AAPC January 5, 2007
Edge Blast Header

Issue #68

Top News

Medicare Auditors Recover Millions in Overpayments

Few HIPAA Privacy Complaints Reach Investigation

CMS Enhances Performance Measures in HCPCS 2007

Federal Register


Nominations for Networker of 2006
are now being accepted online, click here.

Nominations must be submitted by February 2, 2007

Make 2007 the year you get involved with your local chapter.  There are great opportunities for networking,  education, and career development.  There is a local chapter for everyone! 

If you need help finding yours call the AAPC Local Chapter Department at 800-626-2633. 

EdgeBlast Test Yourself


January 19, 2007
Wausau, WI – North Central Technical College
2007 Coding Updates
André McDaniel, CPC

January 20, 2007
San Diego, CA – Sharp Healthcare
2007 Coding Updates
Annette Grady, CPC, CPC-H, CPC-P

January 20, 2007
Seattle, WA – Highline Community Hospital
2007 Coding Updates
Betty Hovey-Johnson, CPC, CCS-P, CCP, CIC

January 20, 2007
Tulsa, OK – University of Oklahoma
Coding for Trauma and Emergency Medicine
Robin Linker, CPC, CPC-H, CPC-P, CCS-P, MCS-P, CHC

January 26, 2007
Auburn Hills, MI – Holiday Inn
E/M Chart Auditing for Physicians and Coders
Jane Tuttle, CPC, CCS-P

January 26, 2007
Austin, MN – Holiday Inn
Advanced E/M Coding
Stephen Levinson, MD

January 26, 2007
Cherry Hill, NJ – 3 Executive Campus
Coding for Internal Medicine and Geriatrics
Vicky O’Neil, CPC, CCS-P

January 27, 2007
Saint Paul, MN – Lakeview Hospital
Surgical Orthopedic Coding
Annette Grady, CPC, CPC-H, CPC-P

Visit our workshop page for more information.

AAPC Audio Conferences

January 17, 2007
Heart Smart: Cardiology Coding
Betty Hovey-Johnson, CPC, CCS-P, CCP, CIC

January 24, 2007
How to Start a Chart Review
Annette Grady, CPC, CPC-H

January 30, 2007
Orthopaedic Coding
Margie Vaught, CPC, CPC-H, PCE, CCS-P, MCS-P

February 7, 2007
Sleep Medicine Coding: Staying Awake Through Updates
Jill Young, CPC

February 13, 2007
Diagnostic Dilemmas in Diabetic Coding
Vicky O’Neil, CPC, CCS-P

February 21, 2007
Functional Endocscopic Sinus Surgery
Barbara Cobuzzi, MBA, CPC, CPC-H, CHBME

To register or for further information on upcoming audio conferences contact the AAPC at 800-626-2633.

Read the EdgeBlast and Earn CEUs Toward Your Annual Renewal

You can now earn continuing education units (CEUs) by reading the Academy’s EdgeBlast. Simply answer the five questions found in the EdgeBlast Test Yourself at the end of the Top Stories and submit your answers at the time of your renewal, using the same process you follow monthly for the Test Yourself in the Cutting Edge. Each EdgeBlast (there are two issued each month,) will feature five questions that can earn you .5 CEUs, for a total of 12 CEUs annually.

Expect Changes to HIPAA Approved Transactions and Code Sets
A proposed rule anticipated for publication in March 2007 would revise some of the adopted transaction and code set standards detailed in regulations published by HHS on August 17, 2000, and February 20, 2003.

Chris Fraizer

Top News

by Chris Fraizer, MA, CPC
Medicare Auditors Recover Millions in Overpayments

Recovery Audit Contractors (RACs) identified $303.5 million in improper payments during the first year of a three-year Centers for Medicare and Medicaid Services (CMS) demonstration project, including $17.9 million from physicians. Three quarters of overpayments (77 percent) came from hospitals.

Of the total amount identified, the RAC has collected $68.6 million and $2.9 million in underpayments have been paid back; an additional $232.0 million is in the collection or repayment process. The project has paid $14.5 million in RAC contingency fees, expenses incurred by the claims processing contractors to support the RAC program, plus the costs of evaluating the program.

CMS plans to release a corrective action plan in February that outlines jurisdiction-specific initiatives to prevent further payments identified during the first year of the project.

The RAC project was established under section 306 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), which requires the demonstration for payments made under Part A or Part B. The demonstration does not include audits of payments for Medicare Part C (managed care) or Part D (the prescription drug benefit).


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Few HIPAA Privacy Complaints Reach Investigation

Less than five percent of the medical privacy complaints lodged with the Office for Civil Rights (OCR), of the Department of Health and Human Services (HHS), made it to the Department of Justice (DoJ) for investigation, according to the Melamedia’s 3

rd Annual Review of Medical Privacy and Security Enforcement.

The report, released in December 2006, shows that of the 22,664 complaints received by the OCR from April 2003 through September 30, 2006, approximately 5,400 (23.8 percent) merited further investigation or action.

Other findings in the Melamedia report include:

  • Of the 5,400 complaints that were pursued, OCR took informal action in 3,700 cases
  • Of the remaining 1,700, OCR found that the covered health care organization named in the complaint had not violated the HIPAA privacy rule
  • Of the 5,612 complaints the department received from January 1, 2006, through October 31, 2006, only 72 were filed with the DoJ, which, at that time, had 346 open cases to resolve since April 2003 when the complaint system started

Melamedia concludes that 17,175 complaints were not referred for investigation since they did not meet the OCR criteria for further investigation due to problems such as a lack of jurisdiction over the entity named in the complaint, untimely filing of the complaint, or allegations in the complaint that do not constitute violations of the privacy rule.


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CMS Enhances Performance Measures in HCPCS 2007

The 155 codes tracking codes (G8191-G8347) that the Centers for Medicare and Medicaid Services (CMS) added to the HCPCS Level II code set are similar to the AMA Category II codes used to measure clinical performance, and they are anextension of the Physician Voluntary Reporting Program (PVRP) that the agency has had on a trial run since January 1, 2006.

The section, which the AMA headlined “Last Minute Code Changes” in its early publication of the HCPCS manual, is the major addition to the HCPCS Level II code set that went into effect January 1, 2007. The codes added this year are in addition to the existing 105 PVRP associated codes.

Under the voluntary reporting program, participating physicians are given the option of sending CMS information about the quality of care they provide to Medicare beneficiaries through the use of CMS selected quality measures. In return, CMS provides them with confidential feedback on their performance.

For each measure, CMS provides several options among the G codes, and many measures have from three to four possibilities. For example, one code can be reported to indicate the patient was eligible to receive a certain therapy, while another G code in the series would indicate was not eligible for the same therapy due to certain restrictions. The other G codes in the same series would report whether the physician documented the therapy and the status of any rehabilation services.

In last year’s set, guidelines provided the CPT® codes to report in associaton with the G code. The guidelines were not available at the same time as the initial release of the HCPCS codes in October; however, the measurements and their associated codes and guidelines are available from the PVRP web site at http://www.cms.hhs.gov/PV RP/01_Overview.asp.


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Federal Register

December 22, 2006 (Volume 71, Number 246)
http://www.acc ess.gpo.gov/su_docs/fedreg/a061222c.html

This proposed rule would implement the provisions of the Deficit Reduction Act of 2005 (DRA) pertaining to prescription drugs under the Medicaid program. The DRA requires the Secretary of Health and Human Services to publish a final regulation no later than July 1, 2007. In addition, we would add to existing regulations certain established Medicaid rebate policies that are currently set forth in CMS guidance. This rule would bring together existing and new regulatory requirements in one, cohesive subpart.

December 21, 2006 (Volume 71, Number 245)
http://www.acc ess.gpo.gov/su_docs/fedreg/a061221c.html

This notice amends Part A (Office of the Secretary), chapter AF of the Statement of Organization, Functions, and Delegations of Authority for the Department of Health and Human Services (HHS) to reflect title changes and responsibilities within the Office of Inspector General's (OIG) Office of Evaluation and Inspections (OEI), Office of Management and Policy (OMP), Office of Investigations (OI), and Office of Audit Services (OAS). The statement of organization, functions, and delegations of authority conforms to and carries out the statutory requirements for operating OIG. Chapter AF was last published in its entirety on April 18, 2005 (70 FR 20147).

These organizational changes are primarily to realign the functions of OMP, OAS, OI, and OEI to better reflect the current work environment and priorities and to more clearly delineate responsibilities for the various activities within these offices.

December 13, 2006 (Volume 71, Number 239)
http://www.acc ess.gpo.gov/su_docs/fedreg/a061213c.html

The final rules govern provisions prohibiting discrimination based on a health factor for group health plans and issuers of health insurance coverage offered in connection with a group health plan. The rules contained in this document implement changes made to the Internal Revenue Code of 1986 (Code), the Employee Retirement Income Security Act of 1974 (ERISA), and the Public Health Service Act (PHS Act) enacted as part of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

December 11, 2006 (Volume 71, Number 237)
http://www.acc ess.gpo.gov/su_docs/fedreg/a061211c.html

The annual notice solicits proposals and recommendations for developing new and modifying existing safe harbor provisions under the Federal anti-kickback statute (section 1128B(b) of the Social Security Act), as well as developing new OIG Special Fraud Alerts.

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EdgeBlast Test Yourself

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 Edge Blast included in your submission. The number is available at the top of the page.

And don’t forget about the new CEU policy: CEU submissions will be submitted every two years instead of every year.  The number required to submit for single certified members will be 36 every two years, 48 every two years for double certified members, and 60 every two years for triple certified members.

1. What are the five G codes that report the various levels of emergency visits, and found in the 2007 HCPCS Level II code set?

2. The Centers for Medicare and Medicaid Services initiated a screening benefit to detect abdominal aortic aneurysms this year and the benefit is offered as part of the Welcome to Medicare physical exam. What G code is used to report the screening benefit?

3. A trained genetic counselor provides 60 minutes of face-to-face services to a patient recently diagnosed with Long QT syndrome. What is the diagnosis code for the syndrome, and the CPT® code for the counseling?

4. The surgeon excises a melanoma of the trunk and prepares a 20 sq cm site for the immediate application of a skin graft (dermal autograft). What are the codes for the surgical preparation and the application of the graft?

5. The radiologist performs a bilateral diagnostic mammography using computer-aided detection in a procedure that includes further review and interpretation. What is the correct way to report the services provided?

This installment of the Edge Blast coincides with the January 1, 2007 effective date of new CPT® and HCPCS Level II codes, so the following questions will require the use of the 2007 manuals. The HCPCS Level II codes are also available online from CMS at http://www.cms.hhs.gov/HCPCSReleaseCodeSets/ANHCPCS/list.asp#TopOfPage .

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