Verify enrollment information in order to avoid claim denials

Physicians who order or refer for items (wheelchairs, oxygen etc) or services (lab, x-ray) must update their Medicare enrollment information (including their NPI) in the Provider Enrollment Chain Ownership System (PECOS). Medicare participation status and/or just having an NPI number does not guarantee that you are enrolled in PECOS. To verify your information, contact the WPS Provider Enrollment Hotline at 866.503.7664 or check the CMS website. (Additional information)

Medicare adopts new accounting system

Effective August 9, 2010 Wisconsin Physicians Service (WPS) will be transitioning to a new standardized accounting system, Healthcare Integrated General Ledger Accounting system (HIGLAS). This system will replace the accounting portion of the current system, Medicare Carrier System (MCS). WPS will continue to use the MCS system for all claims processing functions. Once the MCS system approves a claim, HIGLAS will perform payment calculation, formatting and accounting functions.

In order to install the system, WPS must reduce the payment floor for both paper and electronic claims to zero. Payments will be released early for claims that have already been approved for payment. The payment floor reduction began July 28, 2010 and will be reinstated on August 6, 2010.

What you need to remember! This temporary reduction of the payment floor will result in payments being issued EARLY (both check and Electronic Funds Transfer). This may give the appearance that your cash revenues have increased, when in fact you have just received your payments early. You should monitor payments and make adjustments as necessary to prevent cash flow problems during the transition period.

WPS indicates this will have a minimal impact on the provider community; however, if you experience delays receiving payment after this transition you should contact Ruth.

RAC in Kansas

The Recovery Audit Contractor (RAC), mandated by the Tax Relief and Health Care Act of 2006 directs CMS to implement the RAC program nationwide by January 1, 2010. The goal of the RAC program is to identify improper payment made on claims for services provided to Medicare beneficiaries. Improper payments may be overpayments or underpayments. (More)