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Issue #196 - May 2, 2012

AAPC EdgeBlast

CMS Proposes 2013 Pay Rates and Polices for Hospitals

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule April 24 that would update 2013 Medicare payment policies and rates for inpatient stays to general acute care hospitals paid under the Inpatient Prospective Payment System (IPPS) and long-term care hospitals (LTCHs) paid under the LTCH PPS.

In the proposed rule, which will appear in the May 11 Federal Register, CMS estimates a 2.3 percent increase to IPPS operating payment rates. This reflects a projected update of 3.0 percent for the hospital market basket, adjusted by a multi-factor productivity adjustment of -0.8 percentage point and an additional -0.1 percentage point in accordance with the Affordable Care Act, increased by a 0.2 percent adjustment for documentation and coding.

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I-10 Postponement Comments Due May 17

Department of Health & Human Services (HHS) Secretary Kathleen Sebelius announced a proposed rule that would delay the compliance date for ICD-10 from Oct. 1, 2013 to Oct. 1, 2014. This proposed rule was posted to the Federal Register April 17, which started the stopwatch for the 30-day comment period. All comments are due to HHS no later than 5 p.m. eastern time May 17.

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Providers: High Rate of RAC, CERT Denials Overturned

Close to 50 percent of appealed recovery audit contractor (RAC) payment denials and Comprehensive Error Rate Testing (CERT) claim denials were overturned on appeal, according to the Centers for Medicare & Medicaid Services (CMS). The American Hospital Association (AHA) puts the number closer to 75 percent. Hospital officials say this is proof there are major problems in the CMS audit process, according to

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Medicare Trustees: Reform Needed to Stave Financial Ruin

A report issued April 23 by Social Security and Medicare trustees paints a bleak picture for the future of health care. If expenditures continue to outpace revenues, trustees project the Hospital Insurance trust fund will be depleted by 2024; and the current solvency of the Supplementary Medical Insurance trust fund relies on a scheduled 30 percent reduction in Medicare payment rates for physician services at the start of 2013.

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Modifier KX Doesn’t Guarantee DMEPOS Documentation, OIG Says

Suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) have been applying modifier KX Specific required documentation on file inappropriately to gain payment in the absence of required documentation, according to a recent report by the Office of Inspector General (OIG).

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CMS to Adjust eRx Payments

The Centers for Medicare & Medicaid Services (CMS) is warning providers participating in the 2012 e-Prescribing (eRx) Group Practice Reporting Option (GPRO) incentive program of Medicare Physician Fee Schedule (MPFS) payment adjustments through 2014. Individual eligible providers who are not successful electronic prescribers can avoid the 2013-2014 payment adjustments by meeting reporting requirements during a specified reporting period.

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DMEPOS: Next Steps for Bidding Program

To help Medicare set appropriate payment rates for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), the Centers for Medicare & Medicaid Services (CMS) has announced plans to “recompete” the DMEPOS Competitive Bidding Program contracts in nine areas.

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CMS Corrects Stage 2 Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) published corrections to the Medicare and Medicaid Electronic Health Record Incentive Program—Stage 2 proposed rule in the April 18 Federal Register. The corrections document fixes several technical and typographical errors in the preamble and regulations text.

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Medicare Overpayments/Underpayments Interest Rate on the Rise

Providers and suppliers of health care services and supplies to Medicare beneficiaries will pay contractors more in interest for unrecouped overpayments and delinquent underpayments in this second quarter. The Treasury Department recently notified the U.S. Department of Health & Human Services (HHS) that the private consumer rate has changed.

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Coding Tips

Medicare Puts J3370 Claims on Hold
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CMS Proposes Supervision Levels for Select Services
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Medical News

Physicians See Decline in Patient Visits in 2011
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NQF Pushes Forward with Value-based Purchasing Measures
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Featured Items
2013 Pay Rates/Policies
I-10 Comments Due
RAC & CERT Appeals
Reform Needed
Modifier KX
eRx Payment Adjustments
DMEPOS: Next Steps
Stage 2 Proposed Rule
Medicare Interest Rates
Coding Tips
Medical News
Coding Job Links


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