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Michelle Dick
EdgeBlast Editor
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Top News
HHS and DOJ Take Action Against Infusion Therapy Fraud
On August 20, the Health and Human Services (HHS) and the Department of Justice (DOJ) announced a two-year collaboration effort to protect Medicare beneficiaries from deceptive infusion therapy providers. The targeted areas include South Florida, Southern California, Los Angeles and Houston, as they show high activity of billing fraud from the suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS). Because South Florida is also the leading contender of infusion therapy billing fraud, the Medicare Fraud Strike Force has already begun enforcement in this area.
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Keep Your Anesthesia Claims Up to Code
Starting on Oct. 1, 2007, there will be changes (CR # 5618) for those who bill Medicare carriers and/or Medicare Administrative Contractors (A/B MACs) for the anesthesia services provided with medical and surgical procedures. According to CPT® guidelines, those who will be paid for conscious sedation are physicians who perform the medical/surgical procedure and also provide moderate sedation for the procedure. Those who will not be paid separately for the sedation services are physicians who perform the medical/surgical services and provide local or minimal sedation for the procedures. Note: moderate anesthesia does not include local or topical anesthesia, deep sedation or monitored care.
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Use NPI's Data Dissemination to See How You Compare With Other Providers
National Provider Identifier Standard (NPI) is progressively becoming the standard billing for health plans. It is important to bill health plans that you do business in accordance to NPI. The National Plan and Provider Enumeration System (NPPES) will disclose their health care data on September 4. A week prior, health care providers can view their disclosable NPPES data and edit as necessary.
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The MGMA July questionnaire results are in!
Medical Group Management Association's (MGMA's) July 2007 information exchange revealed valuable information for practices with coding. The questionnaire received responses from 163 medical groups. The results showed the most popular resources for coding information, the top coding newsletter(s) which practices subscribe to and where medical coders choose to find help on the web.
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Test Yourself
- Earn .5 CEUs
By answering the following questions, you can earn .5 continuing education units to apply toward your annual AAPC certification renewal. Simply answer the questions and send in a copy of your work when submitting your CEU package. Do put the number of each EdgeBlast included in your submission. The number is available at the top of the page.
Answers to the questions are not always found directly (word for word) in the EdgeBlast in which they appear. While often related to the EdgeBlast content, they require additional resources such as your ICD-9-CM, CPT® and HCPCS manuals.
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What patients in South Florida were for-profit clinics and doctors recruiting by payment for Medicare billing infusion scams? |
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What CPT® codes should never be reported with the codes in Appendix G and why? |
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Why shouldn't you report when local or topical anesthesia is used? |
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According to MGMA's July survey, what are the majority of practices using for coding sources, and what is the percentage of use? |
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By popular choice, where is the number one source for finding your coding questions on the internet |
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