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Issue #168 - March 2, 2011
AAPC EdgeBlast
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New CLIA Waived List Released
The Centers for Medicare & Medicaid Services (CMS) released Feb. 11 the latest laboratory tests approved by the Food and Drug Administration (FDA) as waived tests under Clinical Laboratory Improvement Amendments of 1988 (CLIA). The recurring update notification includes one code change and one code descriptor change which affects several tests.

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OIG Investigates Diabetic Supply Claims
Home blood-glucose test strips and lancets are big business. In 2007, Noridian Administrative Services, LLC, allowed payments totaling $219 million for just these diabetic control supplies alone. Of that amount, the Jurisdiction D durable medical equipment Medicare administrative contractor (DME MAC) allowed payment for $76 million high-use test strip and/or lancet claims—more than half of which the Office of Inspector General (OIG) says were inappropriately paid.

A February 2011 OIG report details the investigation that led to these claims and provides insight as to how providers and suppliers can get paid for these DME claims without fear of retribution.

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Medicare Appeals Process Brochure Revised
The Centers for Medicare & Medicaid Services (CMS) has revised for 2011 "The Medicare Appeals Process: Five Levels to Protect Providers, Physicians and other Suppliers" brochure. This brochure provides an overview of the Medicare Part A and Part B administrative appeals process available to providers, physicians, and other suppliers who provide services and supplies to Medicare beneficiaries.

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New Requirements for Home Health Certifications
Patient Protection and Affordable Care Act (PPACA) of 2010 provisions mandate new requirements regarding face-to-face encounters for certifications applicable to the home health program. The Centers for Medicare & Medicaid Services (CMS) recently updated the Home Heath Services chapter in the Medicare Benefit Policy Manual to implement these new conditions of payment.

Effective Jan. 1, 2011, a certifying physician or qualified non-physician practitioner (NPP) must document that he or she had a face-to-face encounter with a patient who requires home health services no more than 90 days prior to the start of care or within 30 days after the start of care. A second face-to-face encounter is required within 30 days after the start of care if the patient's condition changes from that documented in the visit made 90 days prior to start of care, and a change in treatment is required.

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Medicare Pays Less for Specimen Collection in 2011
The price of gas is on the rise but the Medicare travel allowance fees for specimen collection are on the decline. A recurring update notification released Feb. 11 by the Centers for Medicare & Medicaid Services (CMS) revises the per mileage and flat fee travel payment allowances for 2011.

Medicare Part B allows payment for a specimen collection fee and travel allowance, when medically necessary, for a laboratory technician to draw a specimen from either a nursing home patient or homebound patient. Payment for these services is made based on the Clinical Laboratory Fee Schedule (CLFS).

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Upcoming Events

Coordination and Maintenance to Discuss Final I-9 and I-10 Full Updates

The last National Committee for Vital Health Statistics (NCVHS) meeting to address regular, full updates for both ICD-9 and ICD-10 code sets will take place March 9-10 at the Centers for Medicare & Medicaid Services (CMS) auditorium at CMS headquarters in Baltimore, Md. Registration for the ICD-9-CM Coordination and Maintenance Committee closes March 4, or when full capacity is reached. However, if you can't be there, you can listen in by phone.

Coordination and Maintenance will discuss proposed annual updates for both ICD-9 and ICD-10 code sets. The tentative agenda runs the gamut, from cardiac valve replacement to cerebral and tissue oximetry. Procedure codes will be discussed the first day and diagnosis codes the second. The comments and discussion will result in the annual ICD addenda.

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Coding Tips

UHC Provides Resource for Coding Well Visits
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Medical News

CMS Calls Providers to Follow Up on CERT Program
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21K "Ready" for EHR Incentives Says CMS
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PHI Breach Affects Millions of New Yorkers
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Medicare University Updated by Jurisdiction B
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UHC Extends Premium Program Dates
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Cignet Health Charged with HIPAA Violation
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Featured Items
New CLIA Waived List
OIG Investigates Claims
Medicare Brochure Revised
Home Health Certifications
Less for Specimens
Upcoming Events
Coding Tips
Medical News
Coding Job Links






























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