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Issue #123 - April 15, 2009
AAPC EdgeBlast

Leaders Propose Ways to Lower Hospital Readmissions
Approximately 20 percent of Medicare beneficiaries discharged from a hospital were rehospitalized within 20 days, according to a recent article in the New England Journal of Medicine. Read more »

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CMS Expands PET Scan Coverage
A National Coverage Determination (NCD) issued April 3 by the Centers for Medicare & Medicaid Services (CMS) expands coverage of positron emission tomography (PET) scans for the diagnosis and treatment of most solid tumor cancers in Medicare patients and removes the clinical study requirement in some cases.
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CMS Eases Internet-based PECOS Security
The Centers for Medicare & Medicaid Services (CMS) has made an important change to its Internet-based Provider Enrollment, Chain and Ownership System (PECOS) that will free up a lot of time for physicians and non-physician practitioners (NPPs). Read more »

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2010 Federal Budget Agreement Draws Near
President Obama’s proposed 2010 federal budget is a vast $3.5 trillion. The House passed their version of the budget April 2, and the Senate passed their version shortly thereafter. Read more »

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Bill Seeks to Advance Cancer Research into the 21st Century
Senator Edward Kennedy (D-Mass.) and four additional sponsors introduced legislation (S.717) on March 26 that seeks to “modernize cancer research, increase access to preventative cancer services, provide cancer treatment and survivorship initiatives,” and more. Read more »

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New Report Outlines Health System Reform
The American Medical Association (AMA) and other national health system stakeholder organizations released a report March 27 entitled “A Dialogue on U.S. Health Reform.” While the AAPC has not endorsed this report, numerous organizations have and we thought you might be interested. The report outlines potential steps health care providers, employers, consumers, insurers, public health professionals, and others need to take toward health system reform.
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Coding Tips
New Clinical Guidelines Released for OB-GYN Visits
New clinical guidelines jointly released by American College of Obstetricians and Gynecologists (ACOG) and the Society of Gynecologic Oncologists (SGO) recommend all obstetrician/gynecologists (OB/GYNs) evaluate a patient’s risk for hereditary breast and ovarian cancer as a routine part of their practice.
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Know Your Hospice Cap Appeal Rights
The Centers for Medicare & Medicaid Services (CMS) issued Change Request (CR) 6400, Hospice Cap Calculations Letters and Administrative Appeals, updating subsection 80.3 of the Medicare Claims Processing Manual, which describes the hospice administrative appeals process. Read more »

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Medical News
Genentech Withdraws Psoriasis Drug, Raptiva
Raptiva® (efalizumab), the psoriasis drug, is being withdrawn from the U.S. market by its manufacturer, Genentech.  The drug is associated with an increased risk of progressive multifocal leukoencephalopathy (PML), a usually fatal neurological disease. Read more »

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Undiagnosed Celiac Disease Has Economic Impact
Celiac disease (CD) is often misdiagnosed because of a lack of awareness, says a Celiac Disease Center at Columbia University Medical Center study. As a result, an unwarranted amount of money is spent every year on medically unnecessary tests performed on patients with the autoimmune disorder. Read more »

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Split Pills, Save Costs in Colorado
Some Colorado health insurers suggest that patients consider splitting pills in an effort to reduce health care costs, while other insurers are worried about the liabilities and safety associated with such measures, the Denver Post reports. Patients whose doctors prescribe a higher-dose pill often can save money. For example, a 30-day supply of a 40-milligram pill costs about the same as a 30-day supply of 20-milligram pills. Doctors are supposed to write such prescriptions only for pills that can be split safely, the Post reports. Read more »

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CVS Fined for HIPAA Privacy Lapses
CVS, the nation’s largest retail pharmacy chain, will pay the U.S. government a $2.25 million settlement and take corrective action to ensure it does not violate privacy when disposing of patient information, such as identifying information on pill bottle labels.

The settlement, which applies to all of CVS’ more than 6,000 retail pharmacies, follows an extensive investigation by the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) for potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule. 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.

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Featured Items
Hospital Readmissions
PET Scan Coverage
PECOS Security
Budget Agreement
Cancer Research
Health System Reform
Coding Tips
Medical News
Test Yourself Online
Coding Job Links


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