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Issue #178 - August 3, 2011
AAPC EdgeBlast

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CMS Updates 5010 Transaction Edits

The Centers for Medicare & Medicaid Services (CMS) is updating specific 5010 837P and 837I transaction edits, which will be implemented by July 31, 2011. Due to the urgency with which these modifications must be made, the most current 837P and 837I Edit Spreadsheets do not reflect these changes. However, the January 2012 5010 837P and 837I Edit Spreadsheets will reflect these edit changes.

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HHS Cash Encourages New CO-OPs

The Department of Health & Human Services (HHS) announced July 18 proposed standards for Consumer Oriented and Operated Health Plans (CO-OPs). Far from simply dictating rules, HHS is also offering cash to help establish would-be CO-OPs. Eligible organizations seeking to establish a CO-OP will be able to apply for a portion of the $3.8 billion in repayable loans made available under the Affordable Care Act to fund start-up and capitalization costs.

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CMS Proposes Depression, Behavioral Counseling, Screening Coverage

Screening for depression and behavioral counseling and screening for alcohol abuse in adults may soon be covered Medicare benefits.

The Centers for Medicare & Medicaid Services (CMS) announced a proposal July 19 "to cover annual screening for depression for Medicare beneficiaries in primary care settings that have staff-assisted depression care supports in place to assure accurate diagnosis, effective treatment, and follow-up." CMS has concluded that detecting and treating depression early will both improve beneficiaries' quality of life and lower long-term medical expenses.

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Reprocess Customized Prosthetic Device Claims

Since April 4, the Medicare claims processing system has been erroneously denying claims for certain custom prosthetic devices. Durable medical equipment Medicare administrative contractors (DME MACs) have been instructed to reprocess any claims for custom prosthetic devices (identified by the L series of HCPCS Level II codes) that were inappropriately denied. If suppliers want to be paid this year, however, they'll have to do the leg work.

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New Interest Rate for Medicare Overpayments/Underpayments

Providers and suppliers of health care services and supplies to Medicare beneficiaries will pay contractors more in interest for unrecouped overpayments and delinquent underpayments in this third quarter. The Treasury Department recently notified the Department of Health & Human Services (HHS) that the private consumer rate has changed.

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Report: Most Wheelchairs Still Not Medically Necessary

The title of a July 2011 review conducted by Office of Inspector General (OIG) says it all: "Most Power Wheelchairs in the Medicare Program Did Not Meet Medical Necessity Guidelines." The agency bases this conclusion on a medical record review of 375 claims for standard and complex rehabilitative power wheelchairs submitted to Medicare in the first half of 2007.

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Coding Tips

Changes to Lab Coverage Software Announced
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CMS Adds Two Codes to CLIA Edits
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ESRD PPS Quarterly Update Corrects Code Lists
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CMS Adds to PT Test Covered Dx Codes
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Medical News

Infection Prevention Tools for OP Facilities Released
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FDA: Surgical Mesh for Pelvic Organ Prolapse Repair Is Risky
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FDA May Oversee Mobile Medical Apps
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Study Supports Personalized Mammography Schedule
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Google Shutting Down PHR Platform
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Featured Items
5010 Transaction Edits
HHS Encourages CO-OPs
New Screening Coverage
Prosthetic Device Claims
New Medicare Interest Rate
Wheelchairs Not Necessary
Coding Tips
Medical News
Coding Job Links


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