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Issue #187 - December 21, 2011
AAPC EdgeBlast

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Physician Pay Cut Up in Air

Congress was unable to come to an agreement that would prevent, among other things, a 27.4 percent cut to Medicare reimbursement rates paid to physicians before the first of the year. In response, the Obama administration said it will instruct Medicare contractors to hold processing physician claims from Jan. 1, 2012 through Jan. 17, 2012.

After voting against the Senate bill, the House voted to set up a committee seeking to negotiate a compromise between the two chambers. Senate Democrats said they will not return from Christmas recess, however.

The House is due back from recess on Jan. 17, but has indicated cutting this vacation short. The Senate isn't scheduled to convene until Jan. 23.

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5010 Discretion Period Doesn't Change Implementation Date

The recent announcement of a discretionary period for Version 5010 by the Centers for Medicare & Medicaid Services (CMS) means fines for noncompliance will not be levied through March 31, 2012. However, providers will still be penalized for failure to adopt the new Medicare transaction standard by the Jan. 1, 2012 deadline, industry sources tell EdgeBlast.

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EHR Adopters Get More Time to Meet Meaningful Use Standards

Physicians and facilities will have more time to qualify for government incentives to achieve meaningful use of electronic health records (EHRs).

Under the current requirements, eligible doctors and hospitals that begin participating in the Medicare EHR Incentive Program this year would have to meet new standards for the program in 2013. If they did not participate in the program until 2012, they could wait to meet these new standards until 2014 and still be eligible for the same incentive.

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Eligibility, Claim Status Transactions Rule Finalized

In a surprise move, the U.S. Department of Health & Human Services (HHS) announced Dec. 7 that, after considering public comment, policies established in the "Adoption of Operating Rules for Eligibility for a Health Plan and Health Care Claim Status Transactions" interim final rule would be finalized as is.

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CMS Clarifies Home Health Documentation

The Centers for Medicare & Medicaid Services (CMS) recently clarified documentation rules for home health care provided following an acute or post-acute stay after CMS contractors denied payment in the following situations:

  • The home health care agency (HHA) uses a single form (i.e., 485) for the plan of care and the certification with a single signature by the community physician who assumes oversight of the patient's home health care.
  • The physician who cared for the patient in the acute or post-acute setting is the certifying physician and has provided and signed attached documentation of the face-to-face encounter.

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Part D Fraud Enforcement Commences

Part D prescription fraud is the latest target of efforts to continue identifying, preventing, and recovering fraud, the Centers for Medicare & Medicaid Service (CMS) announced Dec. 13. CMS is asking Part D prescription drug plan sponsors to stop drug misuse and fraud, especially with pain killers like OxyContin, which are the fifth most filled class of drugs in Medicare totaling $3.9 billion.

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Featured Items
Physician Pay Cut
Version 5010
EHRs + Meaningful Use
HHS Finalizes Rule
Home Health Clarified
Part D Fraud Enforcement
Coding Tips
Medical News
Coding Job Links


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