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Issue #115 - December 17, 2008 
AAPC EdgeBlast
Ground Ambulance Transports Get a Lift
The Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 amends the Social Security Act §1834(l)(13) and provides an increase in payment for ambulance ground transports.

Effective for claims with dates of service on or after July 1, 2008, and before Jan. 1, 2010, ambulance fee schedule amounts for covered ground ambulance transports which originate in a rural area increase by 3 percent, and covered ground ambulance transports which originate in a non-rural area increase by 2 percent.

For further details, read Transmittal 414, CR 6206 on CMS’s Web site.

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ESRD Payment Changes for 2009
End stage renal disease (ESRD) facilities can expect a 1 percent increase to the ESRD composition payment rate and a reduction in the drug add-on adjustment from 15.5 percent to 15.2 percent as a result of the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008. Read more »

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Its Official:
Daschle HHS Secretary Nominee

At a Dec. 11 news conference, President-elect Barack Obama formally nominated former Senator Tom Daschle to be the next Secretary of the Department of Health and Human Services (HHS). The South Dakota Democrat will also lead a White House health care reform team.

In a Dec. 11 news release, HHS Secretary Mike Leavitt said, "I have high regard for Senator Daschle. His leadership experience, familiarity with Washington, and interest in health care will serve him well as secretary." Read more

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Plan for Value-Based
Purchasing Program Underway

On Dec. 9, the Centers for Medicare & Medicaid Services (CMS) held a public listening session to discuss the development of a plan to transition to a Medicare value-based purchasing (VBP) program for physician and other professional services. CMS’s internal PVBP Workgroup released an issues paper outlining the agenda prior to the event.

Design issues discussed during the event and up for public comment until Dec. 16 included overarching questions, measures, incentive structure, data strategy and infrastructure, and public reporting — everything the PVBP Workgroup is charged with as they develop the VBP Plan.  Read more »

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SSA: Access to PHRs Could Benefit All
The Social Security Administration (SSA) is interested in developing a fully automated system to enable them to electronically retrieve information from personal health care records (PHRs). In a Nov. 20 request for information special notice, the SSA sought to identify possible sources who could assist in developing a prototype. Read more »

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NCDs Add to Never Event List
The Centers for Medicare & Medicaid Services (CMS) posted,  Dec. 2, proposed decision memos for three national coverage determinations (NCDs) adding to the list of "Never Events" Medicare will no longer reimburse as of March 2, 2009. Unlike Hospital Acquired Conditions (HACs), which only pertain to hospitals, these NCD-described events could also affect payment to physicians and other health care providers and suppliers involved in the following types of erroneous surgeries:

Read more

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Time to Update
Your RARC and CARC Lists

Make sure your billing staff is using the latest remittance advice remark codes (RARCs) and claim adjustment reason codes (CARCs). The Centers for Medicare & Medicaid Services (CMS) released a periodic update in November that includes several code changes. Read more »

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EHRs May Lower Paid Malpractice Suits
Is it possible that widespread electronic health records (EHRs) usage will result in fewer paid malpractice settlements? A recent study that appeared in the Nov. 24 issue of Archives of Internal Medicine says just maybe.

"The results of this study indicate that preventing medical malpractice claims may be another compelling reason for physicians, practices, and policymakers to forge ahead with efforts toward universal adoption and optimal usage of electronic health records," said Harvard University Assistant Professor Steven Simon, senior author of the paper. Healthcare IT News reports on this story.

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Coding Tips
Check Out Lab NCD Edit Software Changes
Changes made to the laboratory national coverage determination (NCD) edit software for January 2009 affect several areas including codes for HIV testing, partial thromboplastin time, prothrombin time, serum iron studies, blood glucose testing, and more.

For a complete list of changes, read MLN Matters MM6304 on CMS’s Web site.

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CMS: TIPs Not Reasonable or Necessary
The Centers for Medicare & Medicaid Services (CMS) has issued a national coverage determination (NCD) ruling thermal intradiscal procedures (TIPs) not reasonable and necessary for the treatment of low back pain performed on Medicare beneficiaries. Read more »

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CMS Revises HCPCS Jurisdiction List
The Centers for Medicare & Medicaid Services (CMS) has revised the 2008 jurisdiction list for Durable Medical Equipment Prosthetics, Orthotics, and Supply (DMEPOS) Healthcare Common Procedure Coding System (HCPCS) codes to clarify that HCPCS Level II code A4559 Coupling gel or paste, for use with ultrasound device, per ounce may only be billed to the local carrier. Read more »

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Medical News
Coalition: Health Care Reform Starts Now
Can the United States really cut billions of dollars from its health care bill, and improve the quality of medical care, simply by refusing to pay for unnecessary medical procedures? Sure. Can it be done without legislation? A national coalition seems to think so.

Chen May Yee reports for the Star Tribune.

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ACP Recommends Routine HIV Screening
The American College of Physicians (ACP) gave physicians a call-to-action during World AIDS Day, Dec. 1, to routinely encourage HIV screening to all patients 13 years and older.

"ACP recommends that physicians adapt a routine screening policy for HIV and encourage their patients to get tested, regardless of their risk factors," said Amir Qaseem, MD, PhD, MHA, senior medical associate in ACP’s Clinical Programs and Quality of Care department and the lead author of the guideline. Read more »

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Make the E-Prescribing Switch With Ease
Incentives for electronic prescribing or e-prescribing go into effect Jan. 1, 2009 as a result of the Medicare Improvements for Patients and Providers Act (MIPAA) of 2008 (H.R. 6331, Sec. 132). If your practice is considering the switch from paper to e-prescribing, you might first read "A Clinician’s Guide to Electronic Prescribing." Read more »

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Give Your Claims Process a Checkup
Physicians nationwide have made it known that they feel inflated bureaucratic demands are forcing them to spend more time doing paperwork than doctoring. In response, the American Medical Association (AMA) launched the "Heal the Claims Process™" campaign.

November was "Heal the Claims Process™" month, but it’s always a good time to give your claims process a checkup.

Go online to the AMA Web site to learn more about the campaign and the available resources. The checklist "Prescription for a Healthier Practice: Physician Claim Process Checkup" will have you feeling better about your practice in no time.

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CDC: Physicians Continue Flu Vaccine
The Center for Disease Control and Prevention (CDC) is urging physicians to continue administering Influenza (flu) vaccines well past the holiday season. Flu activity historically doesn’t peak until January or later, according to the Advisory Committee on Immunization Practices (ACIP), so it is still very worthwhile to continue immunizing patients well into December and beyond. Read more »

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CPC®s Make "30 Under 30"
Several AAPC members are featured in the Dec. 1 article "30 Under 30" in the industry journal Advance for Health Information Professionals.

The magazine chose the health information management professionals because they are "primed, prepped, and certified to take on the challenges of EHR and HIT."

AAPC certified coders featured include Alaina M. Boncher, CPC®, from Green Bay, Wis.; Jenny Amador, CPC®, of Tampa, Fla.; Jessica Rawl, CPC®, Columbia, S.C.; Rachael Milley, CPC®, Stuart, Fla; and Rachel Senn Wilson, CPC®, Columbia, S.C.

Find out more about these up-and-comers on

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Survey Says: Primary Physicians Want Out
Many physicians battle with how to remain devoted and compassionate to patients when faced with HMO paperwork, long days, and receiving less money for services. Some primary care physicians are opting into early retirement and switching to specialized care due to poor reimbursement, increased regulations, time constraints, and low morale in the primary care setting.

A recent survey shows why many doctors are looking to other professions. Listen to Dr. Sidney Spiesel and surveyed physicians talk about their frustrations and coping mechanisms on NPR Audio News Clip.

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Test Yourself Online
The Test Yourself questions can be accessed online at Once you go there and take the test, you can automatically grade your answers, correct any mistakes, and have your CEUs automatically added to your CEU Tracker for submission.

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Featured Items
Ambulance Transports
ESRD Payment Changes
HHS Secretary Nominee
Value-Based Purchasing
Access to PHRs
Never Event List
Malpractice Suits
Coding Tips
Medical News
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