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Issue #180 - September 7, 2011
AAPC EdgeBlast

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MRIs for Patients with Implanted Pacemakers Covered

Effective for claims with dates of services on or after July 7, 2011 magnetic resonance imaging (MRI) is a covered service for beneficiaries with implanted pacemakers. The Centers for Medicare & Medicaid Services (CMS) is changing the language in section 220.2.C.1 of the Medicare National Coverage Determination Manual to remove the contraindication for Medicare coverage of MRI for beneficiaries with implanted pacemakers. CMS now considers MRI for beneficiaries with implanted pacemakers reasonable and necessary provided the pacemakers are used according to U.S. Food and Drug Administration (FDA)-approved labeling for use in an MRI environment.

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Rural Providers Tap New Vein for Funding Health IT

Rural health care providers looking for financial assistance to help with the expense of purchasing health information technology (IT) may have another resource to tap. The U.S. Department of Health & Human Services' (HHS') Rural Health IT Task Force and the U.S. Department of Agriculture (USDA) recently signed a Memorandum of Understanding (MOU) linking rural hospitals and clinicians to USDA Rural Development grants and loans.

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Medicare Expands DMEPOS Competitive Bidding

The Centers for Medicare & Medicaid Services (CMS) has begun the second phase of an expansion of a competitive bidding program aimed at lowering costs for quality durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).

The competitive bidding program uses competitions between suppliers to set new, lower payment rates for certain medical equipment and supplies, such as oxygen equipment, walkers, and some types of power wheelchairs. The first phase of the program was successfully implemented Jan. 1, 2011 for nine product categories in nine areas of the country.

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CMS Releases New and Revised Medicare Enrollment Forms

The U.S. Office of Management and Budget (OMB) recently approved changes to the Medicare Provider-Supplier Enrollment Applications (CMS-855) to update them from the 2008 versions, as well as the new CMS-855O application form used for the sole purpose of enrolling to order and refer items and/or services to Medicare beneficiaries. The revised and new forms are now available on the CMS Provider-Supplier website.

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Contractors to Process Noncovered Ambulance Services for COB

The Centers for Medicare & Medicaid Services (CMS) has instructed contractors to revise their claims processing systems to allow HCPCS Level II codes identifying noncovered ambulance transportation and transportation-related services into their systems for adjudication. Although these codes (A0021-A0424 and A0998) remain noncovered, accepting these claims will allow providers and suppliers to obtain a Medicare denial so that they may then submit a claim for a patient with Medicare to his or her secondary insurance for coordination of benefits (COB) purposes.

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CMS: Chiropractors Ineligible to Order and Refer

The Centers for Medicare & Medicaid Services (CMS) recently discovered that several of its communications incorrectly included chiropractors in the list of health care professionals who may order and refer, and is in the process of revising those documents, including change requests (CRs).

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Annual Clot Factor Furnishing Fee Updated for 2012

Effective Jan. 1, 2012 the clotting factor furnishing fee will increase 5 cents, to $0.181 per unit—breaking a long-time trend of annual 6 cent increases.

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Bundled Payments Initiative Aimed at Improving Care

The U.S. Department of Health & Human Services (HHS) announced a new initiative that the agency says will help improve care for patients while they are in the hospital and after they are discharged. Doctors, hospitals, and other health care providers can now apply to participate in the new program, known as the Bundled Payments for Care Improvement Initiative (Bundled Payments initiative). Made possible by the Affordable Care Act, the new initiative will align payments for services delivered across an episode of care, such as heart bypass or hip replacement, rather than paying for services separately. Bundled payments will give doctors and hospitals new incentives to coordinate care, improve the quality of care, and save money for Medicare, HHS said.

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Coding Tips

MPFS Update: Dozens of Payment Indicator Changes
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Billing Monthly ESRD Codes
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Medical News

Mayo and Cleveland Clinics Seek Docs Nationwide
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HHS Plans to Ease Clinical Trial Reqs
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CMS Proposes Screening Coverage for Sexually Transmitted Infections
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CDC Warns of Ongoing Salmonella Outbreak
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Featured Items
MRIs & Pacemakers
Funding Health IT
Expanded DMEPOS Bidding
Medicare Enrollment Forms
Noncovered Ambulance
Order and Refer Eligibility
Clot Factor Fee
Bundled Payments
Coding Tips
Medical News
Coding Job Links


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