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Issue #113 - November 19, 2008 
AAPC EdgeBlast

HHS Reports on Personalized Health Care
Someday, patient medical care will be differentiated based on variations on individual biology. Physicians will prescribe medicine according to patient’s metabolism and other factors that cause certain prescription medication to work well with some, but not others. Someday may be sooner than you think. Read more »

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Democratic Health Care Reform Plan Unveiled
Senate Finance Committee Chairman Max Baucus published his plan for health care reform on Nov. 12, and it bears striking resemblance to President-elect Barack Obama’s plan. The message is the same: universal coverage, reduced health care costs, and improved quality care. Read more »

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For Physicians, the Check is in the Mail
More than $13 million in settlement disbursements were mailed out to physicians who submitted valid claims in the Highmark and Capital Blue Cross lawsuits, reported the American Medical Association’s (AMA) eVoice. Read more »

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PHR Choice Pilot Companies Selected
The Centers for Medicare & Medicaid Services (CMS) has named four personal health record (PHR) companies to participate in the Medicare PHR Choice Pilot, according to a Nov. 12 press release. The pilot will be conducted in Arizona and Utah, and is slated to begin early 2009.

The four PHR companies are: Google Health, HealthTrio, NoMoreClipboard.com, and PassportMD. Read more »

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Medical Home Demonstration an Attempt for Reform
In 2007, Medicare Part B covered almost 41 million people with benefit payments equaling $176.4 billion. National health care costs are projected to reach $4.3 trillion in 2017, up from $2.1 trillion in 2006 (Brief Summaries of Medicare & Medicaid, Nov. 1, 2008).

Although the consensus is out on how to decrease health care costs and increase coverage without sacrificing quality of care, everyone seems to agree that these things must be done. Read more »

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Court Finds Medicare Policy Unlawful
A federal district court last month found Medicare and some of its contractors had unlawfully limited payments for DuoNeb, an inhalation drug used to treat chronic obstructive pulmonary disease, according to The New York Times. Read more »

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Red Flag Rule Enforcement Buys More Time for Providers
The Federal Trade Commission (FTC) will suspend enforcement of the new Red Flags Rule until May 1, 2009. This gives financial institutions and creditors (as well as medical practices) additional time to implement written identity theft prevention programs. The Enforcement Policy Statement release does not affect other federal agencies’ enforcement of the original Nov. 1 deadline for institutions subject to compliance. Read more »

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Coding Tips
Therapy Services Coding Requirements Updated
The Centers for Medicare & Medicaid Services (CMS) updated the therapy services chapter of the Medicare Claims Processing manual to reflect the extension of the therapy caps exceptions process to Dec. 31, 2009, mandated by the Medicare Improvements for Patients and Providers Act (MIPAA) of 2008. CMS also added HCPCS Level II coding requirements. Read more »

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New C Code Better Late Than Never
Hospitals can add to their list of covered services new HCPCS Level II code C9899, Implanted prosthetic device, payable only for inpatients who do not have inpatient coverage, that will be effective for services furnished on or after Jan. 1, 2009. Use form TOB-12X for claims of this nature.

This code was missing from an earlier Centers for Medicare & Medicaid Services (CMS) transmittal. Transmittal 1628, issued Nov. 3, rescinds transmittal 1597, issued Sept. 12. Read more »

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Medical News
CMS Proposes to Limit Bariatric Surgery Coverage
In a proposed decision memo, the Centers for Medicare & Medicaid Services (CMS) states that there is little evidence to support open and laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, or open and laparoscopic biliopancreatic diversion with duodenal switch as reasonable and necessary in patients with type 2 diabetes mellitus (T2DM) and a body-mass index (BMI) less than 35. Read more »

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Telehealth Service Sites Expanded
As of Jan. 1, 2009, eligible originating sites for payment of telehealth services will include hospital-based or critical access hospital-based renal dialysis facilities (including satellites), skilled nursing facilities and community mental health centers. This amendment to the Social Security Act is mandated by the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008. Read more »

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OIG: States are Unprepared for Emergencies
In 2002, less than a year after 9/11, the U.S. Department of Health and Human Services (HHS) made available more than $7 billion in funding to increase state and local public health preparedness and emergency response capabilities. In 2006, the Centers for Disease Control (CDC) allocated $766 million of that to 62 awardees to meet nine out of 11 preparedness requirements for Preparedness Goal 3: Detect and Report through its Public Health Emergency Preparedness Cooperative Agreement (Cooperative Agreement).  Six years later, with the completion goal of 2010 less than 2 years away, less than 10 percent of states have met two of the nine requirements, concludes the Office of Inspector General (OIG) in an October 2008 report. Read more »

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FDA Seizes Contaminated Heparin
The U.S. Food and Drug Administration (FDA) seized 11 lots of contaminated heparin—a blood thinner drug—from Celsus Laboratories Inc. on Nov. 6, according to an FDA news release.

The 11 lots consisted of five lots of Heparin Sodium Active Pharmaceutical Ingredient (API) and six lots of Heparin Lithium. These products were manufactured in China and found to be contaminated with over-sulfated chondroitin sulfate (OSCS)—a substance that mimics heparin’s anticoagulant activity. Read more »

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Insulin Syringe May Lead to Death
Let diabetic patients know Tyco Healthcare Group LP (Covidien) recalled one lot of ReliOn 31-gauge, 1cc insulin syringes due to possible mislabeling.

According to a U.S. Food and Drug Administration Nov. 5 news release, there was a mix up during the packaging process and some syringes labeled for use with U-40 insulin were mixed with syringes labeled for use with U-100 insulin. The syringes were then packaged individually and boxed as 100 units for use with U-100 insulin. Read more »

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Featured Items
Personalized Health Care
Reform Plan Unveiled
Check is in The Mail
Pilot Companies Selected
Attempt for Reform
Medicare Policy Unlawful
More Time for Providers
Coding Tips
Medical News
Coding Job Links
Test Yourself Online


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