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Issue #157 - September 15, 2010
AAPC EdgeBlast

2011 MPFS Proposed Rule Stands Corrected
Several technical and typographical errors have been identified in the 2011 Medicare Part B Physician Fee Schedule (MPFS) proposed rule since its July 13 release. Although the corrections the Centers for Medicare & Medicaid Services (CMS) subsequently posted Aug. 22 in the Federal Register do not constitute rule-making, some of the changes are worth noting.

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Final Rule Establishes New DMEPOS Enrollment Standards
The Centers for Medicare & Medicaid Services (CMS) issued a final rule Aug. 27 entitled “Medicare Program; establishing Additional Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Supplier Enrollment Safeguards (CMS-6036-F).” The final rule implements several Patient Protection and Affordable Care Act (Affordable Care Act) requirements designed to prevent and detect fraud, waste, and abuse in the Medicare and Medicaid programs, and to ensure quality care for beneficiaries.

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ESRD PPS Billing Instructions Now Available
The new End Stage Renal Disease Prospective Payment System (ESRD PPS), effective Jan. 1, 2011, means major billing and payment changes for physicians, providers, and suppliers who provide ESRD services to Medicare beneficiaries. A physician education article, issued by the Centers for Medicare & Medicaid Services (CMS) Aug. 20, serves to answer the many questions this new payment system will undoubtedly generate.

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RACs Post New Issues Under Medical Review
Two recovery audit contractors (RACs) for the Centers for Medicare & Medicaid Services (CMS) recently posted several new issues for claims review. DCS Healthcare will begin validating a number of additional medical severity-diagnosis related groups (MS-DRGs) reported by inpatient hospitals in its jurisdiction A. All but one of the new issues are up for medical necessity review. Jurisdiction C RAC, Connolly Healthcare, also posted several new issues for review recently. Seventeen are for MS-DRGs under medical necessity review.

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CLIA Waived Tests Update
New Clinical Laboratory Improvement Amendments of 1988 (CLIA) waived tests approved by the Food and Drug Administration (FDA) were released Aug 27.

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JCAHO Expands Ambulatory Organizations’ Accrediting Process
The Joint Commission for the Accreditation of Health Organizations (JCAHO) announced Sept. 7 plans to expand the process of accrediting ambulatory health care organizations to those who are also interested in electing the Primary Care Home option.

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Coding Tips

J4 MAC Locally Prices Fluzone
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CMS Clarifies Oxygen Equipment Replacement Policy
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WPS Posts POS 81 Usage Reminder
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New HHA Claims Edits Require Attention to Detail
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Update POS Reporting Practices for 5010
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Medical News

CDC: Study Shows ASCs Lack Infection Control
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FDA Approves Emergency Contraceptive Drug ella™
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Article Clarification
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Test Yourself Online
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Featured Items
MPFS Rule Corrected
DMEPOS Final Rule
ESRD PPS Billing
New RAC Issues
CLIA Waived Tests Update
ASC Accrediting
Coding Tips
Medical News
Test Yourself Online
Coding Job Links

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