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Issue #172 - May 4, 2011
AAPC EdgeBlast

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HHS Considers Mystery Patients to Evaluate PCPs

The office of the Assistant Secretary for Planning and Evaluation (ASPE) is proposing to use a mystery shopper approach to collect data from physician offices to accurately gauge availability of primary care physicians (PCPs) accepting new patients, assess the timeliness of services from PCPs, and assess the reasons that PCP availability is lacking.

Over a four-month period, 465 primary care physicians (PCPs) in nine states across the country will be contacted by a mystery shopper on two separate occasions, using two different scenarios. The scenarios will simulate requests for an appointment with the PCP from a new patient with a public or private insurance and either an urgent medical concern or routine exam appointment.

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CMS Issues 2012 IPPS/LTCH/IRF Proposed Rules

The Centers for Medicare & Medicaid Services (CMS) is proposing to update fiscal year 2012 payment policies and rates for hospitals paid under the inpatient, long-term care, and inpatient rehabilitation facilities prospective payment systems (PPS). The two proposed rules with comment periods also would further implement certain Affordable Care Act provisions and several other policy changes.

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PQRS and eRX Programs Pay Off for Participating Providers

A report released by the Centers for Medicare & Medicaid Services (CMS) April 19 shows a growing trend toward physicians and other eligible professionals (EPs) participating in the Physician Quality Reporting System (PQRS) and the Electronic Prescribing (eRx) Incentive Program. Both programs reward physicians and other EPs for successfully reporting quality measures with a percentage of their estimated Part B Medicare Physician Fee Schedule (MPFS) allowed charges for covered professional services.

According to the CMS report "2009 Physician Quality Reporting System and eRx Experience and Trends," 119,804 physicians and other EPs in 12,647 practices satisfactorily reported data on quality measures. As a result, CMS paid over $234 million in PQRS incentive payments in 2009, compared to $36 million in 2007—the first year of the program. CMS additionally paid $148 million to 48,354 successful ePrescribers in 2009—the first payment year of the eRx program.

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CMS Report Highlights RAC Overpayments, Underpayments

Since October 2009, when Medicare's fee-for-service Recovery Audit Contractor (RAC) Program went nationwide, health care providers have returned $313.2 million in alleged Medicare overpayments and received $52.6 million in Medicare underpayments, according to a new report from the Centers for Medicare & Medicaid Services (CMS). The report also identifies the top overpayment issues in each of the four RAC regions nationwide.

RACS report the top overpayment issues from fiscal year 2010 through March 2011 involve incorrect coding and improper billing for separating bundled services.

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Survey Says Physicians Aren't 5010-ready

The transition to the Health Insurance Portability and Accountability Act (HIPAA) Version 5010 standards is just over six months away. Physician practices who fail to make the impending deadline are at risk of not getting electronic payments from private insurers and Medicare. And yet, more than half of physicians' practices haven't even scheduled testing, reports Medical Group Management Association (MGMA).

According to the Centers for Medicare & Medicaid Services (CMS) 5010 implementation schedule, HIPAA-covered entities should have been ready to test with their trading partners the functionality of the entities' practice management and/or other related software featuring Version 5010 standards beginning January 2011.

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Medicare Growth Rate at an All-time Low

Newly published Standard & Poor's (S&P) Indices show the average cost of health care continues to rise, but at a much slower pace than previous years. Although the entire health care industry is likely to feel the pinch, hospitals are showing the greatest strain, as indicated by employment rates.

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AAAASF Approved as Accreditation Organization

Facilities seeking to furnish physical therapy and speech-language pathology services to Medicare and Medicaid patients in an outpatient setting have a new sheriff in town. The American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) has been approved as a national accreditation organization (AO).

The Centers for Medicare & Medicaid Services (CMS) published a final notice April 22 announcing its approval of the AAAASF as a national accreditation program for organizations that provide outpatient physical therapy and speech-language pathology services seeking to participate in the Medicare and Medicaid programs.

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Coding Tips

Changes to CLIA Waived Tests Effective July 1
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Flu Vaccine Q Code Undergoes Price Revision
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New MLN Products Answer DMEPOS Accreditation Questions
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Medical News

Doctors: Be On the Lookout for Dengue Fever
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NCQA's ACO Accreditation Guidelines Almost Ready
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CMS Proposes Adding Coverage to MRI NCD
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Featured Items
Mystery PCP Evaluations
CMS Proposed Rules
PQRS and eRX Programs
RAC Over/Under Payments
Physicians Not 5010-ready
Medicare Growth Rate Low
AAAASF Approved as AO
Coding Tips
Medical News
Coding Job Links
































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