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Issue #176 - July 6, 2011
AAPC EdgeBlast

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CMS Proposes 2012 Payment Changes for 290 Codes

The Centers for Medicare & Medicaid Services (CMS) has proposed revisions to the work relative value units (RVUs) for 290 CPT® codes, to be enacted with adoption of the 2012 Medicare Physician Fee Schedule (Jan. 1, 2012).

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CBO Projects Physician Pay Cut for 2012

The Congressional Budget Office (CBO) projects that, under current law, payment rates for physician services provided to Medicare beneficiaries will be reduced by 29.4 percent in 2012. The large pay cut follows several years of legislative action to either maintain or increase physician payment rates under the Medicare Part B program when those rates were otherwise scheduled to decrease under the Sustainable Growth Rate (SGR) mechanism. Is it time to pay the piper?

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Predictive Technology Fights Medicare Fraud

Crooks who choose to defraud Medicare will now have to square up against technology in uniform. Predictive modeling is the Centers for Medicare & Medicaid Services' (CMS') newest tool to help an administration-wide campaign to cut waste, fraud, and abuse in Medicare beginning July 1. The initiative uses similar technology to that used by credit card companies to identify potentially fraudulent Medicare claims on a nationwide basis, ideally before they are paid, and builds on other tools and resources provided by the Affordable Care Act, the federal agency said.

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"Mystery Shopper" Plan Scrapped

Plans by the U.S. Department of Health & Human Services (HHS) to use "mystery shoppers" to call on physician offices have been scrapped. HHS announced in April its plans to gauge availability of primary care physicians (PCPs) accepting new Medicare patients, assess the timeliness of Medicare services provided to beneficiaries by PCPs, and assess the reasons why PCP availability is lacking.

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MedPAC Recommends New Imaging Payment System

The Medicare Payment Advisory Commission (MedPAC) considers several health care matters in its June 2011 Report to the Congress: "Medicare and the Healthcare Delivery System," but what is making the most waves among the industry are the recommendations pertaining to ancillary services. A new payment system is in order, MedPAC says in the report; one that would reward physicians and hospitals for limiting the number of imaging services they provide. Prior notification and prior authorization also would "ensure the appropriate use of advanced imaging studies," MedPAC says.

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CMS Adopts Two Operating Rules for ASC X12 Transactions

The Centers for Medicare & Medicaid Services (CMS) posted for public inspection an interim final rule with comment period (IFC) in the Federal Register on June 30 to adopt the first set of operating rules for two of the adopted ASC X12 standards: eligibility for a health plan and "health care claim status" transactions. This IFC is the first in a series of regulations required by Section 1104 of the Affordable Care Act of 2010 over the next five years.

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CMS Proposes to Rescind Lab Requisition Sig Requirement

The Centers for Medicare & Medicaid Services (CMS) is proposing to rescind a new requirement that the ordering physician or qualified non-physician practitioner (NPP) sign requisitions for all clinical diagnostic laboratory tests paid under the Clinical Laboratory Fee Schedule (CLFS).

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New Specialty Code 95 Won't See Light

Just days before specialty code 95 Advanced diagnostic imaging accreditation was to go into effect, the Centers for Medicare & Medicaid Services (CMS) decided to eliminate it. CMS notified contractors of this change June 24 in Transmittal 2248. The new code was supposed to go into effect July 1.

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Coding Tips

CMS Posts Final Full Update for 2012 ICD-9
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Medicare Now Covers Tissue of Origin Test
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Wellness Visit Omissions Clarified
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FDA Approves New Waived Tests Under CLIA
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CMS Posts New IPPE FAQs
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Medical News

AMA's Payer Report Card: No A's
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CMS Promotes Medicare Preventive Care
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NQF Updates List of Serious Reportable Events
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FDA Modifies ESA Dosing Recommendations
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Survey: Fewer Physicians Are in Private Practice
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Featured Items
2012 Payment Changes
Physician Pay Cut
Tech vs Medicare Fraud
Nixed: Mystery Shopping
New Imaging Pay System?
Rules for ASC X12
New CLFS Requirements
95 Not Recognized
Coding Tips
Medical News
Coding Job Links




























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CPT® codes Copyright 2010 American Medical Association. All Rights Reserved. CPT® is a trademark of the AMA. No fee schedules, basic units, relative values or related listings are included in CPT®. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.