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Issue #164 - January 5, 2011
AAPC EdgeBlast

Emergency Update to Physician Payment
The Medicare Physician Fee Schedule Database (MPFSDB) has been revised to include MPFS policy and payment indicator revisions, as well as relevant statutory changes applicable Jan. 1, 2011. The Centers for Medicare & Medicaid Services (CMS) issued a 2011 MPFS Final Rule Correction Notice to revise some physician work, practice expense (PE), and malpractice (MP) relative value units (RVUs) set forth in the 2011 MPFS Final Rule, published in the Nov. 29, 2010 Federal Register. Subsequent legislative changes occurring after the publishing of the correction notice have made additional revisions affecting Medicare payments to physicians necessary.

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Register Now for EHR Incentives
Eligible professionals (EPs) and hospitals may now register to participate in the Medicare Electronic Health Record (EHR) Incentive Program and/or, in some states, the Medicaid EHR Incentive Program. On Dec. 22, 2010, CMS and the Office of the National Coordinator for Health Information Technology (ONC) announced that Jan. 3, 2011 marked the beginning of the open registration period for the Medicare EHR Incentive Program and also the Medicaid EHR Incentive Program in Alaska, Iowa, Kentucky, Louisiana, Oklahoma, Michigan, Mississippi, North Carolina, South Carolina, Tennessee, and Texas. "CMS has many resources available to help providers register and participate," said CMS Administrator Donald Berwick, M.D.

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Final Rule for ESRD Quality Incentive Program
CMS issued Dec. 29, 2010 a final rule establishing performance standards for dialysis facilities and providing pay-for-performance adjustments to individual end-stage renal dialysis (ESRD) facilities. The ESRD Quality Incentive Program (QIP) is a companion piece to the ESRD Prospective Payment System (PPS), which is effective Jan. 1, 2011.

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AMA Makes More Corrections to CPT 2011
The American Medical Association (AMA) recently published updates to CPT® Category I and III codes for 2011. The AMA has made a couple of noteworthy changes to its original CPT® 2011 corrections document. To ensure accurate reporting of health care services, you'll need to correct your codebook with a parenthetical note in the Surgery section and an introductory guideline in the Medicine section. While there, you'll also need to make an important change in the Vaccination Products subsection.

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HCPCS Level II Corrections Posted
CMS has released a modification to the HCPCS Level II code set. Among other changes, CMS has reinstated codes L3660 Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, includes fitting and adjustment; L3670 Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, includes fitting and adjustment; and L3675 Shoulder orthosis, vest type abduction restrainer, canvas webbing type or equal, prefabricated, includes fitting and adjustment with the original language.

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Lab Requisition Signature Requirement Postponed
The requirement for a physician's or qualified nonphysician practitioner's (NPP) signature on all requisitions for clinical diagnostic laboratory tests paid under the Clinical Laboratory Fee Schedule (CLFS) will not be enforced beginning Jan. 1, 2011, as finalized in the 2010 Physician Fee Schedule (PFS) final rule.

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CMS Corrects Rural 2011 Pay Rates
Rural health clinics (RHCs) and federally qualified health centers (FQHCs) will see a slightly greater increase in 2011 payments than previously stated. CMS recently corrected 2011 RHC and FQHC payment rates to reflect the 0.4 percent Medicare Economic Index (MEI) update published in the PFS final rule, rather than the 0.3 percent MEI update, published in the PFS proposed rule.

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PECOS Ordering/Referring Edit Reset
CMS has rescinded its previous announcement that, beginning Jan. 3, 2011, claims for certain ordered/referred Part B items and services will not be paid if the ordering/referring provider on the claim does not have an enrollment record in the Medicare Provider Enrollment, Chain and Ownership System (PECOS). The new "placeholder" implementation date for this Patient Protection and Affordable Care Act (PPACA) provision—known as Phase 2—is July 5, 2011.

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Download January 2011 ASP Files
CMS recently released the January 2011 Average Sales Price (ASP) and Not Otherwise Classified (NOC) pricing files and crosswalks as well as updated pricing files for October 2010 and July 2010.

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Medicare: Incentives to Providers Pay Off
CMS announced Dec. 10, 2010 the results of three health care demonstrations that it says provide strong evidence that offering providers financial incentives to improve patient care increases quality of care and can reduce the growth in Medicare expenditures. The Physician Groups Improve Quality and Share Savings demonstrations included one for large physician practices, one for small and solo physician practices, and one for hospitals. Under the Physician Group Practice (PGP) demonstration, physician groups earn incentive payments based on the quality of care they provide and the estimated savings they generate in Medicare expenditures. According to CMS, all 10 of the participating physician groups achieved benchmark performance on at least 29 of the 32 measures reported in year four of the demonstration, and five of the physician groups will receive performance payments totaling $31.7 million.

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9/11 First-responders Get Health Bill
Congress passed a bill Dec. 22 to provide compensation and long-term health benefits for first-responders to the World Trade Center terrorist attack in New York City on Sept. 11, 2001. The $4.2 billion bill passed the Senate by a unanimous voice vote and just hours later was quickly approved by the U.S. House of Representatives by a vote of 206 to 60. President Barack Obama received the bill on his desk Dec. 23 and signed it Jan. 2.

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Surescripts Added As EHR Certifier
Surescripts, a Virginia-based electronic prescribing network provider, is approved as the sixth of groups that can test and certifiy EHR modules, ONC announced Dec. 23, 2010. Surescripts is authorized to test and certify that EHR modules are compliant with the e-prescribing and privacy and security standards, implementation specifications, and certification criteria adopted by the Health and Human Services (HHS) secretary and meet the definition of "certified EHR technology."

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ONC Announces Final Permanent Certification Rule
ONC issued a final rule Jan. 3 establishing a permanent program for certifying EHR technology. Testing and certification is expected to begin Jan. 1, 2012 under the permanent certification program.

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Coding Tips

Correctly Report Rural Preventive Services' Claims
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ASC Interpretive Guidelines Clarified
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Medical News

PharMEDium Markets Prefilled Propofol Syringes
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Coding Job Links
AAPC Job Database

AAPC Employment Forums

Featured Items
Physician Payment Update
EHR Incentives
Final Rule For ESRD
More Corrections to CPT
HCPCS Level II Corrections
Requirement Postponed
CMS Corrects Pay Rates
PECOS Ordering/Referring
January 2011 ASP Files
Incentives Pay Off
9/11 First-responders
Surescripts EHR Certifier
ONC Certification Rule
Coding Tips

Medical News
Coding Job Links

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CPT® codes Copyright 2010 American Medical Association. All Rights Reserved. CPT® is a trademark of the AMA. No fee schedules, basic units, relative values or related listings are included in CPT®. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.