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Issue #138 - December 2, 2009
AAPC EdgeBlast

2010 Medicare Physician Fee Schedule Update
The Centers for Medicare & Medicaid Services (CMS) has issued a corrected 2010 Medicare Physician Fee Schedule (MPFS), available on its Web site.

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Phase 2 Enrollment Implementation Delayed
Ordering and referring physicians and nonphysician practitioners (NPPs) have a bit more time to comply with new Medicare enrollment requirements. Phase 2 of the claims editing expansion will now begin April 5, 2010, rather than Jan. 4.

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Medicare Participation Enrollment Deadline Jan. 31
The 2010 Annual Participation Enrollment Program end date has been extended from Dec. 31 to Jan. 31, 2010. The extension is due to recent revisions the Centers for Medicare & Medicaid Services (CMS) made to the 2010 Medicare Physician Fee Schedule (MPFS), according to the American Medical Association (AMA).

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Therapy Cap Values Set for 2010
Therapy cap exceptions provided by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) end Dec. 31. The Centers for Medicare & Medicaid Services (CMS) announced the therapy cap values for 2010 on Nov. 13.

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New Bill to Boost Fight Against Medicare Fraud
New legislation would give payers more time to reimburse providers for Medicare claims when waste, fraud, and/or abuse are suspected.

Senator Chuck Grassley introduced the Fighting Medicare Payment Fraud Act of 2009 on Nov. 16.

"As Medicare spending continues to skyrocket, everything possible must be done to protect Medicare dollars from being lost to fraud, waste, and abuse," Grassley said in a press release.

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Mammography Coverage Remains As Is
News of updated U.S. Preventative Services Task Force (USPSTF) guidelines for breast cancer screening for women hit the airwaves like a maelstrom over past weeks.

New USPSTF guidelines now recommend women 50 years of age and older receive mammograms every two years. Previous recommendations were for women 40 years and older to receive mammograms every year.

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Outpatient Mental Health Treatment Limitation Set
The Centers for Medicare & Medicaid Services (CMS) is phasing out the outpatient mental health treatment limitation (the limitation) over a five-year period, from 2010-2014. At the end of the five-year period, Medicare will pay outpatient mental health services at the same rate as other Part B services — that is, at 80 percent of the physician fee schedule.

Section 102 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) requires the current 62.5 percent limitation (effective since the inception of the Medicare program until Dec. 31) to be reduced as follows:

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CMS: Tougher Error Rate Standards
The Centers for Medicare & Medicaid Services (CMS) announced recently that changes the agency made this year to its fee-for-service (FFS) medical review process are proving favorable.

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DMEPOS 2010 Fee Schedule Updates
Suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) will not see a fee schedule update for 2010 due to a negative 1.41 percentage change in the Consumer Price Index-Urban (CPI-U) for the 12-month period ending with June 2009.

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Ingenix Survey: We’re Not 5010 Prepared Yet
Conversion to the ASC X12 version 5010 architecture, mandated by the Health Insurance Portability and Accountability Act (HIPAA), is a reality. The apparent opinion of many payers and providers, however, is that it is but a dream.

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Coding Tips
CPT® 2010 Revamps Urodynamics Section
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Anesthesia Payment Policy Revised for 2010
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Self-administered B-12 Injection Noncovered
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Medical News

FDA Warns Against Plavix/Prilosec Negative Interaction
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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
Fee Schedule Update
Phase 2 Delayed
Medicare Enroll Deadline
Therapy Cap Values
Medicare Fraud Bill
Mammography Coverage
Mental Health Limits Set
Tougher Error Rates
DMEPOS 2010 Fees
Not Yet Ready for 5010
Coding Tips
Medical News
Test Yourself Online
Coding Job Links

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