Medicare - Wisconsin Physicians Service Insurance Corporation (WPS)

Updated 2012 Part B Participation and Fee Information

CMS is extending the 2012 Annual Participation Enrollment Program. The participation enrollment period will now end February 14, 2012, instead of December 31, 2011. Select the link for your contract area (J5 MAC Part B or Legacy Part B) below for more information.

Medicare Physician Fee Schedule Database

WPS Medicare published the revised 2012 Fee Schedules (Legacy Part B and J5 MAC Part B) on January 5, 2012. These files include the PAR and Non-PAR amounts as well as the limiting charge. If you are looking for information on status codes, relative value units, global surgery, physician supervision of diagnostic procedure, or other fee schedule indicators, please refer to the Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule (PFS) Relative Value Files(external link).

eRx Payment Adjustment (1% Reduction)

Eligible professionals who met the eRx payment adjustment inclusion criteria, but failed to meet the reporting requirements in 2011, may receive the 2012 eRx payment adjustment (1% reduction) starting January 1, 2012. Check your remittance advice for the term "LE", Claim Adjustment Reason Code (CARC) 237, and Remittance Advice Remark Code (RARC) N545. More information is available in the CMS Special Edition MLN Matters article 2012 Electronic Prescribing (eRx) Payment Adjustment: Assessment and ApplicationAdobe Portable Document Format .

Is your vendor, billing service, or clearinghouse ready for 5010?

WPS Medicare maintains a listing of contact information for vendors, Network Service Vendors (connectivity vendors), billing services, and clearinghouses that have tested their product/service with Medicare and have been approved for format 5010. We encourage you to access this listing by visiting our website(external link) and selecting Electronic Media Claims Approved Vendors, Billing Services, and Clearinghouses on the right hand side of the page.

Deductible and Coinsurance Rates for Calendar Year (CY) 2012

For CY 2012, the Part B deductible is $140.00 and coinsurance is 20%. The CY 2012 inpatient deductible (Part A) is $1,156.00 and Hospital Coinsurance (Days 61-90) is $289.00. More information about CY 2012 deductible and coinsurance is available in the MLN Matters article, "Update to Medicare Deductible, Coinsurance and Premium Rates for 2012"Adobe Portable Document Format.

2012 Participation & Fees MPFS Database eRx Adjustment 5010 2012 Deductible