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Issue #175 - June 15, 2011
AAPC EdgeBlast


Are You Testing 5010 Today?

Six months before every Health Insurance Portability and Accountability Act (HIPAA)-covered entity switches over to the new 5010 standards, the nation is taking a day at the direction of the Centers for Medicare & Medicaid Services (CMS) to gauge its readiness for implementation. Are you participating?

The 5010 standards for electronic claims submission will replace the 4010 X-12 electronic transaction standards currently being used, and they are intended to better accommodate the soon-to-be launched ICD-10 and national guidelines for electronic health records (EHRs). CMS intends this test to give all "trading partners" (physicians, clearinghouses, payers, Medicare administrative contractors, and Medicaid agencies) an opportunity to perform dry-run claim submissions. The agency hopes all gremlins will be exterminated by the program's implementation on Jan. 1, 2012.

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CMS Posts Last Regular ICD-9-CM Update Before Freeze

The partial code freeze on ICD-9-CM is just a little over three months away. Oct. 1, 2011 is the last day for regular updates to the ICD-9-CM code set.

Download the new, deleted and revised ICD-9-CM code summary tables, effective Oct. 1, 2011, now available on CMS' website. The Vol. 3 Procedure Code final addendum which describes all changes to the procedure part of ICD-9-CM also is posted on CMS' website. The final addendum for Vols. 1 and 2 is forthcoming.

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Congress Proposes ASC Reimbursement Overhaul

A bipartisan proposal in Congress may enact two long-awaited changes in ambulatory surgical center (ASC) reimbursement: Medicare payment updates tied to hospital market and a value-based purchasing program to generate shared savings for the Centers for Medicare & Medicaid Services (CMS) and high-performing ASCs.

The Ambulatory Surgical Center Quality and Access Act of 2011, introduced by Reps. Pete Sessions (R-Texas), John Larson (D-Conn.), Shelley Berkley (D-Nev.) and Bill Cassidy (R-La.), attempts to preserve "patient access to the high quality, cost-effective health care services that" ASCs provide, says the Ambulatory Surgery Center Association in a news release.

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New Demo Pays FQHCs to Coordinate Medicare Patients' Care

A new demonstration being offered by the Centers for Medicare & Medicaid Services (CMS), in partnership with the Health Resources Services Administration (HRSA), gives federally qualified health centers (FQHCs) an opportunity to improve care and earn a little extra money at the same time.

The FQHC Advanced Primary Care Practice (APCP) three-year demonstration is an Affordable Care Act initiative that will test FQHCs' ability to coordinate care for Medicare patients using a patient-centered medical home model. Beginning Sept. 1, CMS expects to test the effectiveness of doctors and other health care professionals working in teams to improve care for up to 195,000 Medicare patients in up to 500 FQHCs.

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CMS Proposes Changes to eRx Incentive Program

Under the Electronic Prescribing (eRx) Incentive Program, the Centers for Medicare & Medicaid Services (CMS) will dole out incentives to successful electronic prescribers (e-prescribers), and penalize those who aren't, beginning in 2012. On June 1, however, the agency published a proposed rule in the Federal Register that would give providers more reasons and more time to excuse themselves from the program without being penalized.

CMS proposes to modify the 2011 eRx quality measure used for certain reporting periods this year; permit eligible professionals (EPs) and group practices four additional categories they can report to exempt themselves from the 2012 eRx payment adjustment, and allow three additional months in which to do it.

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Medicaid Adopting "Never Event" Payment Rules

Medicaid is following the lead of Medicare and will stop paying for about two dozen "never events" in hospitals, according to a final rule published in the Federal Register on June 1. The rule nationalizes a nonpayment policy already implemented in 21 states, preventing funds from being used to pay for services that "result from certain preventable health care-acquired illnesses or injuries," Centers for Medicare & Medicaid Services (CMS) officials said.

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New Deadlines for ACO Letter of Intent and Application

Organizations interested in applying to the new Pioneer ACO Model must submit a letter of intent and an application. The deadlines for submitting these documents, however, have changed.

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ASC Same-Day Notification Rule Soon May Cease to Be

Medicare's same-day notification rule may soon undergo revisions that would ease requirements for ambulatory surgery centers (ASCs) and improve timely access to care.

The Centers for Medicare & Medicaid Services' (CMS) Same-Day Services Final Rule requires ASCs to inform patients of their rights and facility's ownership prior to the date of surgery (with exceptions for medically-necessary, same-day procedures). Through its advocacy groups, the ASC industry has been seeking broader exceptions to the rule.

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Coding Tips

CMS Announces OPPS July 1 Update
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DMEPOS Fee Update Includes Retroactive Changes
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ASC Update: New Bone Marrow Therapy Codes and More
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Compliance Newsletter Clarifies Recent RAC Findings
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Helpful Hints for Crosswalking ICD-9/ICD-10 Codes
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Medical News

Proposed Rule Gives Patients Right to Know Who Viewed Records
Read more »

Study: Bevacizumab "Equivalent" to Ranibuzumab for Treating AMD
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Featured Items
Testing 5010
Last ICD-9 Update
ASC Reimbursement
CMS Demo for FQHCs
Changes to eRx Incentive
"Never Event" Rules
New ACO Deadlines
ASC Same-Day Notice Rule
Coding Tips
Medical News
Coding Job Links

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