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Issue #169 - March 16, 2011
AAPC EdgeBlast
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Earn CEUs Thru v5010 Readiness Call

The Centers for Medicare & Medicaid Services (CMS) will host its 15th national education call regarding Medicare fee-for-service's implementation of Health Insurance Portability and Accountability Act (HIPAA) Version 5010 and D.0 transaction standards on March 30. This is an opportunity to learn how to meet this essential requirement. And as a bonus, participating coders may qualify to earn a Continuing Education Unit (CEU) from AAPC.

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AMA Adds to CPT® 2011 Corrections Document

The American Medical Association (AMA) recently updated its CPT® 2011 corrections document. Most of these latest corrections are grammatical, but there also are several changes to parenthetical notes and code descriptions that you should make note of in your codebook to ensure accurate coding.

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Contractors Holding AWV Claims Until April 4

If you're wondering why your annual wellness visit (AWV) claims aren't being paid, there's a good reason. The Centers for Medicare & Medicaid Services (CMS) has instructed all Medicare contractors to hold all AWV claims submitted on types of bill 12X and 13X with dates of service on and after Jan. 1 through April 3.

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Policy Update: Reviewers May Use Claims History When Indicated

Medicare claims reviewers were given a yellow light for using claims history information when making complex review determinations in a recent policy update. Claims history information should only be used "in limited circumstances," and as a supplement to the medical record, the Centers for Medicare & Medicaid Services (CMS) instructs its contractors. "However," CMS says, "this policy does not prevent contractors from using claims history for other purposes such as data mining."

Change Request (CR) 7305, issued Feb. 25, instructs ACs, Medicare administrative contractors (MACs), comprehensive error rate testing (CERT) contractors, and recovery audit contractors (RACs) conducting complex medical reviews on the use of claims history information when making payment determinations during the course of medical review. The policy is effective for CERT reviews retroactively for the November 2011 report period, and 30 days on or after the release of CR 7305 (March 25) for ACs, MACs, and RACs.

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Processing Error Results in Underpaid Faslodex Claims

A claims processing issue has resulted in claims for HCPCS Level II code J9395 Fulvestrant, 25 mg with dates of service on or after Jan. 1 to be improperly paid. The Centers for Medicare & Medicaid Services (CMS) recently discovered that providers were being underpaid for these claims because the payment limit for the breast cancer treatment drug was incorrectly set.

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Proposed Rule Outlines State Innovation Waiver Process

The Departments of Health and Human Services (HHS) and Treasury proposed a new rule, March 10, outlining the steps states can take to receive a State Innovation Waiver under the Patient Protection and Affordable Care Act (Affordable Care Act).

The Affordable Care Act gives states the flexibility to receive a State Innovation Waiver beginning in 2017. President Obama has said he supports bipartisan legislation that would make waivers available to states beginning in 2014.

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Coding Tips

Check for Transforaminal Epidural Injection Errors
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Submit DMEPOS Claims in Sequence
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NHIC: How to Prevent Ambulance Claim Denials
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CMS Newsletter Aims to Reduce Billing Errors
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Medical News

MRI NCD Being Reconsidered, Again
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CMS Opens NCAs for Depression, STI Screenings
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Files Left on Subway: Mass General Charged
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Coding Job Links

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Featured Items
CEUs for v5010 Readiness
New CPT Changes
AWV Claims Held
Claims History Use OK
Faslodex Underpaid
State Innovation Waiver
Coding Tips
Medical News
Coding Job Links


























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