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Issue #150 - June 2, 2010
AAPC EdgeBlast

Physicians' Pay Rates in Limbo This Week
The Continuing Extension Act of 2010, which extended the zero percent update to the 2010 Medicare Physician Fee Schedule (MPFS), expired May 31. Legislation on the table that would prevent a 21 percent pay cut to physicians from going into effect June 1 was approved by the U.S. House of Representatives (215-204) on May 28. The Senate, however, did not take up the bill before all of Congress recessed for a week-long holiday.

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Congress Delays Red Flags Rule
A lawsuit filed in federal court May 21 seeking to prevent the Federal Trade Commission (FTC) from extending identity theft regulations to physicians may be the reason behind why the Red Flags Rule didn't go into effect June 1. The American Medical Association (AMA), American Osteopathic Association (AOA), and the Medical Society of the District of Columbia (MSDC) filed the suit on the grounds that the FTC exceeded its authority under the Fair and Accurate Credit Transaction Act of 2003.

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No Delay for SNF RUG-IV Oct. 1 Implementation
The Centers for Medicare & Medicaid Services (CMS) announced, May 24, it will not delay implementing its new Resource Utilization Group payment categories for skilled nursing facilities (SNFs), known as RUG-IV, citing limitations in its SNF payment software.

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Prepare for New Radiology Prior Authorization Requirements
Beginning June 7, UnitedHealthcare will require prior authorization for certain advanced outpatient imaging procedures for Medicare Advantage members whose claims are accessible online. As such, the insurer has developed tools that physicians can use to better understand this new requirement.

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CMS Reinstates Expired Ambulance Add-ons
The Patient Protection and Affordable Care Act of 2010, or health reform law, extends a number of provisions that expired Dec. 31, 2009. The Centers for Medicare & Medicaid Services (CMS) recently released instructions to its contractors to implement three health reform law provisions that will have ambulance providers breathing a sigh of relief.

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Medicare Suspends, Fines Insurer QHP
Quality Health Plans (QHP) received notice on May 17 of the Centers for Medicare & Medicaid Services' (CMS) intent to impose intermediate sanctions and a civil monetary penalty (CMP). The federal agency contends that the Tampa, Fla.-based insurer has failed to comply with a number of administrative and contract management requirements.

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Not in PECOS? Expect a Letter
Physicians and non-physician practitioners (NPPs) who are currently enrolled in Medicare but do not have an enrollment record in the Provider Enrollment, Chain and Ownership System (PECOS) can expect to receive a one-time solicitation letter in the mail sometime soon.

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Physicians Begin Claiming Damages from UnitedHealth Settlement
Have your practice's physicians filed their UnitedHealth Group UCR settlement paperwork yet? Settlement notices, claim forms and claim form instructions for the UnitedHealth Group UCR settlement to physicians were mailed April 16. All affected parties should have received by now a plain white mail with "UnitedHealthcare" written on the bottom and with the return address referencing the Settlement Claims Administrator: UnitedHealthcare Class Action Litigation c/o Berdon Claims Administration LLC, P.O. Box 15000, Jericho, NY 11853-1001.

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ASC Association Discontinues Management for Eight States
The Ambulatory Surgery Center Association (ASCA) — a membership and advocacy organization for ASCs — will no longer manage eight state ASC groups, reports Outpatient Surgery Magazine in its May online edition. Although an official statement has not yet been made by the association, "Sources are calling it a business decision made at ASCA's annual meeting in Anaheim, Calif., [held May 19-22]," according to Outpatient Surgery Magazine Editor-in-Chief Dan O'Connor.

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Coding Tips
Three New HCPCS Codes Payable July 1
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New CR/ICR Coverage, New Supplier Code
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RACs Post New Issues Under Review
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Knee Joint Injections: Watch for Ultrasound Guidance Denials
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Pain Management Payment in Five Easy Steps
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Medical News

CDC Updates 2009 H1N1 Guidance
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Hot Topic: Breast Cancer Screening Recommendations
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Provenge Stimulates Immunity Against Prostate Cancer
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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
Physician Pay Rates
Red Flags Rule Delay
SNF RUG-IV
UHC Requirements
Ambulance Add-ons
QHP Sanctioned
Not in PECOS?
UnitedHealth Settlement
ASC Association Mgt
Coding Tips
Medical News
Test Yourself Online
Coding Job Links

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