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Issue #167 - February 16, 2011
AAPC EdgeBlast
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CMS Ready to Reprocess 2010 Claims
Nearly one year after President Barack Obama signed health care reform legislation into law, the Centers for Medicare & Medicaid Services (CMS) is ready to begin the daunting task of reprocessing claims. This reprocessing of Medicare fee-for-service (FFS) claims is necessary due to the retroactive effective dates of select provisions in the Patient Protection and Affordable Care Act of 2010 and subsequent 2010 Medicare Physician Fee Schedule (MPFS) corrections.

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April Update to 2011 Physician Fee Schedule Released
The Centers for Medicare & Medicaid Services (CMS) released, Feb. 4, the April update to the 2011 Medicare Physician Fee Schedule Database (MPFSDB). Changes to payment files include revised payment indicators and practice expense relative-value units (PE RVUs). A handful of procedure and supply codes were added or deleted, as well.

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Proposed Rule Expands Patient Rights to Quality Care
The Centers for Medicare & Medicaid Services (CMS) recently published a proposed rule that would add to the existing requirements providers and suppliers must meet to participate in Medicare and Medicaid. The new Condition of Participation (CoP) for providers or Condition for Coverage (CfC) for suppliers would require most providers and suppliers to give their Medicare patients the information they need to file a complaint if they are dissatisfied with the care they are receiving. Presently, only hospitals are required to provide this information to inpatients.

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Medicare Contractors to Hold '11 Home Dialysis Claims
Year 2011 end stage renal disease (ESRD) home dialysis claims for continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD) are being held and will not be released for processing until as late as Feb. 21.

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Oops. MAC Denies Annual Wellness Visit Claims
At least one Medicare administrative contractor (MAC) has reportedly denied annual wellness visit (AWV) claims in error. The Patient Protection and Affordable Care Act of 2010 (PPACA) provides for the implementation of Medicare AWVs. Full Medicare Part B coverage and payment of the AWV went into effect Jan. 1.

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CMS Implements Affordable Care Act Provisions
There has been a lot of talk about the preventive care provisions in the Patient Protection and Affordable Care Act, but the law also requires the Centers for Medicare & Medicaid Services (CMS) to make changes to Medicare Part B policy that are likely to affect consumers less and physicians more. Take a closer look at some of the less touted Part B policy changes CMS has already implemented or will implement this year.

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CMS: Final Steps Toward Medicare Imaging Demo
A new demonstration project slated to begin in July will assess whether decision support systems and a new payment method decrease the amount of advanced imaging services physicians order for their Medicare patients. The Centers for Medicare & Medicaid Services (CMS) recently released claims processing instructions to contractors and announced the selected participants for overseeing the Medicare Imaging Demonstration (MID).

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Coding Tips

DME Suppliers: Get Paid for These HCPCS Codes
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Dressings Not Separately Payable Under ESRD PPS
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April Update Makes Change to Blood Counts NCD
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Medical News

NHIC Updates Stand on Avastin Use
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OIG Releases New Physician Educational Material
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Study: Pay for Performance Doesn't Improve Quality of Care
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Featured Items
CMS Reprocessing Claims
April Physician Fee Update
Patient Rights Expanded
Home Dialysis Claims Held
MAC Denies AWV Claims
CMS Implements Care Act
Medicare Imaging Demo
Coding Tips

Medical News
Coding Job Links
























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