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Issue #190 - February 1, 2012

AAPC EdgeBlast

Providers Must Agree to EFT for Medicare Payment

Providers and suppliers have until March 31 to comply with the new Health Insurance Portability and Accountability Act (HIPAA) transaction standards for submitting claims electronically, and can even opt out and continue to submit paper-based claims if they so choose. If they want to get paid, however, they'll have to accept the wave of the future.

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CMS Releases EHR Incentive Appeals Process Info

If you are an eligible hospital or provider that hasn't received your payments through the government's Medicare Electronic Health Records (EHR) Incentive Program, or if you want to challenge a payment amount you've received, you are in luck. The Centers for Medicare & Medicaid Services (CMS) recently released guidance on the appeals process for this incentive program.

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ICD-10 Guidelines for 2012 Offer Insight to Future

Despite the urgings of the American Medical Association (AMA) for Congress to stop the implementation of ICD-10, ICD-9 updates have ceased (other than those necessary to accommodate new technology), and the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics (NCHS) is focusing its energy on ICD-10. Most recently, the agency, under authorization by the World Health Organization (WHO), updated its ICD-10-CM Official Guidelines for Coding and Reporting for 2012.

Although these codes are not currently valid for any purpose or use in the United States, with an ICD-10 implementation date of Oct. 1, 2013, now is a good time to become familiar with these new guidelines for diagnosis coding and reporting.

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CMS Updates OPPS Pricer File

The Centers for Medicare & Medicaid Services (CMS) has updated the 2012 first quarter Outpatient Prospective Payment System (OPPS) pricer file. The PC Pricer is a tool used to estimate Medicare PPS payments. The file had to be updated to reflect corrections recently made to the OPPS 2012 final rule and also the change to the conversion factor resulting from the passage of the Temporary Payroll Tax Cut bill that delayed the physician pay cut.

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Why So Much N22226? More 5010 Guidance

The Centers for Medicare & Medicaid Services (CMS) has reissued communication to clarify Medicare's capability to cross over version 4010A1 and National Council for Prescription Drug Programs (NCPDP) version 5.1 batch claims to the supplemental payers that have cut over to exclusive receipt of version 5010 837 claim formats or NCPDP D.0 batch claim formats. Also in the revised communication, CMS downplays the impact on providers permitted to submit claims using the CMS 1500 or UB04 hardcopy (paper) formats.

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Coding Tips

Change to OPPS Allow Payment for 33249
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HCPCS Quarterly Update Adds, Deletes Codes
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MACs Update LCDs for 2012
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Medical News

CMS Revises Home Health ABN
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Fee-for-service Dooms Medicare Cost Cutting, CBO Says
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Fifth Largest Hospital Chain Pares Religious Ties
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Featured Items
Required: Agree to EFT
EHR Incentive Appeals
2012 ICD-10 Guidelines
OPPS Pricer File Updated
More 5010 Guidance
Coding Tips
Medical News
Coding Job Links



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2012 Code Books

AAPC Physician Services ICD-10 Assessment: Documentation Evaluation

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