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Issue #120 - March 4, 2009  
AAPC EdgeBlast

Obama Pulls Health Team Together
President Obama is pulling his health care team together.

Monday, he nominated Kansas Governor Kathleen Sebelius as his choice for secretary of Health and Human Services (HHS) Monday.  As secretary of HHS, Sebelius would oversee a department of 65,000 employees with a budget of more than $700 billion. Sebelius is currently in her second term as govenor of Kansas, where she served as state insurance commissioner for eight years and oversaw the state’s Medicaid program. Read more »

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2009 HCPCS Codes
Affected by CLIA Edits

The Centers for Medicare & Medicaid Services (CMS) has updated the list of HCPCS codes subject to or excluded from Clinical Laboratory Improvement Amendments (CLIA) edits for 2009.
Read more »

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ASP Amount for OPPS Changed
Beginning Jan. 1, 2009, under the Outpatient Perspective Payment System (OPPS), payment allowance limits for specified covered outpatient drugs are paid at the average sales price (ASP) plus 4 percent. Read more »

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New Billing
Instructions for DME Suppliers

New HCPCS Level II codes for the repair, maintenance, and servicing of oxygen equipment go into effect April 1. The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) changed how Medicare pays for oxygen equipment and supplies. Read more »

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2009 PFS Changes
Anti-Markup Payment Limitations

Contractors will soon process Medicare claims for diagnostic tests subject to the anti-markup payment limitation based on new rules outlined in the 2009 Physician Fee Schedule (PFS). Read more »

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Implementation of
DMEPOS Final Rule Delayed

The effective date for the final rule "Medicare Program; Competitive Acquisition of Certain Durable Medical Equipment, Prosthetic, Orthotics and Supplies (DMEPOS) by Certain Provisions of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA)" has been delayed another 60 days. Read more »

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Be Prepared
When Calling CMS Customer Service

Very soon you won't be able to make inquiries to the Centers for Medicare & Medicaid Services' (CMS) interactive voice response (IVR) system or a customer service representative (CSR) without some very specific information. Read more »

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MedPAC Backs Physician Pay Raise
Medicare Payment Advisory Commission (MedPAC) said it will recommend in it's annual report to lawmakers that an annual update of 1.1 percent should be given to physicians and 0.6 percent to Ambulatory Surgical Centers (ASCs) in 2010. Although the pay increase is not in keeping with the 2.5 percent cost increase the commission estimates physicians will incur for providing care next year, it's far better than the 21 percent pay cut currently on the table. AMNews has the rest of the story.

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Coding Tips
Outpatient Therapy Caps Updated
The Centers for Medicare & Medicaid Services (CMS) updated the outpatient therapy cap exception policy and dollar amount for 2009.

Effective Jan. 1, the allowed outpatient therapy dollar limits, excluding outpatient hospital services, for physical therapy and speech-language pathology combined is $1,840 and for occupational therapy is $1,840. Providers who perform services meeting the exceptions criteria and report modifier KX Specific required documentation on file will be paid beyond this limit. Read more »

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CMS Clarifies DOS for Ambulance Services
The Centers for Medicare & Medicaid Services (CMS) reminds providers not to submit claims for services performed on deceased Medicare beneficiaries. And why not? Read more »

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Pain Management Diagnosis Tips
What do you do if your pain management specialist treats a chronic pain patient but can't uncover a definitive diagnosis? Using a non-specific diagnosis code may mean you don't get paid or are paid incorrectly. An article in Anesthesia & Pain Management Coding Alert may be just what the doctor ordered. Learn how to select the most specific diagnosis appropriate for the patient and make sure it's well-documented in the medical record as you read the article "Keep Chronic Pain Denial at Bay With Surefire Dx Tips" — compliments of The Coding Institute.

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CMS Warns of Modifier 79 Use
The Centers for Medicare & Medicaid Services (CMS) are instructing contractors to look much more closely at claims for services billed with modifier 79 Unrelated procedure or service by the same physician during the post operative period. Read more »

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Medical News
ACOG Issues New Guidelines for Managing Stillbirths
The American College of Obstetricians and Gynecologists (ACOG) issued, Feb. 20, a new Practice Bulletin for Ob/Gyns on the clinical management of stillbirths. The guidelines review what is known about stillbirth and highlight the importance of uniform data collection, according to an ACOG press release. Read more »

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Heartsbreath Test Rejected
The Centers for Medicare & Medicaid Services (CMS) has determined there is insufficient evidence the Heartsbreath Test for predicting heart transplant rejection improves health outcomes and says it is not covered. Read more »

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CT Colonography Fails NCA Test
The Centers for Medicare & Medicaid Services (CMS) proposes to make computed tomography (CT) colonography's noncovered status a national coverage determination (NCD). Read more »

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Artificial Kidney, Heart Pioneer Kolff Dies
Dr. Willem Kolff, a pioneer of kidney dialysis, heart-lung machines, and artificial organs, died in Pennsylvania February 11 of natural causes. He was 97. Read more »

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Test Yourself Online
The Test Yourself questions can be accessed online at www.aapc.com/testyourself/. 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.

Coding Job Links
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AAPC Employment Forums

Featured Items
New Health Team
CLIA Edits
ASP Amount
DME Suppliers
2009 PFS Changes
DMEPOS Final Rule
CMS Customer Service
Physician Pay Raise
Coding Tips
Medical News
Test Yourself Online
Coding Job Links


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