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Issue #126 - June 3, 2009
AAPC EdgeBlast

HHS: $81.7 Million to Expand Health Center Services
The Department of Health and Human Services (HHS) announced, May 28, the release of $81.7 million to expand services offered at the nation's health centers.  On the same day—100 days after the signing of the Recovery Act—HHS also awarded $25.6 million in non-Recovery Act grants to expand medical capacity at 54 existing health centers, helping an additional 230,000 individuals in 25 states receive primary health care services, the agency said. Read more »

Comment »

July OPPS Update Changes Policies
The July 2009 update of the hospital Outpatient Prospective Payment System (OPPS) implements a number of changes to and billing instructions for various Medicare policies. The most affected areas of note are drugs and biologicals and Part B hospital outpatient services. Read more »

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HITECH Implementation Plan Released
Recently, the Office of the National Coordinator for Health Information Technology (ONC) released the implementation plan relative to the Health Information Technology for Economic and Clinical Health Act (HITECH) Act. The plan is titled "The Health Information Technology American Recovery and Reinvestment Act Implementation Plan" (the Implementation Plan).

The HITECH Act, a component of the American Recovery and Reinvestment Act of 2009 (ARRA), authorized $2 billion in spending to expand usage of electronic health records (EHRs) capable of sharing data between systems. The Implementation Plan addresses the need to meet the short implementation deadlines created by the ARRA, as well as the need to achieve long-term improvements in health and health care through adoption of information technology. The ONC will continue to hold hearings to develop additional policies and procedures necessary to achieve the goals of the ARRA. Read more »

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Clarifying Inpatient vs. Outpatient
A recent review conducted by Trailblazer, the A/B Medicare Administrative Contractor (MAC) for jurisdiction four (J4), shows hospitals are ultimately confused as to where to draw the line between inpatient and outpatient status.  Even more recent editorial changes to the Medicare Claims Processing Manual may help hospitals clarify the terms "observation" and "admission." Read more »

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Missing NPI Won't Delay Processing CMS
A recent change to Medicare policy made by the Centers for Medicare & Medicaid Services (CMS) helps ensure claims processing isn't delayed when the only missing information on the CMS-1490S form is the provider or supplier's National Provider Identifier (NPI). Read more »

Comment »

New Bill Addresses Primary Care Shortage
Numerous health care organizations joined U.S. Rep. Allyson Schwartz May 20 on Capitol Hill to announce a new bill (H.R. 2350) that addresses the shortage of primary care providers in America.

"As we move toward creating a uniquely American solution in which all Americans have access to affordable, meaningful health coverage, it becomes clear that successful health care reform must include primary care reform," said Representative Schwartz (D-Pa.). Read more »

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Feds Turn Up HEAT on Fraud
Department of Justice (DOJ) Attorney General Eric Holder and Health and Human Services (HHS) Secretary Kathleen Sebelius announced May 20 that they intend to step up efforts to combat Medicare fraud with the newly formed Health Care Fraud Prevention and Enforcement Action Team (HEAT) and Strike Force team expansion. Read more »

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Trailblazer Initiates Claims Adjustments
Trailblazer Health Enterprises, LLC posted on its Web site May 15 a notice of mass adjustments it needs to make to claims for 2009 inpatient (Part A) claims with Medicare Severity-DRG (MS-DRG) 956 Limb reattachment, hip & femur proc for multiple significant trauma paid under the special-pay method. Read more »

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Coding Tips
CMS Clarifies Billing Policy for Lab Services
It seems the new date of service (DOS) for the technical component (TC) of pathology, mandated by the 2007 Medicare Physician Fee Schedule (MPFS) final rule and implemented May 23, 2008, has caused some confusion. Does the DOS requirement apply to pathology tests when the TC and professional component (PC) are performed by the same lab and billed globally? Enquiring minds want to know!

To clarify, the Centers for Medicare & Medicaid Services (CMS) recently updated Pub. 100-04, Medicare Claims Processing Manual, chapters 1 and 16. Read more »

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Laboratory NCD Edit Module Changes
The July 2009 quarterly update of the edit module for clinical diagnostic laboratory services will include several changes in laboratory national coverage determination (NCD) code lists, according to a transmittal the Centers for Medicare & Medicaid Services (CMS) issued May 15. Read more »

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Dose Counts Matter When Billing 95165
Is your practice billing the number of services for Allergy Immunotherapy CPT® code 95165 Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens (specify number of doses) correctly? The Comprehensive Error Rate Testing (CERT) Payment Safeguard contractor, AdvanceMed, seems to think not, and has put Medicare contractors on the alert. Read more »

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CAH Outpatient Criteria Changes for Specimen Collections
A provision in the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 will soon change the policy of who is considered a critical access hospital (CAH) outpatient when outpatient clinical diagnostic laboratory services are provided. Read more »

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Medical News
Comparison Study Looks at Ultrasound
A literature review of comparison studies for medical imaging methods, published in the May/June issue of the Journal of Diagnostic Medical Sonography, puts ultrasound at the top of the list for accuracy and cost effectiveness. Read more »

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Twin City Hospitals Accused of Overcharging
Three Minnesota hospitals have agreed to pay the federal government $2.28 million to settle allegations that they overcharged Medicare during a five-year period. 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
Health Center Services
July OPPS Update
HITECH Plan Released
Inpatient vs. Outpatient
Missing NPI
Primary Care Shortage
Medicare Fraud
Trailblazer Initiates Claims
Coding Tips
Medical News
Test Yourself Online
Coding Job Links

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