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Issue #149 - May 19, 2010
AAPC EdgeBlast

Cost Estimate on SGR Fix Increases
With less than two weeks to go before the Continuing Extension Act of 2010 expires, a great number of people are on the edge of their seats wondering what will happen June 1. Will Medicare cut physician pay rates by 21 percent? No one knows for sure what will happen on that fateful day just yet. Speculation abounds among Congress members and industry stakeholders, however.

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CMS Corrects 2010 MPFS Final Rule
The Centers for Medicare & Medicaid Services (CMS) released new regulations on May 11 which affect physicians. "Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2010; Corrections; Final Rule" corrects several technical and typographical errors in the final rule with comment period (74 FR 61738) that appeared in the Nov. 25, 2009 Federal Register and also in the Dec. 10, 2009 corrections notice (74 FR 65449).

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Expect Small Decrease in 2010 Conversion Factor
A 0.015 percent reduction to the 2010 conversion factor is the result of relative value unit (RVU) corrections to the Medicare Physician Fee Schedule (MPFS) and physician reimbursement formula changes mandated by the Patient Protection and Affordable Care Act of 2010, or Health Reform law.

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Take a Look at the New, Revised and Invalid ICD-9 Codes
The Centers for Medicare & Medicaid Services (CMS) has posted on its website new, revised and invalid diagnosis and procedure codes that will go into effect Oct. 1.

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HIT Makes Recommendations for EHR Certification Plan
The Health IT (HIT) Policy Committee has approved recommendations on the Department of Health and Human Services' (HHS) proposed rule-making regarding the establishment of a permanent certification program for purposes of testing and certifying health information technology made by the Adoption-Certification Workgroup and the Privacy & Security Policy Workgroup. The HIT Policy Committee approved the recommendations during a May 6 teleconference call.

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Year 1 of HHP4P Demo Pays Off
First year results for the Medicare Home Health Pay for Performance (HHP4P) demonstration are in and the news is good. The Centers for Medicare & Medicaid Services (CMS) announced May 6 that the demonstration saved the agency over $15 million. Incentive payments are being made to 166 home health agencies (HHAs) in the intervention group.

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Interim Final Rule Implements Health Care Law Provisions
An interim final rule with comment period (IFC), which the Centers for Medicare & Medicaid Services (CMS) published in the Federal Register on May 5, implements provisions in the Patient Protection and Affordable Care Act (Health Reform law). The provisions serve to promote quality health care and eliminate fraud and abuse in high-risk areas by enforcing stricter provider enrollment and claims submission requirements.

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States Encouraged to Examine Insurers' Rate Increases
Health and Human Services (HHS) Secretary Kathleen Sebelius wrote a letter to governors and state insurance commissioners May 4, urging them to re-examine any WellPoint, Inc. rate increases in their states. The letter was in response to a California Department of Insurance report stating that rate increases Anthem Blue Cross was proposing were based on inflated medical costs projections.

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July 2010 RARC, CARC, and MREP Update
Change Request (CR) 6901 announces the latest update of Remittance Advice Remark Codes (RARCs) and Claim Adjustment Reason Codes (CARCs), effective July 1.

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Coding Tips
HCR: Technical Component Reduction Effective July 1
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Changes to Laboratory NCD Edit Software Due in July
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Medicare Adds Pulmonary Rehab as Covered Benefit
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CMS Clarifies Proper Discarded Drug Use
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Suppliers Receive Payment for Separately Billable Repairs
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Eliminate Transgender or Hermaphrodite Denials
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Good Faith Effort Warrants Level 5 E/M
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Medical News

FDA Recommends Suspended Use of Rotarix
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Joint Commission Seeks Heart Failure Certification Input
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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
Price Tag for SGR
2010 MPFS Correction
2010 Conversion Factor
2011 ICD-9 Codes
EHR Certification Plan
HHP4P Demo Pays Off
Health Care Law Provisions
Insurers' Rate Increases
2010 RARC, CARC, MREP
Coding Tips
Medical News
Test Yourself Online
Coding Job Links

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