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Issue #185 - November 16, 2011
AAPC EdgeBlast

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Health Care Reform Law To Be Addressed By Supreme Court

The Supreme Court said Monday it will hear arguments next March over President Barack Obama's health care overhaul.

The justices announced they will hear an extraordinary five-and-a-half hours of arguments from lawyers on the constitutionality of a provision at the heart of the law and three other related questions about the act. The central provision in question is the requirement that individuals buy health insurance starting in 2014 or pay a penalty.

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OPPS/ASC 2012 Final Rule Gets Mixed Reviews

The Centers for Medicare & Medicaid Services (CMS) announced in a final rule issued Nov. 1 that Medicare payments in 2012 will increase by 1.9 percent to hospital outpatient departments (HOPDs) and 1.6 percent to ambulatory surgery centers (ASCs).

In addition to establishing 2012 payment rates for HOPDs and ASCs, the final rule with comment period:

  • Expands the measures to be reported under the Hospital Outpatient Quality Reporting Program
  • Creates a new quality reporting program for ASCs
  • Addresses Hospital Value-based Purchasing (Hospital VBP) program requirements
  • Establishes an electronic reporting pilot that will allow additional hospitals, including critical access hospitals (CAHs), to report clinical quality measures in 2012 for the purpose of participating in the Medicare Electronic Health Record Incentive Program
  • Provides a payment adjustment for designated cancer hospitals

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ESRD PPS Rates, Other Items Change for 2012

The Centers for Medicare & Medicaid Services (CMS) is implementing new rates for payment, changes to the outlier policy, and consolidated billing requirements. The extensive announcement, Change Request 7617, can be found on the CMS website. Changes also include the payment and management of specific services.

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ONC Delays EHR Certification Program

The Office of the National Coordinator for Health IT (ONC) has delayed the permanent program for electronic health records (EHRs) certification launch until the summer of 2012. This is to coincide with the anticipated final rule for stage two of meaningful use and standards and certification criteria. According to a Nov. 3 Federal Register (Vol. 76, No. 213) notice:

"We believe that the sunset of the temporary certification program should be tied to the effective date of the final rule that we intend to issue in summer 2012, which is expected to adopt new and revised standards, implementation specifications, and certification criteria for EHR technology in support of the next stage of meaningful use under the Medicare and Medicaid EHR Incentive Programs."

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2012 DMEPOS Pay Rates on the Increase

The most recent update to the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) fee schedule is now available. The changes, effective Jan. 1, 2012, will affect all providers and suppliers submitting claims to Medicare contractors for DMEPOS items and services.

The big news is a 2.4 percent overall increase to the 2011 payment rate, as well as a 3.6 percent increase in the labor rate for services described by K0739 (repair/service oxygen equipment), L4205 (repair orthotic device), and L7520 (repair prosthetic device).

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Coding Tips

Donor Post-Kidney Transplant Complications Billing Clarified
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CMS Clarifies Coverage for Prostate Cancer Immunotherapy
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Two Laboratory NCDs Get Last Minute Code Changes
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Medical News

MedPAC: Reduce E/M Rates in HOPDs
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CMS: New I-10 Implementation Resources Available
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CMS Posts a List of Who Needs to Revalidate Enrollment
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A Million Hearts Welcome Expanded Cardio Coverage
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Featured Items
Health Care Reform Law
OPPS/ASC 2012 Final Rule
ESRD PPS Rates
ONC Delays EHR Program
2012 DMEPOS Pay Rates
Coding Tips
Medical News
Coding Job Links


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