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Issue #147 - April 21, 2010
AAPC EdgeBlast

Obama Signs Bill to Extend 2009 Medicare Pay Rates
Congress has diverted the 21.3 percent Medicare pay cut to physicians once again. President Obama signed the Continuing Extension Act of 2010 (HR 4851) into law on April 15—just hours after the Senate voted 59-38 in favor of their amended version of the bill and the House subsequently passed the Senate’s amended version by a voice vote.

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2011 Proposed IPPS Rule Posted
The Centers for Medicare & Medicaid Services (CMS) announced a proposed rule Monday, March 19, that would change Medicare policies and payment rates for inpatient services furnished by both acute care hospitals and long-term care hospitals in 2011.

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AAPC Adds Auditing Services
The AAPC is opening a new audit services division that will provide full-service health care compliance and corporate integrity audits. The new audit division will service outpatient practices, health plans, health care attorneys, and government regulators, to determine key areas of risk and provide detailed recommendations to resolve them. AAPC will use member auditors to provide services in all specialties and are leveraged from the credentialed AAPC members nationwide.

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Parts C and D 2011 Final Rates, Policies Released
The Centers for Medicare & Medicaid Services (CMS) issued on April 6 its final rule implementing policy and technical changes to the Medicare Advantage (Part C) and Medicare prescription drug benefit programs (Part D). That same day, CMS announced that capitation rates for Medicare Advantage (MA) plans in 2011 will be unchanged from this year. The 2011 Rate Announcement was accompanied by the final 2011 Call Letter for Part C and Part D plans.

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New DEA Regs Allow "Meaningful EHR Use"
The Department of Justice (DOJ) Drug Enforcement Administration (DEA) issued an interim final rule with comment period on March 31, revising its regulations to allow pharmacies, hospitals, and physicians to use electronic prescriptions for controlled substances.

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GAO Report: RAC Program Lacks Follow-through
A U.S. Government Accountability Office’s (GAO) March 2010 report to Congress concludes that, although the Center for Medicare & Medicaid Services (CMS) has taken steps to improve recovery audit contractor (RAC) oversight and related services to providers, the agency has not established processes to ensure prompt resolution of RAC-identified improper payment vulnerabilities.

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CMS Issues Intermediate Sanction Notice to Aetna
On April 5, the Centers for Medicare & Medicaid Services (CMS) issued a notice to Aetna Inc. of its intent to impose an intermediate sanction to prevent the insurance company from marketing to and enrolling new Medicare beneficiaries. The sanction goes into effect April 21, and will remain in effect until CMS determines Aetna has corrected its alleged deficiencies for the long term.

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OIG: Medicare DME Program Vulnerable for Fraud
On Jan. 3, 2011, the Centers for Medicare & Medicaid Services (CMS) intends to implement changes to the Medicare claims-processing system that would end a temporary provision that allows suppliers to use their own national provider identifiers (NPI) in the referring provider field. The Office of Inspector General (OIG) says in an April report the implementation date of these edits has been delayed twice already permitting a claims-processing vulnerability for nearly two years now.

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Senators Urge CMS to Modify "Meaningful Use" criteria
Special interest groups aren’t the only ones disputing the Center for Medicare & Medicaid Services’ (CMS) vision of “meaningful use” as defined in the government agency’s Electronic Health Record Incentive Program Proposed Rule (42 CFR parts 412), released in January. An AAPC article in EdgeBlast No. 146 reported on how 96 various specialty and state medical associations recently sent a letter to CMS stating their case for why Stage 1 of the electronic health record (EHR) incentive program is too aggressive. Since then, the offices of CMS and Health and Human Services (HHS) have been bombarded with letters from Congress.

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HCR: Imaging Society Takes Issue with Utilization Rates
The Health Care and Education Affordability Reconciliation Act of 2010 (HR 4872), signed into law March 30, sets the assumed utilization rate at 75 percent for the practice expense portion of advanced diagnostic imaging services. The fact that this bill delays assumed utilization rate changes from Jan. 1, 2010 (as in the Senate-passed bill) to Jan. 1, 2011, or that low-tech imaging, such as ultrasound, X-rays, and EKGs, are excluded from this adjustment, does not make at least one imaging society feel any better.

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S.C. Hospital Faces $44.8M in Damages for Stark Violation
A federal jury ruled that Tuomey Healthcare System acted in violation of the Stark Law and may order the Sumter, S.C. hospital to pay as much as $44.8 million in damages.

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HCR: Physicians Get Geographic Pay Raises
Physicians in 42 states and territories stand to benefit from revisions to the geographic adjustments made in calculating payments for their services over the next two years, according to the American Medical Association (AMA). The revisions are a provision in the Patient Protection and Affordable Care Act (health reform bill), enacted March 23.

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EHR Adoption Lags Despite Success Stories
A recent Center for Information Technology Leadership (CITL) study comparing health information technology (IT) in the Department of Veteran Affairs (VA) to norms in the private sector concludes that the VA spent proportionately more on IT than the private health care sector spent between 1997 and 2007, but it achieved higher levels of IT adoption and quality of care.

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Coding Tips
HCR: Reasonable Cost Payment for Clinical Lab Tests Extended
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HCR: Therapy Caps Exception Extended
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HCR: Labs May Bill TC for Path Services
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MAC Gives Top Five EDI Reasons for Claim Rejections
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Medical News

FDA Launches Initiative to Reduce Radiation Exposure
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OsmoPrep Lawsuits on the Rise
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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
Medicare Rates Extended
2011 IPPS Posted
AAPC Audit Services
Part C & D Final Rates
DEA & "Meaningful Use"
RAC Lacks Follow-through
CMS Sanction to Aetna
OIG: Medicare Vulnerable
"Meaningful Use" Criteria
Imaging Utilization Rates
S.C. Hospital $44.8M Suit
Physician Pay Raises
EHR Adoption Lags
Coding Tips
Medical News
Test Yourself Online
Coding Job Links

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