs, etc. If you are not currently on the mailing list for the webinar you can email me at Audit.Advisement@wpsic.com and I can send that to you so that you can access the links. Regarding the audio, it appears those cutouts were in the recording itself, since nothing was brought up during the live session that this is a recording of. Unfortunately, there are some instances where the webinar recording tool that we use drops a few seconds here and there. We have expanded to two sessions to allow for more flexibility for people to attend live, which may be better quality. We still load the recording of the webinar, in lieu of this being a live only event. Hopefully you were able to at least get most of the information out of the recording. I can add you to that webinar mailing list if you send me an email to the above. Hope this helps!

Thank you for the feedback!

The upload can occur in a variety of formats. The way you create the files is not something we can help with. We are not sure what features your printer has available or if it is also a scanner.

Hi, we ask that all questions be sent to wps.gha.education@wpsic.com. In the subject line include the name of the video. After receiving the question, one of our team will provide an answer.

Hi, we ask that all questions be sent to wps.gha.education@wpsic.com. In the subject line include the name of the video. After receiving the question, one of our team will provide an answer.

You are very welcome. Thanks for tuning in.

You are welcome.

We're glad you found it helpful.

We do not complete the application. If you have questions, contact customer service. med.wpsgha.com/contact

You're welcome!

You're welcome!

Procedure code 99490 is the primary code for procedure code 99439. The dates of service should be the same. If you submitted with the same date of service, please request an appeal of the denial. If you did not submit with the same date of service, please resubmit using the date of service for the 99439 as the same date of service as the 99490.

We are so glad you found it useful.

Thanks for watching. Glad it was helpful!

The forms are federally controlled. WPS Government Health Administrators does not have control over this.

​​@wpsghaeducation What does that mean? Whose responsibility is it for a health provider to make sure they are using a current and not expired ABN form?

The Office of Management of Budget (OMB) completes the reviews. This is part of the federal requirement of 5 CFR Part 1320 in the Code Federal Regulations. As a contractor for the Centers for Medicare & Medicare Services, we are required to use the OMB approved form. Each healthcare provider is responsible to use the current version.

@wpsghaeducation Thank you for that. What happens if a healthcare provider bills a client based on an expired ABN? You say "responsible." Where is that written? Is it a law? How are they supposed to know that?

Using an expired form would make the notice defective and shifts financial liability to the provider rather than the beneficiary. Some additional resources for you are in 100-04, Chapter 30, Section 50 B. Compliance with Limitation on Liability (LOL) Provisions "A notifier who fails to comply with the ABN instructions risks financial liability and/or sanctions. LOL provisions shall apply as required by law, regulations, rulings and program instructions. Additionally, when authorized by law and regulations, sanctions under the Conditions of Participation (COPs) may be imposed. The Medicare contractor may hold any healthcare provider or supplier who either failed to give notice when required, or gave defective notice, financially liable." CMS announced the date for mandatory use of the new form on their website at: www.cms.gov/medicare/forms-notices/beneficiary-notices-initiative/ffs-abn. This page also contains a link to the manual reference above.

This has been corrected

Home health is a separate contractor from us. We are unable to comment on if your business would be meet the requirements. You can contact Palmetto, GBA for assistance. www.palmettogba.com/

Thank you for your question, but I am unclear about what you are asking. If you have a claim specific question, please contact our Customer Service area.

Thank you for your reply. I am an OP surgery coder. Sometimes, I am coding inpatient procedures done in the outpatient department. In this scenario, how should I manage the claims?

The patient's status in the facility determines the type of bill you send. If they have been admitted, you will send an inpatient claim regardless of which department the procedure is done in. If the patient is not admitted, but having a procedure on the inpatient-only list, your facility would not be paid by Medicare for that procedure.

Thank you

You're welcome.

HI. Thanks for the question. The provider enrollment for Texas is not with WPS. View the CMS Medicare Enrollment for Providers & Suppliers web page for the correct contractor. www.cms.gov/medicare/provider-enrollment-and-certification Individual providers do not pay fee for enrollment. They must enroll, then reassign benefits to your organization.

Thank you. We are glad it was helpful for you.

Thank you for the feedback. The on-line system is currently being upgraded. We are not aware of when CMS will release the upgrade.

The allowed amount for procedure code G0511 is a combination of the Medicare Physician Fee Schedule non-facility amount for several procedure codes. The CMS Internet-Only Manual (IOM) Publication 100-02, Medicare Benefit Policy Manual, Chapter 13, Section 230.2.5 lists the procedure codes based on the date of service. For 2023 dates of service states "CCM, PCM, CPM or general BHI services furnished on or after January 1, 2023 are paid at the average of the national non-facility PFS payment rate for CPT codes 99490, 99487, 99484, 99491, 99424 and 99426 when general care management HCPCS code G0511 is on an RHC or FQHC claim, either alone or with other payable services. The payment rate for HCPCS code G0511 is updated annually based on the PFS amounts for these codes." You can find the information using this link - www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/bp102c13.pdf

@@wpsghaeducation Thank you. Would I calculate this average based on my state?

Is every element needed on the Care Plan?

To bill Chronic Care Management, you would have to address all elements on the care plan.

Hello. Medicare limits provider types. Without knowing what type of agency, we're unable to answer the question. If you want to know if your agency qualifies, review Publication 100-08, Medicare Program Integrity Manual, Chapter 10 - Medicare Enrollment. www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/pim83c10.pdf