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Issue #154 - August 4, 2010
AAPC EdgeBlast

CMS Releases 2011 IPPS/LTCH Final Rule
The Centers for Medicare & Medicaid Services (CMS) issued a final rule July 30 establishing fiscal year (FY) 2011 policies and payment rates for inpatient services furnished to people with Medicare by acute care hospitals, long-term care hospitals (LTCHs), and certain excluded hospitals.

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HHS Withdraws Breach Notification Rule From Review
The U.S. Department of Health and Human Services (HHS) announced July 29 that it is temporarily withdrawing the Breach Notification for Unsecured Protected Health Information final rule from administrative review. "Given the Department's experience to date in administering the regulations," HHS said, further consideration has been deemed necessary.

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CMS Announces PPS for ESRD Facilities
The Centers for Medicare & Medicaid Services (CMS) issued a final rule that changes how physicians are paid for furnishing dialysis services for patients with end stage renal disease (ESRD) from partial bundled composite rates to a new partial payment system (PPS). The rule also establishes a quality incentive program (QIP) linking a facility's payments to performance standards. This is the first time a QIP is part of a PPS.

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CIGNA Awarded A/B MAC J15
CIGNA Government Services, LLC (CGS) announced July 23 that it is the new Parts A and B Medicare administrative contractor (A/B MAC) for jurisdictions 15 and B. Effective July 8, CGS is responsible for the administration, processing, and paying of Medicare physician and hospital claims in Kentucky and Ohio (J15) as well as home health and hospice claim processing services in Colorado, Delaware, Iowa, Kansas, Maryland, Missouri, Montana, Nebraska, North Dakota, Pennsylvania, South Dakota, Utah, Virginia, West Virginia, Wyoming, and the District of Columbia (JB).

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President Signs "Improper Payments Elimination" Bill
President Obama signed the Improper Payments Elimination and Recovery Act (IPERA) July 22. The bill is designed to cut waste, fraud, and abuse due to improper payments by federal government agencies. Areas with a history of improper payments, such as chiropractic services, will be targeted. In 2009, improper payments totaled nearly $110 billion—the highest amount to date. This includes tens of billions of dollars in payments made in error or because of fraudulent claims by contractors and organizations as well as more than $180 million in improper payments sent to individuals who are dead and $230 million in improper payments to prisoners and fugitives—none of whom qualify for benefits.

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RAC Expands to Medicaid by Year-end
The Patient Protection and Affordable Care Act (health reform law) enacted earlier this year mandates the expansion of recovery audit contractor (RAC) audits beyond Medicare to Medicaid by the end of this year. While RACs are gung-ho to begin auditing, administrators at the Centers for Medicare & Medicaid Services (CMS) are voicing concerns whether coordinating with 50 state programs is manageable.

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New Demo Tests Decision Support Systems for Imaging
In light of reports regarding unnecessary radiation exposure and over-utilization of advanced imaging services, the Centers for Medicare & Medicaid Services (CMS) announced July 22 that it is soliciting proposals for paid participation in a new two-year demonstration that will test whether the use of decision support systems (DSSs) can improve care quality by promoting appropriate ordering of advanced imaging services among the Medicare fee-for-service (FFS) population.

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Massachusetts Hospital Security Breach Affects 800,000
South Weymouth, Mass. South Shore Hospital reported July 19 a massive security breach conceivably affecting some 800,000 individuals—including patients, physicians, employees, donors, volunteers, and vendors. Back-up computer files containing 14 years' worth of personal health and financial information were lost while in transit to a data management company hired to destroy them. The files were shipped to the unnamed data management company Feb. 26, but the hospital says it wasn't until June 17 that the data management company admitted to only receiving and destroying a portion of the shipped back-up computer files.

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Medicare Will Pay SNFs More in 2011
A notice with comment period the Centers for Medicare & Medicaid Services (CMS) published July 22 in the Federal Register updates the 2011 Skilled Nursing Facility Prospective Payment System (SNF PPS) and delays implementation of a Patient Protection and Affordable Care Act provision. Skilled nursing facilities can expect an increase in 2011 payment rates. SNF PPS payment rates for 2011 will include a negative 0.6 percentage point forecast error adjustment that, when combined with the 2011 market basket increase factor of 2.3 percent, yields a net update of 1.7 percent for 2011. The update goes into effect Oct. 1, 2010.

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Medicare Cuts Home Health Agency Pay Rates
A proposed rule that went on display in the Federal Register July 16 indicates a 4.75 percent decrease in 2011 Medicare payments to home health agencies (HHAs). Compared to 2010 payments, this amounts to about a $900 million pay cut for HHAs across the nation. HHAs that submit the required quality data would receive payments based on the home health market basket update of 1.4 percent for 2011. If an HHA does not submit quality data, the home health market basket percentage increase would be reduced by 2 percentage points to -0.6 percent for 2011.

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eRx Incentive Program 2010 Updates
It's not too late for physicians to participate in the Electronic Prescribing (eRx) Incentive Program and potentially qualify for a full-year incentive payment. Eligible professionals (EPs) may begin reporting eRx at any time throughout 2010. The eRx Incentive Program is separate from the Physicians Quality Reporting Initiative (PQRI) and physicians can participate in both programs. Note, however, that EPs may not earn an eRx incentive payment the same year they participate in the Electronic Health Record (EHR) Incentive Program, which runs from 2011-2015.

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Coding Tips

AMA Corrects CPT Errors and Omissions
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Hospice Rates Updated for 2011
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DMEPOS Fee Schedule Updates for October
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Hospitals Billing Practices Under Scrutiny
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Bill the TC Modifier Lately? Expect a Letter
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NCCI Edit File Format Changes
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Marshfield Clinic Sets an Example of EHR Meaningful Use
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Medical News

Out With the Old, In With the New … H1N1 Vaccines
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ACOG: Exceptions to Pap Test Guidelines
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New VBAC Guidelines Less Restrictive
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First Smallpox Vaccine Delivered to United States
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Mayo Offers Social Media School
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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
CMS IPPS/LTCH Final Rule
HHS Withdraws Rule
CMS Announces PPS
CIGNA Awarded A/B MAC
President Signs Bill
RAC Expands to Medicaid
New Demo for Imaging
Breach Affects 800,000
Medicare to Pay SNFs More
Medicare Cuts Rates
eRx Incentive Updates
Coding Tips
Medical News
Test Yourself Online
Coding Job Links

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