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Issue #199 - June 20, 2012


AAPC EdgeBlast

Time is Running Out for 5010 Compliance

The Medicare 90-day discretionary enforcement period for non-compliant Health Insurance Portability and Accountability Act (HIPAA)-covered entities to begin using the new versions of the X12 standards for electronic transactions ends June 30. Beginning July 1, only the new ASC X12 Version 5010 and National Council for Prescription Drug Program (NCPDP) Telecom D.0 formats will be accepted by Medicare contractors.

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NPPES Issues Resolved, NPI Registry Tip

Any latency and performance issues you may have experienced with the National Plan and Provider Enumeration System (NPPES) have been resolved, according to the Centers for Medicare & Medicaid Services (CMS). The National Provider Identifier (NPI) registry is fully operational again.

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Physicians Offered Cash for Improved, Coordinated Primary Care

The Centers for Medicare & Medicaid Services (CMS) Innovation Center has announced a four year pilot initiative to pay primary care practices a care management fee, initially set at an average of $20 per beneficiary, per month, to support enhanced, coordinated services. Participating commercial, state, and other federal insurance plans will also offer enhanced payments to primary care practices that provide high-quality primary care.

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MPFS Payment Files Updated for July

The Centers for Medicare & Medicaid Services (CMS) recently released payment files to contractors that reflect up-to-date payment policy in line with the 2012 Medicare Physician Fee Schedule (MPFS) Final Rule and the Middle Class Tax Relief and Job Creation Act of 2012. The latter legislation extended through Dec. 31, 2012 the zero percent update mandated in the Temporary Payroll Tax Cut Continuation Act of 2011, which curtailed a Medicare reimbursement rate reduction of 27.4 percent scheduled to take place Jan. 1, 2012.

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CMS Tweaks PECOS Enrollment Again

Signing up on the authenticated Internet-based Medicare Provider Enrollment, Chain, and Ownership System (PECOS) just got a little easier for providers and their staff. The Centers for Medicare & Medicaid Services (CMS) has issued a new rule that allows the authorized official (AO) or the delegated official (DO) of an organization to electronically sign the enrollment application.

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Supervision Requirements Change for 27 Codes

The Centers for Medicare & Medicaid Services has changed the supervision requirement for 27 hospital outpatient therapeutic services from direct supervision to general supervision. General supervision requires the service to be performed under the overall direction and control of a physician or non-physician practitioner (NPP), but the physician's or NPP's personal presence is not required.

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New Initiative Digs Gold Mine of Medicare Data

The Centers for Medicare & Medicaid Services (CMS) announced a new data and information initiative it says will be a key tool in the agency's evolution from a fee-for-service based payer to a value-based purchaser of care. A new Office of Information Products and Data Analytics (OIPDA) will oversee CMS' portfolio of data and information and make it more accessible to health care professionals and patients. Under OIPDA, the development, management, use, and dissemination of data and information resources will become one of CMS' core functions. CMS says the agency and its partners will be better able to define and reward high quality, low cost care.

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Coding Tips

J1 MAC: Prostate Molecular Markers Not Covered
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Contractor Warns of Incorrect Use of AQ Modifier
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Get Paid for Bendamustine Injections
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Medical News

CMS to End Contracts with Three MICs
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CMS: TENS Not Reasonable and Necessary
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CareFirst Releases Medical Home Project Results
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NCQA Seeks Comment on Patient-centered Medical Homes
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Improper Diagnoses Reporting a Costly Mistake for PacifiCare
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Featured Items
5010 Compliance
NPPES Issues Resolved
Cash for Improved Care
MPFS Updated
PECOS Enrollment Tweaked
Supervision Requirements
New CMS Initiative
Coding Tips
Medical News
Coding Job Links


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