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Issue #151 - June 16, 2010
AAPC EdgeBlast

Physicians' Medicare Pay Rates Cut 21 Percent
The U.S. House of Representatives and the Senate were unable to resolve their differences in the American Jobs and Closing Tax Loop Holes Act of 2010 (tax extenders bill) in time to further delay a 21.3 percent negative update to Medicare reimbursement rates for physicians. The long anticipated pay cut went into effect June 1, but stalling tactics may result in physicians getting paid more, not less, this year.

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Physician Orgs Say July PECOS Deadline is Premature
An interim final rule issued by the Centers for Medicare & Medicaid Services (CMS) requires physicians and other eligible professionals (EPs) who order or refer most types of covered Medicare services and items to have an active record in the Provider Enrollment, Chain, and Ownership System (PECOS) much sooner than expected. A group of medical associations continues to urge CMS to reconsider the recent ruling.

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CMS Issues Supplemental IPPS Proposed Rule
On May 21, the Centers for Medicare & Medicaid Services (CMS) issued a supplemental proposed rule implementing changes in payments for inpatient stays in general acute care hospitals paid under the 2011 Inpatient Prospective Payment System (IPPS) and long-term care hospitals (LTCHs) that were required by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the health reform law). CMS also issued a notice publicizing revised rates effective for payment years beginning Oct. 1, 2009. These revised rates are used to pay hospitals for discharges on or after April 1, as a result of provisions in the health reform law. The resulting change in aggregate payments across all IPPS hospitals is projected to decrease by $820 million, while payments to LTCHs in 2011 are projected to increase by $13 million.

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Only Days Left to Comment on ICD-9 Freeze Before I-10
Health care providers have just two years to prepare for ICD-10 implementation on Oct. 1, 2013, and there are only days remaining to ensure the transition goes more smoothly. The 2011 Inpatient Prospective Payment Systems (IPPS) for Acute Care Hospitals and Long Term Care Hospital Prospective Payment System (LTCH PPS) proposed rule comment period ends June 18.

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WellPoint Will Implement Key Breast Cancer Provisions
The Breast Cancer Patient Protection Act of 2009, which aims to expand coverage for certain breast cancer procedures, has yet to even make it out of committee, but WellPoint, Inc. says it will implement certain provisions of the bill regardless.

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Providers Say EHR Criteria Are Unattainable
The opportunity to comment on the Medicare and Medicaid electronic health record (EHR) program proposed rule, which defines "meaningful use" of EHR technology and outlines provisions governing EHR incentives, ended March 15. Industry stakeholders, however, continue to voice their concerns about the criteria providers must meet to receive incentive payments, saying they are unrealistic and impossible for even the most sophisticated facilities to obtain.

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HIPAA Violator Gets Jail Time
Classic coding job search advice includes submitting a professional resume that touts your Certified Professional Coder (CPC®) credential, dressing appropriately and being on time for interviews, and being a courteous and respectful interviewee. Here's one more piece of advice: Make sure your credit record is in good standing. Surprisingly, a poor rating could cost you a job.

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CMS Clarifies Physician Supervisory Role
The Medicare manual and previous guidance stipulates that physician assistants, nurse practitioners, clinical nurse specialists, and certified nurse midwives who operate within the scope of practice under state law may order and perform diagnostic tests. That much was clear, but then the 2010 Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) final rule implemented a few changes to this policy. New guidance from the Centers for Medicare & Medicaid Services (CMS) helps clarify any misconceptions providers may have about Medicare's current policy for physician supervision of diagnostic and therapeutic services provided to hospital outpatients.

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Let Recent False Claims Settlements be a Lesson
Nine hospitals in seven states recently agreed to pay the federal government more than $9.4 million to settle whistleblower allegations that they overcharged Medicare for spinal kyphoplasty procedures, the U.S. Department of Justice announced May 17. Experts say this isn't the first settlement of this nature, and it won't be the last.

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Four HHAs Under Investigation for Medicare Fraud
Four of the largest home health care agencies (HHA) in the nation are reportedly being investigated by the U.S. Senate Finance Committee for suspected Medicare abuse.

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Coding Tips
NCHS Releases Conversion Table with New I-9 Codes
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New Codes, New Rates in OPPS July Update
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New Waived Tests Effective July 1
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Collagen Meniscus Implants Non-covered
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Part B MAC Says it Will Deny Heparin, J1642
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OIG Report Reveals Inappropriate Neulasta Claims
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CMS Updates EFT Authorization Agreement Form
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Medical News

Propofol Demand Remains High Despite Controversy
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Certain IV Drugs Potentially Contaminated
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ASGE Recommends Widening Scope for GI Screenings
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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 Pay Cut
New PECOS July Deadline
IPPS Proposed Rule
ICD-10 Comment Period
WellPoint Provisions
EHR Criteria Unattainable
HIPAA Violator Jail Time
Physician Supervisory Role
False Claims Settlements
Medicare Fraud Investigation
Coding Tips
Medical News
Test Yourself Online
Coding Job Links

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