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Issue #144 - March 3, 2010
AAPC EdgeBlast

Senate Gives Physicians a 30-day Reprieve
Late last night the Senate passed the Temporary Extension Act of 2010 (HR 4691) by a vote of 78-19, extending the Medicare physician 21.2 percent pay cut exemption and the physical therapy services cap exceptions process until March 31.

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House Votes to Repeal Insurers' Antitrust Exemption
The U.S. House of Representatives voted Feb. 24 in favor of repealing an antitrust provision that has exempted the health insurance industry from federal law for the past 65 years.

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PECOS Phase II Enforcement Delayed
During a Special Open Door Forum to discuss provider enrollment issues on Feb. 17, the Centers for Medicare & Medicaid Services (CMS) announced they are delaying (Provider Enrollment, Chain and Ownership System) PECOS Phase II enforcement from April 2010 until Jan. 3, 2011.

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CMS Issues Preliminary 2011 Payment Policies
The Centers for Medicare & Medicaid Services (CMS) issued an “Advance Notice” Feb. 19, notifying health plans of its intention to calculate health care capitation rates for 2011 payments to Medicare Advantage organizations using a changed methodology. The Advance Notice also addresses policy and technical changes to payment methodologies for Medicare Advantage (Part C) and Medicare prescription drug (Part D) plans.

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HHS Secretary Invites Insurers to Discuss Rate Hikes
Health and Human Services (HHS) Secretary Kathleen Sebelius sent a letter Feb. 24 to the heads of five insurers—UnitedHealth Group, WellPoint, Aetna, Health Care Service Corporation and CIGNA—inviting them along with leaders from the National Association of Insurance Commissioners (NAIC) to discuss planned premium increases across the country.

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Modifier Payment Policy Changes on the Horizon
Effective May 17, Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) will implement policy and procedural changes in regard to how services submitted with certain modifiers are reimbursed. The insurer notified participating physicians of the changes in a letter dated February 2010.

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CMS Identifies Supplemental Payer Crossover Error
The Centers for Medicare & Medicaid Services (CMS) recently identified a problem that requires immediate action on the part of Medicare Part B providers. Apparently, claims were not automatically crossing over to supplemental payers even though provider remittance advice indicated otherwise.

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Controversy in California: Should CRNAs Be Supervised?
Californian hospitals and nurse anesthetists generally agree with Gov. Arnold Schwarzenegger’s decision last summer to opt out of a Medicare provision requiring physician supervision of certified registered nurse anesthetists (CRNAs) in hospitals, but a couple of state physician organizations do not. Whereas the former group says opting out will ensure patient access to anesthesia services, the latter group says lack of physician oversight puts patients at risk.

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OIG: RAC Program is Lacking
The Office of Inspector General (OIG) says recovery audit contractors (RACs) referred two cases of potential fraud to the Centers for Medicare & Medicaid Services (CMS) during the 3-year RAC demonstration project conducted between March 2005 and March 2008. Because of inadequacies in the program, however, no action was taken.

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AAPC Hosts 18th National Coding Conference in Nashville
Coders and their providers can bone up on coding, regulation, compliance, and billing while earning continuing education units (CEUs) and continuing medical education (CMEs) at AAPC’s 2010 National Conference in Nashville, Tenn. on June 6–9. This annual event draws thousands of attendees including doctors, medical coders, and office/practice managers to connect on the business side of health care. This is the first conference to be approved for 15.75 CME (AMA PRA Category 1™) credits.

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Coding Tips
CCI 16.0 Bundles EP Study with Ablations in Error
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CMS Revises ESRD Quality Reporting Requirements
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Suppliers Face O2 Equipment Maintenance Fee Change
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Palmetto: Lab Ordering Trends Are Problematic
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Medical News

Technitium Tc-99m Drought May End
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FDA Announces Safety Concern for HIV Drug Combo
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Survey: We’re Not Ready for Meaningful Use
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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
Medicare Pay Cuts
Insurers & Antitrust
PECOS Enforcement
CMS Payment Policies
HHS & Rate Hikes
Modifier Payments
Crossover Error
CRNA Supervision
OIG & RACs
National Conference
Coding Tips
Medical News
Test Yourself Online
Coding Job Links

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