The Edge Blast E-Newsletter
Issue #97
posted 03/19/2008
Electronic news for March 2008

Read the EdgeBlast and Earn CEUs Toward Your Annual Renewal
Earn continuing education units (CEUs) by reading the EdgeBlast. Simply answer the five questions found in the EdgeBlast Test Yourself at the end and submit your answers at the time of your renewal, using the same process you follow monthly for the Test Yourself in the AAPC Cutting Edge. Each EdgeBlast (there are two issued each month) will feature five questions that are worth 0.5 CEUs, for a total of 12 CEUs annually.


MedPAC: Stop Medicare Cuts to Docs!

On March 12, Congress’ Advisory Committee on Medicare went to Capitol Hill to urge lawmakers to increase Medicare physician payments to mirror medical practice costs rather than make payment cuts. The American Medical Association (AMA) agrees with this recommendation to help secure accessibility to care for seniors.

Nancy Nielsen, MD, AMA President-elect, says, “If Congress does not take action before July 1, physicians caring for Medicare patients will be hit with a 10.6 percent payment cut this year. Seniors and their physicians need Congress to enact an important mid-year update to preserve seniors’ access to care. A full 60 percent of physicians say a cut of this magnitude will force them to limit the number of new Medicare patients they can treat, and more than half say it will force them to reduce their medical office staff.”

The AMA is asking Congress to replace 18 months of Medicare physician payment cuts beginning in July with funds that reflect medical practice cost increases. This gives Congress time to collaborate with physicians to find a solution for long-term Medicare physician payment problems. The AMA says it agrees with MedPAC to use innovative solutions like comparative effectiveness research to help sustain Medicare for generations.



CMS to Pay for CPAP Therapy for OSA

After receiving many requests to reconsider the 2005 National Coverage Determination (NCD) for continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea (OSA) (CAG-00093R), CMS decided to allow coverage of CPAP based upon a diagnosis of OSA by home sleep testing (HST).

After considering public comments and additional information, CMS made the following changes to the NCD for CPAP:

  • Coverage of CPAP is limited to a 12-week period for beneficiaries diagnosed with OSA as described. CPAP is covered for beneficiaries diagnosed with OSA whose OSA improved as a result of CPAP during this 12-week period.
  • CPAP for adults is covered when diagnosed using a clinical evaluation and a positive:
    • polysomnography (PSG) performed in a sleep laboratory; or
    • unattended home sleep monitoring device of Type II; or
    • unattended home sleep monitoring device of Type III; or
    • unattended home sleep monitoring device of Type IV, measuring at least three channels
  • A positive test for OSA is established using the Apnea-Hypopnea Index (AHI) or Respiratory Distress Index (RDI) and specified criteria are met.
  • If the AHI or RDI is calculated based on less than two hours of continuous recorded sleep, the total number of recorded events to calculate the AHI or RDI during sleep testing is at least the number of events that is required in a two hour period.
  • They are deleting the distinct requirements that an individual “have moderate to severe OSA” and that “surgery is a likely alternative.”
  • CPAP based on clinical diagnosis alone or using a diagnostic procedure other than PSG or Type II, Type III, or a Type IV HST measuring at least three channels is covered only when provided in the context of a clinical study when that study follows specified standards.
NCD revised indications and limitations are noted in Appendix B. You can find the complete CMS update at: http://www.cms.hhs.gov/CoverageGenInfo/EmailUpdates/ItemDetail.asp?ItemID=CMS1208822


Special DME Review Moved to MACs

CMS transmittal CR 5909 replaces CR 5765, revising the transition date of medical review duties from the durable medical equipment (DME) program safeguard contractors (PSCs) to the DME Medicare administrative contractors (MACs).

Changes were made to Chapter 5 of the Program Integrity Manual (PIM). The items and services having special DME review considerations rules were revised and went into effect on March 1, and reflect the transition of medical review duties from DME PSCs to DME MACs.

You can find the complete transmittal on the CMS website at:
http://www.cms.hhs.gov/transmittals/downloads/R242PI.pdf.


"Spring" to Your Chapter in May

The weather is breaking and spring is upon us. It’s a great time to attend local chapter meetings, especially in May, as it will be Support Your Local Chapter month. Start spreading the word about your chapter and get involved in the action. There'll be contests, prizes and giveaways, so watch for more information to come from the AAPC. Spring to your local chapter—don't miss out on the fun!


EdgeBlast Test Yourself

By answering the following questions, you can earn 0.5 continuing education units to apply toward your annual AAPC CEU renewal every two years. 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.

Index #EB03022008A
Use this number to document your ½ CEU for this EdgeBlast.

1. How long is the coverage of CPAP limited to for beneficiaries diagnosed with OSA?

Answer:

2. CMS allows coverage of CPAP based upon a diagnosis of OSA by what?

Answer:

 

3. The AMA agrees with MedPAC to use innovative solutions like comparative effectiveness research to do what?

Answer:

 

4. The items and services having special DME review considerations rules were revised to reflect what transition of medical review duties?

Answer:

 

5. What pay cut will force 60 percent of physicians to limit the number of new Medicare patients they can treat, and more than half say it will force them to reduce their medical office staff?

Answer:

 

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