Frequently Asked Questions - Top 10 Written Inquiries
WPS Medicare is pleased to publish FAQs based upon topics we have identified as those generating a high volume of written inquiries to Customer Service. The following table lists ten reasons (by topic) our Medicare providers and their agents sent in a written inquiry during the fourth quarter of Fiscal Year (FY) 2009.
Top 10 Written Inquiries
Fourth Quarter FY09 (July, August, September 2009)
(Excluding Claim Status and Eligibility Issues)
| Description | Occurrences |
| Appeals, Process Rights | 1270 |
| Remittance Advice, Duplicate Remittance Notice | 1141 |
| General Information, Issue Not Identified/Incomplete Information Provided | 253 |
| General Information, Misrouted Telephone Call/Written Correspondence | 219 |
| Appeals, Status/Explanation/Resolution | 200 |
| Policy/Coverage Rules, Benefits/Exclusion/Coverage Criteria/Rules | 93 |
| General, Other Issues | 69 |
| General Information, Reference Resources Referral Request | 60 |
| Policy/Coverage Rules | 55 |
| Policy/Coverage Rules, Statutes and Regulations | 42 |
1. Medicare deactivated my Provider Transaction Access Number (PTAN) because I haven't submitted any claims for more than 12 months. When I submitted a new CMS-855 enrollment application to have my PTAN reactivated, the provider enrollment unit didn't make my billing effective date retroactive. Why not?
Although the Centers for Medicare & Medicaid Services allows Medicare contractors to backdate the effective date of PTANs for new enrollments for up to 30 days prior to the filing date of the application, the same is not true for reactivated PTANs. The CMS does not permit Medicare contractors to backdate the effective date of most PTAN reactivations.
For Physicians, Physician Assistants, Nurse Practitioners, Clinical Nurse Specialists, Certified Registered Nurse Anesthetists, Certified Nurse Midwives, Clinical Social Workers, Clinical Psychologists, and Registered Dietitians/Nutrition Professionals:
The CMS Internet Only Manuals (IOM), Publication 100-08, Chapter 10, section 13.1.B., indicates that the effective billing date for reactivation for physicians, designated non-physician practitioners, and group practices of these individuals is either: (a) the date of filing of the CMS-855 enrollment application, or (b) the date they first began furnishing services at a new practice location (unless the provider has at least one other actively-billing Medicare-enrolled practice location under the same tax identification number), whichever is later. This means WPS Medicare generally establishes the provider's billing effective date based on the date we receive the provider's new CMS-855 enrollment application. You can locate this section of the IOM on the CMS Website.
If a physician, designated nonphysician practitioner, or a group practice of these individuals has at least one other enrolled practice location under the same tax identification number (TIN), the reactivation effective date is either: (a) the date the supplier first saw a Medicare patient at the location indicated on the new CMS-855 enrollment application, or (b) the same date as the non-billing end-date in Medicare's claims processing system, whichever is later.
All Other Individuals and Organizations:
For individuals and organizations other than those described above, the effective billing date for reactivation is the later of the date the provider first saw a Medicare patient at the location or the same date as the non-billing end date.
Note: In all cases, a new PTAN is assigned for reactivation. Dates of service prior to the effective date of the new PTAN are not payable.
If you have any questions, please contact the provider enrollment department at the applicable phone number:
877-908-8476: Wisconsin, Illinois, and Michigan providers
866-564-0315: Minnesota providers
2. Does Medicare require the use of the JW modifier when billing for discarded drugs?
WPS Medicare does not require providers to use the JW modifier to report discarded drug amounts. The Centers for Medicare & Medicaid Services (CMS) regulations allow contractors the option of not requiring the use of the JW modifier. The JW modifier is not used on claims for Competitive Acquisition Program (CAP), for Part B drugs and biologicals. This information is located in the CMS Internet Only Manual (IOM) 100-04, Chapter 17, Section 40.
3. Can providers bill Medicare for discarded contrast materials in the same way that they bill Medicare for discarded drugs and biologicals?
Yes, providers can bill discarded contrast materials to Medicare. WPS Medicare does not require providers to use the JW modifier to report discarded contrast materials. Providers should bill Medicare for discarded contrast materials in the same manner that they bill Medicare for discarded drugs and biologicals.
4. When I receive a developmental letter from WPS Medicare requesting additional documentation for a claim submitted what is the process I would take to return all supporting documentation for the claim?
When you receive a developmental letter from WPS Medicare, you should follow the instructions on the developmental letter. The instructions indicate to mail all supporting documentation to WPS Medicare. You would mail all supporting documentation to the address listed on your developmental letter.
5. Does WPS Medicare provide Part B prior authorization for medication?
WPS Medicare does not process claims for prescription medication; therefore, we cannot authorize the coverage. With the exception of immunosuppressive, anti cancer, and anti-emetic drugs, the Medicare Part B program does not cover prescription drugs. However, a Medicare Prescription Drug Plan (PDP or "Medicare Part D") may cover this medication. If the patient is enrolled in a PDP, you may wish to contact the PDP directly regarding the possible coverage of the medication.
Page Last Updated: Friday, 06-Nov-2009 14:16:19 CST
