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Issue #158 - October 6, 2010
AAPC EdgeBlast

OIG 2011 Work Plan: Old and New Targets
The Office of Inspector General (OIG) released Oct. 1 its annual work plan for the coming year. Not surprisingly, the federal agency said it will review many Medicare Part B issues which have been under the looking glass in years past. With everything that’s been going on this past year with health reform, however, the OIG has plenty of new projects to address as well.

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ICD-9-CM Changes, Effective Oct. 1
Additional changes have been made to ICD-9-CM. The Centers for Disease Control and Prevention (CDC) have finalized the addition, revision or deletion of several diagnosis codes, as was discussed at the March 9-10 ICD-9-CM Coordination and Maintenance Committee meeting.

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October Update to 2010 MPFSDB
Physicians and non-physician practitioners (NPPs) submitting claims for services provided to Medicare beneficiaries should be aware that the Centers for Medicare & Medicaid Services (CMS) issued, Sept. 17, changes to payment files in the 2010 Medicare Physician Fee Schedule Database (MPFSDB). Medicare contractors will process Part B claims using these updated payment files, but are not instructed to automatically adjust claims.

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October Updates to OPPS and ASC PS
Quarterly updates to the Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Payment System (ASC PS) for separately paid drugs and biologicals, covered surgical procedures, and ancillary services have been released to Medicare contractors. The updates include one newly created pass-through device HCPCS Level II code, five newly created drug HCPCS Level II codes, and six newly created HCPCS Level II codes for imaging services.

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Medicare Enrollment Requirement Extends to EPs Who Order/Refer
Physicians and non-physician practitioners (NPPs) who order and refer items and services for Medicare beneficiaries—even if that’s all they do— must be enrolled in the Medicare program, according to the Centers for Medicare & Medicaid Services (CMS). The government agency announced recently that it is implementing this requirement as it appears in the Medicare and Medicaid Programs; Changes in Provider and Supplier Enrollment, Ordering and Referring, and Documentation Requirements; and Changes in Provider Agreements Interim Final Rule..

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ONC Names Third EHR Certification Body
InfoGard Laboratories, Inc., of San Luis Obispo, Calif., is the third electronic health record (EHR) certification body to be named by the Office of the National Coordinator for Health Information Technology (ONC) to date. The Certification Commission for Health Information Technology (CCHIT) and Drummond Group, Inc. (DGI) were the first to be named, Aug. 30, as ONC-Authorized Testing and Certification Bodies (ONC-ATCB) by the ONC.

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COBC Error Causes ESRD Claims to be Rejected
Several thousand End-Stage Renal Disease (ESRD) facility claims (type of bill 72x) submitted to Highmark Medicare Services between July 5 and Aug. 16 were erroneously rejected. This holds true even if a provider’s Medicare remittance advice indicates that Medicare transferred a patient’s claim to a given supplemental insurer.

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Get Your EHR Certification FAQs Straight
The Office of the National Coordinator for Health Information Technology (ONC) recently added a question and answer section to its website that generally pertains to compliance of certified electronic health record (EHR) systems. Questions are broken up into three sections: Regulations, Standards and Certification Criteria Final Rule, and Temporary Certification Program.

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Coding Tips

CMS Revises Ornish and Pritikin Program NCDs
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CMS Amends NCD for FDG PET
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5010 Requirements for Ambulance Suppliers
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RAC Demonstration Identifies Improper Payment and Coding Vulnerabilities
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New Dosing for FASLODEX Injections
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Medical News

Mandatory Flu Shot Bill Is Reintroduced
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FDA Approves New Drug for Gout
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Tech-Savvy Patients Present with Modern-day Ailments
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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
OIG 2011 Work Plan
ICD-9-CM Changes
2010 MPFSDB
OPPS and ASC PS Updates
Medicare Enrollment
EHR Certification
COBC Error
EHR Certification FAQs
Coding Tips
Medical News
Test Yourself Online
Coding Job Links

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