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Issue #197 - May 16, 2012


AAPC EdgeBlast

Current Status of Version 5010: Just a Call Away

Implementation of the Health Information Portability and Accountability Act (HIPAA) version 5010 standard, originally expected to be implemented at the beginning of 2012, was extended to April 1, and then again to July 1 to accommodate providers and payers that had not successfully tested and implemented the claim guidelines. June 30 most likely will be the last day before penalties for not correctly using 5010 are imposed. Is your practice ready?

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Proposed Legislation Would Repeal SGR

U.S. Reps Allyson Schwartz, D-Pa., and Joe Heck, DO, R-Nev., reintroduced on May 9 legislation that would repeal the sustainable growth rate (SGR) and award annual payment updates to physicians for providing seniors with high-quality care.

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Upward Trending of E/M Levels Worries OIG

The U.S. Department of Health & Human Services (HHS) Office of Inspector General (OIG) says that physicians are reporting high-level evaluation and management (E/M) codes more frequently for all types of E/M services. Medicare payments for E/M services increased 48 percent in the decade ending 2010, from $22.7 billion to $33.5 billion. Overall, Medicare payments for Part B goods and services increased 43 percent during the same period, from $77 billion to $110 billion.

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Primary Care Docs May See Pay Raise

Primary care physicians could receive a pay raise bringing Medicaid primary care service fees in line with those paid by Medicare. The proposed boost would be in effect for calendar years 2013 and 2014. States would receive a total of more than $11 billion in new funds to bolster their Medicaid primary care delivery systems, U.S. Department of Health & Human Services (HHS) Secretary Kathleen Sebelius announced.

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Dawn of Sunshine Act Postponed to 2013

The Centers for Medicare & Medicaid Services (CMS) is postponing until 2013 the collection of data mandated by the Physician Payments Sunshine Act. CMS missed the implementation deadline of October 2011, and instead released draft regulations that solicited strong reactions from stakeholders.

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PECOS: Medicare Referral Rules Change

Provider Enrollment, Chain and Ownership System (PECOS) rules finalized by the Centers for Medicare & Medicaid Services (CMS) will make it easier for physicians to refer patients to specialists.

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Coding Tips

Check Claims History Before Billing G0443
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NHIC Adds 95930 Coverage
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Sleep Medicine Docs Get Their Own Specialty Code
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CMS Covers New Technology for Heart Valve Damage
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Temporary Workaround Billing for Organ Donor Complications
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New Occurrence Code for Reporting Date of Death
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Medical News

Lithotripsy Payment Cut 21 Percent
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Highmark Now Novitas
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Look Out for Ultrasound Gel Recall
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What Docs Like EHR the Best?
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Featured Items
Status of Version 5010
Legislation: Repeal SGR
Up-trending E/M Levels
Primary Care Pay Raise
Dawn of Sunshine Act
Medicare Referral Rules
Coding Tips
Medical News
Coding Job Links


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