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Medical Review

WPS Medicare is Currently Not Accepting Therapy Cap Preapproval Exception Forms

Any therapy preapproval requests received by WPS Medicare on or after December 17, 2012, may not be reviewed. Claims associated with these requests may be subject to prepayment or post payment review. A Therapy Cap Preapproval form should not be submitted with documentation for therapy claims that have received an Additional Documentation Request (ADR). Further information will be posted in the near future.

Welcome to the WPS Medicare Medical Review (MR) web page. Here you will find basic Medical Review information, relevant current topics, and feedback regarding service specific probe findings.

Information You Will Find Below on the Medical Review web page - Select from the list to be taken to a specific area or continue scrolling

Basic Medical Review Information
Comparative Billing Reports for Service Specific Probes
Current Topics
Evaluation and Management Resources
Forms
Medical Review Calculator
Other Medical Review Resources
Prepayment Widespread Service Specific Probe Reviews

Basic Medical Review Information

Comparative Billing Reports for Service Specific Probes

Find a wide range of Comparative Billing Reports by procedure code and specialty.

Current Topics

Please visit the Provider Specialties/Services portion of the website to find other useful information organized by topics of interest. This can be found by selecting the Resources tab on the top navigation bar, then Provider Specialties/Services.

Evaluation and Management Resources

Find comprehensive evaluation and management information including educational articles, questions and answers, resources, and a live video presentation regarding E/M.

CMS E/M Resources

Forms

Find Medical Review forms including the Appointment of Representative (CMS-1696), Attestation Statement for signatures forms, and the Request for Waiver of Monthly Face-to Face Visit for Home Dialysis Monthly Capitation Payment (MCP) on the Medical Review (MR) Forms page.

Medical Review Calculator

WPS Medicare offers a Medical Review Calculator to assist with the medical review process.

Other Medical Review Resources

CMS Medical Review and Education Homepage
CERT Articles
This portion of the website includes information on Signature Requirements, Medical Record Documentation, and much more.

Prepayment Widespread Service Specific Probe Reviews

Completed Prepayment Widespread Service Specific Probe Reviews
Articles with findings and educational information stemming from completed widespread service specific probe reviews.
Planned Prepayment Widespread Service Specific Probe Reviews
Articles concerning upcoming widespread service specific probe reviews, including information on the medical record documentation necessary for the review of your claims.

Page Last Updated: Monday, 29-Sep-2014 14:03:06 CDT