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Issue #177 - July 20, 2011
AAPC EdgeBlast

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CMS Proposes 2012 Payment Policy and Rate Changes

The Centers for Medicare & Medicaid Services (CMS) ran a triple play on July 1, issuing proposed rules that will affect physicians, hospital outpatient departments (HOPD), ambulatory surgical centers (ASC), and suppliers of renal dialysis services in the upcoming year. Most notable in all three proposed rules are the updates to payment policies and rates for 2012 and the steps being taken to further implement Affordable Care Act provisions intended to improve the quality of care beneficiaries receive and, at the same time, reduce government spending.

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Top 10 Version 5010 Submission Errors

The Centers for Medicare & Medicaid Services (CMS) held its first National 5010 Testing Day on June 15, with interesting results. TrailBlazer and NHIC, Corp. recently posted testing outcomes in the form of a top 10 submission error list specific to each Medicare administrative contractor's (MAC's) jurisdiction.

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Meet Advanced Diagnostic Imaging Accreditation Requirements

Attention physicians, non-physician practitioners (NPPs), and independent diagnostic testing facilities (IDTF) supplying imaging services and submitting Medicare claims for the technical component (TC) of advanced diagnostic imaging (ADI) procedures: MLN Matters SE1122 provides assistance to help you meet the accreditation requirements established in Section 135 (a) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).

For you to furnish the TC of ADI services for Medicare beneficiaries, you must be accredited by Jan. 1, 2012 to submit claims with a date of service on or after Jan. 1, 2012.

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CMS Establishes Laboratory Demonstration Project

The Centers for Medicare & Medicaid Services (CMS) announced July 5 in the Federal Register an opportunity for hospital-based and independent laboratories to participate in the Treatment of Certain Complex Diagnostic Laboratory Tests Demonstration.

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Finding E-prescribing Facts Just Got Easier

The Centers for Medicare & Medicaid Services (CMS) has added two new fact sheets to the Educational Resources portion of its website to help providers who are interested in participating in the Electronic Prescribing (eRx) Incentive Program.

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PWK Segment for X12N Version 5010 Postponed

Implementation of the X12N version 5010 electronic claim transaction is still on track for Jan. 1, 2012, but the paperwork (PWK) segment of the new standard is not. The Centers for Medicare & Medicaid Services (CMS) recently informed Medicare contractors that it is delaying the PWK segment originally scheduled for implementation in July and October.

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Three New Educational Resources for 2011 PQRS

The Centers for Medicare & Medicaid Services (CMS) announced on July 6 three new fact sheets for the 2011 Physician Quality Reporting System (PQRS):

  • Physician Quality Reporting System: Satisfactorily Reporting 2011 Physician Quality Reporting System Measures – Claims and Registry Fact Sheet
  • 2011 Physician Quality Reporting System Made Simple for Reporting the Preventive Care Measures Group Fact Sheet
  • Physician Quality Reporting System: (Physician Quality Reporting, formerly called Physician Quality Reporting Initiative or PQRI) Reporting Periods for 2011 Fact Sheet

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Payers Will Pay Less for Late Payments Through Year-end

The Treasury Department posted the latest prompt pay interest rate payable when clean non-periodic interim payment (PIP) Medicare claims are not paid in a timely manner by Medicare contractors. Payers unable to pay providers for services rendered to Medicare beneficiaries within a certain time will pay slightly less in interest penalties between July 11 and Dec. 11.

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Coding Tips

Provenge Covered for Prostate Cancer Patients
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Medicare Expands MRI Coverage for Pacemaker Patients
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Teleconference Provides Insight on 2011 Therapy Update Coding
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Medical News

Medicare Revises Timing of "Flu Season"
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HHS Seeks Better Minority Health Data
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Coding Job Links

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Featured Items
2012 Payment Policy
Top Version 5010 Errors
Imaging Accreditation
Lab Demonstration Project
eRx Fact Sheets
Postponed: 5010 PWK
2011 PQRS Resources
Less for Late Payments
Coding Tips
Medical News
Coding Job Links


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