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Issue #112 - November 5, 2008 
AAPC EdgeBlast

FCA Ruling Reiterates the Importance of Compliance
A recent U.S. Supreme Court ruling re-affirms liability under the federal False Claims Act (FCA) regardless of whether the person causing the submission of false claims to the government financially benefitted from their actions. The ruling denied a petition requesting the review of an appeal’s court decision to allow a Qui Tam suit against state officials involved in federal-state programs such as Medicaid under the federal False Claims Act (FCA) (Wilcox v. United States ex rel. Stoner, U.S., No. 07-1336, review denied 10/6/08). Read more »

Comment »

Protests Halt RAC Activity
Protests by companies not chosen have forced the Centers for Medicare & Medicaid Services (CMS) to halt the activity of four new Recovery Audit Contractor (RAC) winners awarded Oct. 6:
  • Diversified Collections Services
  • CGI Technologies and Solutions
  • Consulting Associates
  • HealthDataInsights
Read more »

Comment »

CMS Issues 2009 OPPS/ASC Final Rule
The Outpatient Prospective Payment System/Ambulatory Surgical Center Payment System (OPPS/ASC) 2009 final rule includes a 3.6 percent annual inflation update for hospital outpatient departments (HOPDs), but sets the ASC update at 0 percent. The Centers for Medicare & Medicaid Services (CMS) projects final 2009 payment rates under the OPPS will result in a 3.9 percent increase in Medicare payments for providers paid under the OPPS. CMS issued the OPPS/ASC 2009 final rule Oct. 30. Read more »

Comment »

2009 MPFS Final Rule: Tidings of Joy
Physicians and non-physician practitioners (NPPs) who provide health care to people with Medicare can expect a pay hike next year, but just how much depends on their willingness to accept the conditions put forth in the 2009 Medicare Physician Fee Schedule (MPFS) final rule. Read more »

Comment »

Goblins Bring 2009 HCPCS Level II Codes
The Centers for Medicare & Medicaid Services (CMS) may have posted HCPCS Level II Halloween day, but there is little terrifying in the more than 400 additions, deletions, changes, and administrative adjustments.

The file, which will most assuredly be updated by year’s end and is slated to be altered quarterly through next year, included 160 new, 187 changed, and 77 deleted codes and modifiers. A number of codes received administrative changes or were re-used codes with new descriptions. Read more »

Comment »

Debate Over Drug Lawsuits Continues
Should individuals be allowed to sue pharmaceutical manufacturers when adverse reactions not clearly identified on drug labels occur? A recent court case has brought that question up for debate again.

The White House and the FDA general counsel say no. Drug regulators and advocacy group leaders say yes. David G. Savage reports on this Oct. 30 story for the Los Angeles Times.

Comment »

Health Insurers Enter Financial Sector
Don’t be surprised if your health insurer asks if you’d like a free gift for opening a health savings account (HSA). In exchange for a $10 toaster, there’s a lot of money to be had in managing your account.

“Insurers are moving away from their traditional role of pooling health risks and are reinventing themselves as money managers—providers of financial vehicles through which consumers pay for their own health care,” reports Michael A. Hiltzik (Los Angeles Times, Oct. 22). Read more »

Comment »

Bailout Could Undermine Health Reform
The $700 billion government plan to rescue the financial sector-passed by the U.S. House of Representatives on Oct. 3 will impact health care regardless of who is elected as the next president of the United States, according to writer Bryant Furlow for the November edition of The Lancet Oncology.

Even though Sens. John McCain's and Barack Obama's health care plans are radically different, Furlow writes prior to the Nov. 4 election, "The U.S. government economic bailout will almost certainly diminish prospects for health reform." Read more »

Comment »

2009 Ambulance Inflation Factor Set
Providers and suppliers of ambulance services can expect a 5 percent inflation adjustment in their 2009 Medicare reimbursements, compared to 2.7 percent in 2008.

You only have until Dec. 31, however, to collect the 25 percent per mile bonus payment for ground ambulance trips 51 miles or greater. Medicare has paid the 25 percent increase in addition to the existing per mile reimbursement rate since July 1, 2004, but the party ends on New Year’s Eve.

For more information about the ground ambulance base rate, go to the Centers for Medicare & Medicaid Services’ (CMS) Web site and read transmittal R1607CP or MLN Matters article MM6113.

Comment »

Celebrate National Radiologic Technology Week
Have you thanked your radiologic technologists (RT) today? It’s not too late to join the American Society of Radiologic Technologists (ASRT) Nov. 2-8 in their 29th annual National Radiologic Technology Week (NRTW) celebration.

The NRTW celebration commemorates the anniversary of the X-ray’s discovery by Wilhelm Conrad Roentgen on Nov. 8, 1895 and calls attention to the valuable work of RTs in the health care field. This year’s NRTW theme: “Every Picture Tells a Story.”

To recognize the vital work of your RTs, the ASRT recommends organizing activities that bring prestige, credibility, and value to the profession. Go to the ASRT Web site for more information and for ideas on how to celebrate NRTW.

Comment »

HHS Preparing to Open FDA Offices Overseas
To better safeguard the supply of food and medicines imported into the United States, the U.S. Department of Health and Human Services (HHS) will send the first U.S. Food and Drug Administration (FDA) staff to China, India, Europe, and Latin America before the end of 2008, HHS Secretary Mike Leavitt announced in an Oct. 16 news release.

“In the past year, we’ve upgraded labs and equipment, hired additional staff, and begun implementing product safety agreements with key trading partners, including China,” Secretary Leavitt said. Read more »

Comment »

Coding Tips
CPAP Therapy Test Criteria Open to Interpretation
Centers for Medicare & Medicaid Services (CMS) released a transmittal on Oct. 15 clarifying the policy for conducting continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea (OSA). Guidelines specify that the respiratory disturbance index (RDI) is equal to the average number of respiratory disturbances per hour of continuous monitoring. “However, there is variability in the published medical literature about the definition of the events that constitute a respiratory disturbance,” states CMS in transmittal 96.

A respiratory disturbance does not require direct measurement of airflow because RDI is defined in the context of the specific sleep test technology under review. This clarification allows local contractors to determine, based on their review of the published, peer-reviewed medical literature, the equivalent test result criteria.

CPAP therapy is a non-invasive technique for relieving OSA.

Comment »

Medical News
Vaccines Ready For Flu Season
If your practice or facility isn’t vaccinating patients by now, the vaccines are available. Here’s the latest from the FDA.

The Federal Food and Drug Administration (FDA) has approved six vaccines for the 2008-2009 flu season:

  • Afluria, for adults 18 years of age and older
  • Fluarix, for adults 18 years of age and older
  • FluLaval, for adults 18 years of age and older
  • Fluvirin, for people 4 years of age and older
  • Fluzone, for people 6 months of age and older
  • FluMist, for people ages 2 to 49

Read more »

Comment »

Raptiva Label Warns of Opportunistic Infections
The U.S. Food & Drug Administration (FDA) announced on Oct. 16 labeling changes, including a boxed warning, to highlight the risks of life-threatening infections with the use of Raptiva (efalizumab). The FDA requires the submission of a Risk Evaluation and Mitigation Strategy (REMS), which includes a medication guide for patients and a timetable for REMS assessment. Read more »

Comment »

FDA Creates Drug Safety Web Page
Consumers and health care professionals can now go to a single page on the U.S. Food and Drug Administration’s (FDA’s) Web site to find a wide variety of prescription drugs safety information. The Web page provides links to everything drug related—from information regarding drug labeling to drug-specific safety information, and much more.

Comment »

New Treatment Options for Allergy Sufferers
Allergy suffers have a couple of new treatment options. For patients 12 years of age and older diagnosed with seasonal allergic rhinitis, the U.S. Food and Drug Administration (FDA) has approved Astepro Nasal Spray—the new formulation of Astelin. Read more »

Comment »

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Featured Items
Importance of Compliance
Protests Halt RAC Activity
2009 OPPS/ASC Final Rule
'09 MPFS Final Rule
'09 HCPCS Level II Codes
Debate Over Drug Lawsuits
Insurers Financial Sector
Bailout Undermine
'09 Ambulance Inflation
Radiologic Tech Week
FDA Offices Overseas
Coding Tips
Medical News
Coding Job Links
Test Yourself Online

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