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Issue #152 - July 7, 2010
AAPC EdgeBlast

Berwick Expected to Head CMS
Using the recess appointment process, President Obama is expected this week to appoint Donald Berwick, MD, MPP, as Centers for Medicare & Medicaid Services (CMS) administrator. Dr. Berwick is president and CEO of the Institute for Healthcare Improvement, clinical professor of Pediatrics and Health Care Policy at the Harvard Medical School and professor of Health Policy and Management at the Harvard School of Public Health. He is also a pediatrician, adjunct staff in the Department of Medicine at Boston's Children's Hospital and a consultant in pediatrics at Massachusetts General Hospital.

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New Rates, New Policies in 2011 OPPS/ASC Proposed Rule
The 2011 Outpatient Prospective Payment System (OPPS)/Ambulatory Surgical Center (ASC) payment system proposed rule, released July 2 by the Centers for Medicare & Medicaid Services (CMS), proposes payment system changes and 2011 payment rates. The proposed rule also would implement several health care reform law provisions, including some pertaining to certain inpatient hospital services, graduate medical education costs, and physician self-referral rates, which did not make it into the 2011 Inpatient Prospective Payment System (IPPS) proposed rule, published May 4.Overall, CMS estimates that providers would receive a 2.2 percent payment increase in 2011 under the proposed rule.

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CMS Proposed Rule Projects Physician Pay Cut in 2011
The 2011 Medicare Physician Fee Schedule (MPFS) proposed rule, issued June 25 by the Centers for Medicare & Medicaid Services (CMS), projects a negative 6.1 percent update to physician payment rates at the start of 2011. Added to that the 2.2 percent update legislation recently awarded to physicians, which expires Nov. 30, and the negative 21.3 percent update, which subsequently applies Dec. 1, and physicians are really looking at ringing in the New Year with a negative 29.6 percent update—barring further Congressional intervention.

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Changes Lie Ahead for PQRI and eRx Program
The Centers for Medicare & Medicaid Services (CMS) released June 25 a preliminary version of the 2011 Medicare Physician Fee Schedule (MPFS) proposed rule. The proposed rule contains a number of policy changes >insert article link< that will affect practitioners who are paid under Medicare Part B. Many of the proposed changes are Affordable Care Act (health reform) provisions, which CMS is required to implement. Changes to the Physician Quality Reporting Initiative (PQRI) and the Electronic Prescribing (eRx) Program are among those provisions.

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ONC Issues Temporary EHR Certification Program Final Rule
The Office of the National Coordinator for Health Information Technology (ONC) issued a final rule June 18 to establish a temporary certification program for electronic health record (EHR) technology. The temporary certification program establishes processes that organizations will need to follow in order to be authorized by the National Coordinator to test and certify EHR technology.

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FTC: Physicians Should be Exempt From Red Flags Rule
The head of the Federal Trade Commission (FTC) now says physicians should not be included in the Red Flags Rule's definition of a "creditor," but it would take Congressional action to exempt them. "We agree with you that the Red Flags Rule reaches too far," said FTC Chair Jon Leibowitz June 14 at the American Medical Association's 2010 Annual Meeting of the House of Delegates in Chicago.

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CMS Processes Claims Despite PECOS Enrollment Status
Providers that did not get their Provider Enrollment, Chain and Ownership System (PECOS) enrollment applications approved by the July 6 deadline are getting a temporary reprieve. The Centers for Medicare & Medicaid Services (CMS) says it will not, for the time being, implement automatic rejections of claims submitted by providers that are not enrolled in PECOS. Until the automatic rejections are operational, submitted claims will continue to be reviewed and paid as usual.

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New Pre-existing Condition Insurance Plan in Operation
The U.S. Department of Health and Human Services (HHS) announced July 1 the establishment of a new Pre-existing Condition Insurance Plan (PCIP) that offers coverage to uninsured Americans who have been unable to obtain health coverage because of a pre-existing health condition.

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Physicians May Waive Coinsurance During Retroactive Period
After President Barack Obama signed legislation June 25 granting a 2.2 percent update to physicians' Medicare payments, the Office of Inspector General (OIG) the same day waived a Medicare regulation that would require providers to bill patients for additional coinsurance relative to the rate increase, which is retroactive to June 1.

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OIG Activity Amounts to $3.1B in Expected Recoveries
Office of Inspector General (OIG) audit and investigative activity between Oct. 1, 2009 and March 31, 2010 resulted in expected recoveries amounting to approximately $3.1 billion, according to the agency's Semiannual Report to Congress. This dollar amount is considerably lower than the $20.97 billion the OIG said it expected to recover in its Semiannual Report to Congress for the period of April 1, 2009 through Sept. 30, 2009.

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New Proposed Rules Ensure Equal Visitation Rights
Two new proposed rules implement an April 15 presidential memorandum in which President Barack Obama requested the U.S. Department of Health and Human Services (HHS) develop standards that would require Medicare- and Medicaid-participating hospitals (including critical access hospitals (CAHs)) to preserve the rights of all inpatients to choose who may visit them.

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Agencies Team Up to Reduce Medicare Fraud
In response to President Barack Obama's recent request for the U.S. Department of Health and Human Services (HHS) to cut the Medicare fee-for-service program's improper payment rate in half by 2012, HHS and the U.S. Department of Justice (DOJ) are stepping up efforts to detect and discourage Medicare and Medicaid fraud and abuse. Although the current focus is on safeguarding seniors from Medicare scams, legitimate health providers can expect added scrutiny from auditors looking for unsubstantiated claims.

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AAPC Launches Latest Billing Course
AAPC is releasing its 10th edition of its Medical Billing and Reimbursement online course. "This course is a great way to enhance your coding education by delving into specifics about the health insurance industry and different reimbursement methodologies for correct claim submissions," said Shelly Cronin, CPC, CANPC, CGIC, CGSC, AAPC Business and Member Development.

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Commission Warns Facilities of Increasing Violence
Health care facilities should be associated with healing, but a Sentinel Event Alert released June 3 by The Joint Commission warns these organizations of the rising threat of violence and suggests steps they can take to protect patients, staff, and visitors.

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CMS Launches EHR Incentive Program Website
The Centers for Medicare & Medicaid Services (CMS) has launched the official website for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. Look to this website for up-to-date, detailed information about the EHR incentive programs.

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Coding Tips
MPFSDB July Update Corrects Payment Files
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New CPT® Flu Vaccine Codes Effective July 1
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New CPT® Category II Codes in Effect Oct. 1
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New and Revised Category III Codes to Report
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New Codes, New Rates for ASCs in July
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Medical News

First Rapid Test for HCV Antibodies Approved
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ACOG Recommends Dedicated OB Visits for Teens
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CDC Issues New Contraceptive Use Recommendations
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CMS Opens NCA for Provenge Therapy
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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
Berwick to Head CMS
OPPS/ASC Proposed Rule
CMS Rule Projects Pay Cut
Changes for PQRI & eRx
ONC Issues Final Rule
FTC on Red Flags Rule
CMS to Process Claims
PCIP in Operation
Waiving Coinsurance
OIG's Expected Recoveries
Equal Visitation Rights
Reducing Medicare Fraud
AAPC Launches Course
Increasing Violence
EHR Incentive Website
Coding Tips
Medical News
Test Yourself Online
Coding Job Links

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