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Issue #160 - November 3, 2010
AAPC EdgeBlast

Medicare Asks Questions First, Pays Later
Beginning in 2011, new legislation requires the Centers for Medicare & Medicaid Services (CMS) to do away with its age-old fast food methodology of paying claims first and asking questions second—otherwise known as "pay and chase"—and adopt billing software designed with predictive modeling capabilities.

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2011 First Quarter Interest Rate Released
Medicare contractors will charge/pay a slightly lower interest rate for claims underpayments/overpayments this period than in the last. Effective Oct. 22, the private consumer interest rate is 10.75 percent—compared to 11 percent for the previous quarter.

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NGS Reports Erroneous Part B Claims Rejection
National Government Services (NGS) has identified an issue with their daily National Provider Identifier (NPI) crosswalk file. The issue may have potentially caused claims to reject in error. It began on or around Oct. 12, and impacts all Part B providers in Connecticut, New York, Indiana, and Kentucky.

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TrailBlazer: Part B Claims Rejected in Error
If your practice submits claims to TrailBlazer Health Enterprises, you might want to check the remittance remarks on any recently rejected claims. The jurisdiction 4 Part B Medicare administrative contractor (MAC) recently posted an alert on its website stating that some Medicare Part B claims cycled on Oct. 4 were rejected in error with message M81, "You are required to code to the highest level of specificity."

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Check With Payer for Hizentra Coverage
Effective for service dates on or after Dec. 15, HCPCS Level II code J3490 Unclassified drugs will be non-covered as a self-administered drug when used to bill Medicare Part B for Hizentra™ (Immune Globulin Subcutaneous (Human) (IGSC)). This is in accordance with the recently updated Self-Administered Drug Exclusions List, TrailBlazer Health Enterprises announced Oct. 22 in a notice posted on its website.

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Community Centers Get $335M Federal Boost
Community health centers across the country now have $335 million in federal grants at their disposal to boost access to those in need of primary health care, including dental health, behavioral health, pharmacy, vision, and/or enabling services. The funds are made possible by the Patient Protection and Affordable Care Act, commonly known as the Affordable Care Act, under the Expanded Services (ES) initiative, the U.S. Department of Health and Human Services (HHS) announced Oct. 26.

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Feds Meet to Discuss ACO Regulations
During a daylong event convened, Oct. 5, by the Centers for Medicare & Medicaid Services (CMS), the Federal Trade Commission (FTC) and the Office of Inspector General (OIG), leaders shared their views about what the government needs to do to ensure the success of Accountable Care Organizations (ACO). A key focus of the workshop was on how the requirements of various fraud and abuse laws could or should be addressed in the regulations that CMS is developing for the Medicare Shared Savings Program, and to what extent any safe harbors, exceptions, exemptions, or waivers from these laws may be warranted.

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DMEPOS Competitive Bidding: Exceptions to Every Rule
A new fact sheet posted Oct. 22 on the Centers for Medicare & Medicaid Services (CMS) MLN General Information website provides helpful information for physicians and other practioners who provide items to Medicare patients who are affected by the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program.

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Certified EHR Product List Grows
Eligible professionals (EPs) and hospitals should not have any trouble finding a certified electronic health record (EHR) product to help them meet "meaningful use" standards under the federally run EHR incentive programs. This list of certified EHRs is growing rapidly.

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UnitedHealthcare Tests Lump Sum Cancer Payments
UnitedHealthcare Group announced Oct. 20 that it is working with five medical oncology groups around the country to advance a new cancer-care payment model that "focuses on best treatment practices and better health outcomes for patients with breast, colon, and lung cancers." The five medical practices participating in the one-year pilot have between 18 and 35 oncologists on staff and are based in Dayton, Ohio; Fort Worth, Texas; Kansas City, Mo.; Marietta, Ga.; and Memphis, Tenn.

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Coding Tips

CMS Clarifies Status Indicator Effective Date for 80101
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Three-Day Payment Rule Affects Inpatient and Outpatient Coders
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Medical News

Diabetes Projected to Double or Triple by 2050
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FDA Rescinds Marketing Clearance for Menaflex
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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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Featured Items
Questions First, Pay Later
2011 Q1 Interest Rate
NGS Erroneous Rejection
TrailBlazer Part B Claims
Hizentra Coverage
Community Centers Boost
ACO Regulations
DMEPOS Bidding
Certified EHRs Grow
Cancer Payments
Coding Tips
Medical News
Test Yourself Online
Coding Job Links

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