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Issue #182 - October 5, 2011
AAPC EdgeBlast

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At What Cost Is Repealing the SGR?

In the Medicare Payment Advisory Commission's (MedPAC) Sept. 15 report "Moving Forward from the Sustainable Growth Rate System," the agency addresses the problems with the Sustainable Growth Rate (SGR) system—namely, the current call for a 30 percent pay cut to 2012 physician fee schedule (PFS) services. But repealing the SGR and putting a recommended 10-year freeze across all services would cost in the neighborhood of $300 billion.

Paying for an SGR repeal would indeed require significant offsets. But which health care sector would be most affected, and how? MedPAC answered those questions in a draft options list it posted Sept. 20 on its website.

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Bundled Payments Acute Care Deadline Extended

The Centers for Medicare & Medicaid Services (CMS) has extended the deadline for Model 1 of its Bundled Payments for Care Improvement program, giving providers for whom the episode of care is the acute care hospital stay only until Oct. 6 to apply. Sept. 22 was the original deadline.

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CMS Launches New Primary Care Initiative

Building on the patient-centered medical home concept, the U.S. Department of Health & Human Services (HHS) launched a new initiative Sept. 28, which the agency says will "help primary care practices deliver higher quality, more coordinated and patient-centered care." Known as the Comprehensive Primary Care Initiative, the collaborative will seek to align "multi-payer payment reform with practice transformation, holding practices accountable for total cost of care," HHS states in the full Comprehensive Primary Care Initiative solicitation.

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President Proposes $320 Billion in Health Care Cuts

As part of a plan to reduce the federal budget by more than $3 trillion over 10 years, President Obama has proposed $320 billion in cuts to Medicare and Medicaid. Most of the savings ($248 billion) would come by slowing the projected growth of Medicare in the coming decade, according to the White House. The remaining $72 billion would be shaved from Medicaid and other health programs.

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Incident-to Rx Billing Clarified

In what situations a pharmacy can bill when it's dispensing certain drugs has been clarified in Transmittal 2312, posted by the Centers for Medicare & Medicaid Services (CMS). The transmittal also cautions physicians on not billing what the pharmacy has dispensed.

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Coding Tips

AMA Releases CPT 2012 Category II Codes
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2011-2012 Influenza Vaccine Pricing Now Available
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Ambulance Inflation Factor Set for 2012
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CMS Updates Teaching Physician Services Guidance
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Medical News

OMG! HHS Task Force Launches Text4Health Recommendations
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CDC Drafts Guidelines to Reduce HIV, HBV, HCV Transmission
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But, Can Watson Code?
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Featured Items
Cost: Repealing the SGR
Acute Care Payments
Primary Care Initiative
$320B Health Care Cuts
Incident-to Rx Billing
Coding Tips
Medical News
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