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Issue #183 - October 19, 2011
AAPC EdgeBlast

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OIG 2012 Work Plan Targets Familiar Concerns

The U.S. Department of Health & Human Services (HHS) Office of Inspector General's (OIG) 2012 Work Plan should look familiar to experienced coding and compliance personnel. Among those areas of investigation that carry over from previous years, the OIG will continue to review whether payments made to physicians have the proper place-of-service code, and will continue to identify providers who exhibit questionable billing of evaluation and management (E/M) codes.

The OIG's 2012 Work Plan, released Oct. 5, identifies specific areas with respect to HHS programs (including Medicare Parts A-D), on which the OIG plans to focus its attention for the fiscal year Oct. 1, 2011 through Sept. 30, 2012. The Work Plan is a valuable tool to identify potential billing problems within your own practice or facility.

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Last Chance to Avoid 2012 eRx Payment Adjustment

Providers have only two weeks remaining to request a hardship exemption for the 2012 electronic prescribing (eRx) payment adjustment. The deadline is Nov 1.

Eligible professionals (EPs) who have not met eRx Incentive Program requirements (and who are not exempt) will incur a 1 percent payment reduction to their allowable Medicare Part B charges beginning Jan. 1, 2012.

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CMS Rescinds New Enrollment Requirements

Two new requirements recently added to the Medicare enrollment process may not be required after all.

The Centers for Medicare & Medicaid Services (CMS) recently added to the CMS-855I enrollment application and the Internet-based Provider Enrollment, Chain, and Ownership System (PECOS) equivalent a question that asks:

"Do you accept new Medicare patients?"

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Providers: Apply for Bundled Payments Initiative

Due to a large number of inquiries about the Bundled Payments for Care Improvement initiative, and many requests for additional time to prepare applications, the Centers for Medicare & Medicaid Services (CMS) has, for the second time, extended the deadlines for submitting letters of intent and applications.

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Data Breach Affects 20,000 Patients, Prompts $20M Lawsuit

As a reminder of the perils surrounding protected health information (PHI), Stanford Hospital & Clinics is facing a very expensive lawsuit for a data breach affecting approximately 20,000 patients.

A spreadsheet containing the protected information of patients seen in the emergency room from March through August 2009 was posted as an attachment to Student of Fortune, a website for students seeking help with homework, as part of a question about how to convert the data into a bar graph. The spreadsheet contained names, diagnosis codes, account numbers, and admission and discharge dates. The data did not include social security or credit card numbers. The spreadsheet was posted Sept. 9, 2010 and remained on the site until Aug. 22, 2011, when it was discovered by a patient.

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MLN Updates Medicare Claim Submission Guidelines

A September 2011 "Medicare Claim Submission Guidelines" fact sheet is now available on the Centers for Medicare & Medicaid Services (CMS) website.

This Medicare Learning Network® (MLN) fact sheet offers providers and suppliers up-to-date guidance on how to:

  • Apply for a national provider identifier (NPI) and enroll in the Medicare program
  • File Medicare claims
  • Opt out of Medicare and arrange private contracts with Medicare beneficiaries

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Coding Tips

AMA Posts 2012 Codebook Corrections
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Medicare Pays 90654
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J1-MAC Updates Percutaneous Endovascular Cardiac Assist Coverage
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TrailBlazer Identifies Improper Use of Initial Hospital Care Codes
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Medical News

Swine Flu Count Up to 3 in Pennsylvania
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CDC Aims for Healthy People with Mixed Results
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Coding Job Links

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Featured Items
OIG 2012 Work Plan
eRx Payment Adjustment
Medicare Enrollment
Bundled Payments
Data Breach Costs $20M
Medicare Claim Guidelines
Coding Tips
Medical News
Coding Job Links


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