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Issue #204 - September 13, 2012


AAPC EdgeBlast

Are You Ready for ICD-10? CMS Wants to Know

The Centers for Medicare & Medicaid Services (CMS) is conducting another ICD-10 readiness assessment, according to a notice posted in the Aug. 10 Federal Register. Selected participants have until Oct. 9 to comment.

A previous assessment CMS conducted in 2011 surveyed health care providers, payers, and vendors about their awareness of and preparation for the upgrade to Version 5010 and transition to ICD-10. In that survey, 79 percent of providers said their organization was taking steps to prepare for the ICD-10 transition, and 82 percent of providers said they believe they will be compliant by the deadline.

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OPPS Update Includes Added Coverage, New Codes, and Corrected Pay Rates

The October 2012 update to the Outpatient Prospective Payment System (OPPS) includes added coverage, two new drug/biological codes, and three corrected payment rates. Providers and suppliers paid under the OPPS should take note of these changes to ensure proper reimbursement.

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PECOS Easier to Use Than Ever, CMS Says

Based on provider feedback, the Centers for Medicare & Medicaid Services (CMS) has made several upgrades to the Provider Enrollment, Chain, and Ownership System (PECOS) to increase access to more information.

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Outpatient Hospitals Down One Quality Reporting Measure

Effective immediately, the Centers for Medicare & Medicaid Services (CMS) is removing OP-16 Troponin results for emergency department acute myocardial infarction (AMI) patients or chest pain patients (with probable cardiac chest pain) received within 60 minutes of arrival from its hospital Outpatient Quality Reporting (OQR) program.

On July 11, however, the Food and Drug Administration (FDA) issued a class 1 recall on several point-of-care testing kits, including those providing Troponin results.

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Panel Advises CMS to Reduce Supervision Level for 28 Outpatient Services

After meeting for two days, Aug. 27-28, the Centers for Medicare & Medicaid Services' (CMS) Advisory Panel on Hospital Outpatient Payment offered up its recommendation to reduce the supervision level for 28 outpatient services.

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Stage 2: EHR Incentives Available If You're Schooled

Stage 2 Meaningful Use guidelines become effective November 5. To take full advantage of financial incentives available to your practice, knowing what is expected will help.

The Centers for Medicare & Medicaid Services (CMS) announced a final rule after Labor Day specifying the Stage 2 criteria set for eligible professionals, eligible hospitals, and critical access hospitals (CAH) to quality for Medicare and Medicaid electronic health record (EHR) incentive payments. The rule also outlines payment adjustments made if program participants fail to meaningfully use EHR technology. However, the new rules provide a flexible reporting period for 2014 so providers will have sufficient time to adopt or upgrade to the latest technology available in 2014.

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Therapists Required to Submit Threshold Exception Request by Year-end

If your office provides physical therapy (PT), speech-language pathology (SLP), or occupational therapy (OT) services, you may receive a letter titled "Notification of Request for Exception Requirements for Therapy" from the Centers for Medicare & Medicaid Services (CMS). All therapy services rendered above the $3,700 threshold set by Congress are subject to manual medical review. Beginning Oct. 1, some therapy providers will also be required to submit requests for exceptions (pre-approval for up to 20 therapy treatment days for beneficiaries at or above the $3,700 threshold).

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Companion Guide for 835 Available

Sometimes all you need to make something work is an actual manual where all the parts are explained. Practices implementing version 5010 have access to such a manual from the Centers for Medicare & Medicaid Services (CMS).

"Instructions related to the 835 Health Care Claim Payment/Advice based on ASC X12 Technical Report Type 3 (TR3), version 005010A1" won't make your book club sit up and take notice, but it includes explanations of all the fields, their codes, and functions to make complying with the new electronic transaction standards easier. The 10-page manual is free and downloadable.

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Are You Ready for ICD-10?
OPPS Updates
PECOS Easier
Loss of Reporting Measure
Panel Advises Reduction
EHR Incentives
Threshold Exception
Companion Guide for 835
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