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Issue #122 - April 1, 2009
AAPC EdgeBlast

Red Flag Combats PHI Theft May 1
The new Red Flags Rules go into effect May 1. These rules, enforced by the Federal Trade Commission (FTC), are meant to combat consumer identity theft, and apply to any business qualifying as a creditor or financial institution under the law. Read more »

Comment »

OIG Sends an Open Letter to Providers
Inspector General Daniel R. Levinson said in an Open Letter sent to health care providers March 24 that the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) is refining its Self-Disclosure Protocol (SDP).

"We are narrowing the SDP’s scope regarding the physician self-referral law," Levinson writes. Read more »

Comment »

A/B MAC J14 States Get New Workload Numbers
Part of the transition to Part A and Part B Medicare Administrative Contractors (A/B MACs) involves the Centers for Medicare & Medicaid Services (CMS) assigning new workload numbers. CMS Transmittal 463, Change Request (CR) 6406, issued March 24, conveys new Medicare contractor workload numbers for states in jurisdiction 14 to go into effect as early as May 2. Read more »

Comment »

Stimulus Bill Provides Hospitals
Extra $268 Million

The U.S. Department of Health and Human Services (HHS) announced March 20 that states can access an additional $268 million in stimulus funds to help hospitals cover the costs associated with treating a large share of under-privileged people. Read more »

Comment »

AMA Led Group Sues WellPoint
Over Reimbursement

The American Medical Association (AMA) is leading a group of doctors and medical societies in a lawsuit against payer WellPoint, Inc., charging it set reimbursement rates for out-of-network services artificially low.
Read more »

Comment »

Doctors Raise Doubts
on Digital Health Data

Articles published in the New England Journal of Medicine’s April issue present a bleaker picture for the $19 million, multi-year electronic health record (EHR) initiative included in the Stimulus Package adopted last month. 

The papers point to greater obstacles, practical and financial, than previously thought. Read more »

Comment »

GAO: CMS Must Contain
Home Health Spending

A U.S. Government Accountability Office (GAO) report says improvements are needed to address improper payments in home health—indicating fraud and abuse are largely to blame for Medicare home health spending skyrocketing to $12.9 million in 2006. Read more »

Comment »

President Obama Proposes
Imaging Preauthorization
A line item in the proposed 2010 federal budget sent to Congress Feb. 27 by the White House asks to "ensure that Medicare makes appropriate payments for imaging services through the use of radiology benefit managers" in order to cost utilization costs. Read the full story on DiagnosticImaging.com.

Comment »

Roundtable Considers
Quality of Care Methodology

A recent government-industry roundtable discussion surmised that quality of care cannot be measured in financial terms alone. Adequately measuring quality of care requires a committed and informed board of directors, an effective use of dashboards, a sound business case, accountability, participation, transparency, and peer-to-peer comparisons.
Read more »

Comment »

Coding Tips
Abbreviated PQRI and E-Prescribing Guidance
Have you had a chance to read the 2008 Medicare Improvements for Patients and Providers Act (MIPPA) yet? How about the 2009 Medicare Physician Fee Schedule (MPFS) final rule? Come on, it’s only 513 pages! Well, if you’re short on time, you may want to read Transmittal 459, Change Request (CR) 6394. The Centers for Medicare & Medicaid Services (CMS) issued the transmittal March 20 to provide an overview of the 2009 Physician Quality Reporting Initiative (PQRI) and E-prescribing Incentive Program.
Read more »

Comment »

Important Changes in April 2009 OPPS Update
A Recurring Update Notification (RUN) released March 13 by the Centers for Medicare & Medicaid Services (CMS) describes important coding and billing changes and instructions for various payment policies implemented in the April 2009 Outpatient Prospective Payment System (OPPS) update. Read more »

Comment »

Don't Choose Shoulder Scope Codes Off the Cuff
Reimbursement for orthopedic surgeries under the Medicare Ambulatory Surgical Centers (ASC) payment system may be on the rise, but improper coding based on inadequate documentation can still leave your practice shouldering the burden. An article in the March issue of Outpatient Surgery Magazine offers guidance for accurately coding shoulder scopes. Read more »

Comment »

Medical News
CMS Reconsiders NCD for PTA
In light of recent data, the Centers for Medicare & Medicaid Services (CMS) is reconsidering the National Coverage Determination (NCD) for percutaneous transluminal angioplasty (PTA) of the carotid artery concurrent with stenting. Read more »

Comment »

Federal Court Orders Teen Access
to Morning After Pill

A federal court ordered the Food and Drug Administration (FDA), March 16, to expand access to emergency contraception (also known as Plan B or the "morning after" pill). Read more »

Comment »

Stent Renders Dialysis Unnecessary
A small metal tube or stent that connects her kidney to her bladder has eliminated one 63-year-old London woman’s need for dialysis. Read more »

Comment »

Contraceptive Makers Get an Incentive to Lower Costs
A provision in the 2009 federal budget bill (H.R. 1105), signed March 11 by President Barack Obama, could possibly undo what the Deficit Reduction Act of 2007 (DRA) did, which was to double or, in some cases, triple the price of oral contraceptives, AP/Google.com reports.
Read more »

Comment »

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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Featured Items
Combat PHI Theft
Open Letter to Providers
A/B MAC J14
Stimulus Bill
AMA Sues WellPoint
Digital Health Data
Home Health Spending
Imaging Preauthorization
Care Methodology
Coding Tips
Medical News
Test Yourself Online
Coding Job Links


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