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Issue #179 - August 17, 2011
AAPC EdgeBlast

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AMA Releases Category II Updates

The American Medical Association (AMA) released an update to the CPT® Category II code list Aug. 10. Providers should take note of this update because there are many revisions, significant new codes and deleted codes scattered among previous updates the AMA has released throughout the year.

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New Payment, Policies for Inpatient Rehab

The Centers for Medicare & Medicaid Services (CMS) issued a final rule this month that increases reimbursement rates paid under the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) by 2.2 percent and establishes a new quality reporting system authorized by the Affordable Care Act. CMS projects total payments under the IRF PPS will increase by $150 million in 2012. The final rule will affect payments to more than 200 freestanding rehabilitation hospitals and more than 1,000 IRF units in acute care hospitals and critical access hospitals (CAHs), beginning with discharges on or after Oct. 1, 2011.

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National 5010 Testing Day Results Spurs CMS to Step Up Efforts

The Centers for Medicare & Medicaid Services (CMS) recently announced the results of its first National Version 5010 Testing Day, held June 15. No significant errors were detected, according to the agency, but participation was low, as was the confidence level of trading partners that they will be ready to implement the new electronic standard in time.

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MAC Demand Letters Replace RAC Demand Letters

As of Jan. 3, 2012 you no longer have to worry about receiving demand letters from recovery audit contractors (RACs). Instead, if a RAC—now referred to simply as a "recovery auditor"—identifies an instance of improper payment, it will submit a claim adjustment to the appropriate Medicare administrative contractor (MAC). The MAC will then issue an automated demand letter for any overpayment, and will follow the same process as is used to recover any other overpayment. The decision to shift responsibility for issuing demand letters from RACs to MACs was made "to increase consistency and efficiency through automation," according to the Centers for Medicare & Medicaid Services (CMS).

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Coverage for Women's Preventive Services Expanded

The Department of Health & Human Services (HHS) announced Aug. 1 new guidelines that will ensure women receive the preventive health services they need to stay healthy. Previously, preventive services for women had always been recommended individually or as part of guidelines targeting men as well. For the first time, at the request of HHS, the independent Institute of Medicine has developed new guidelines requiring health insurance plans to cover women's preventive services without charging a co-payment, co-insurance, or a deductible.

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New ESRD Quality Initiative Program Launched

The Centers for Medicare & Medicaid Services (CMS) has launched a new quality initiative for Medicare-certified renal dialysis facilities. The End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) will begin Jan. 1, 2012. Facilities that do not meet quality measures established by CMS may be subject to a payment reduction of up to 2 percent on Medicare claims, according to a July 14 ESRD QIP fact sheet, issued by CMS.

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$50 Billion in Improper Payments Prompts Action

Inspector General Daniel R. Levinson testified before several U.S. House of Representatives committees about the Office of Inspector General's (OIG's) effort to monitor and make recommendations to reduce Medicare improper payments. His comments provide a clue as to which types of services and providers will come under increased OIG scrutiny in the coming months.

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Coding Tips

NCCI v.17.3 Effective Oct. 1
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Organ Disease Panels Paid Under Clinical Lab Fee Schedule
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CMS Clarifies ESRD-related Services Monthly Capitation
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Be Paid for Modifier 24
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Medical News

CMS: ACO Prototype Succeeds
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Medicare Compare Updates Please Some, Not All
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Featured Items
Category II Updates
Inpatient Rehab Policies
5010 Testing Results
RAC Demand Letters
Women's Preventive Care
ESRD Quality Initiative
Improper Payments
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.