AAPC April 4, 2007
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Issue #74

Top Stories

Claims Attachment is Final Rule in the Works
(forget about the play)

Project Xtern Puts Coder and Company in the Driver's Seat

Shot in the Arm Relieves the Pain
(although surgery may be the next step)

Does the Latest NPI Guidance Affect You?


Test Yourself

UB-92 Use Ends May 22

The UB-92 will not be accepted by CMS after May 22, 2007.
The National Uniform Billing Committee (NUBC) is replacing the UB-92 with the UB-04 paper form. The Health Insurance Portability and Accountability Act (HIPAA) requires submission of National Provider Identifiers (NPIs) on claims effective May 23, 2007, and the UB-92 does not have a field for reporting of NPIs. During the period March 1, 2007 through May 22, 2007, providers that use paper forms for claim submission will be able to submit either the UB-92 or the UB-04 form.
More information about the transition is available from the NUBC Web site (http://www.nubc.org/). The UB-04 will retain the CMS-1450 designation.


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Chris Fraizer Top News

by Chris Fraizer, MA, CPC

Claims Attachment is Final Rule in the Works
(forget about the play)

There are parts to working at the senior level of the Centers for Medicare & Medicaid Services (CMS) that wouldn't be all that enviable.

Take, for example, the Federal Register notices you might have to write and review and the hundreds of comments you might receive in response to a proposed rule.

"It can be quite a job," said Lorraine Tunis Doo, senior policy advisor for the CMS Office of eHealth Standards and Services.

And, in Doo's situation, it was a job someone had to do in response to the much-anticipated rule for electronic health care claims attachments. The proposal published in the September 5, 2005, Federal Register drew over 600 public comments that she is now incorporating into a final rule that could go out sometime late in 2007.


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Project Xtern Puts Coder and Company in the Driver's Seat

Got a credential but looking for experience?

The AAPC has the perfect solution: Project Xtern.

The initiative, headed by Stanley M. Szelazek, CEO, CPC, CPC-H, CCP, CCAT, CMC, ACS-OR, ACS-EM, and AAPC Project Xtern program manager, matches coders in need of hands-on training with companies willing to mentor them.

"The AAPC Project Xtern program puts everyone in the driver's seat," said Szelazek.

The coder gets valuable experience and the business has an enthusiastic coder, eager to learn the ropes and contribute to the good of the company.

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Shot in the Arm Relieves Pain
(although surgery may be the next step)

A cortisone shot was all it took to relieve the incredible pain from a wear and tear injury to a rotator cuff tendon in Susan Tanner's right shoulder.

"I thought the same would work on the left side," said Tanner, who for the past several months has been losing sleep due to the chronic and intense pain. "I was wrong."

Tanner, a doting grandmother and outdoor enthusiast, knew she was headed for surgery but had been hoping to put off the day until "things were in order" at the family cabin near the Wasatch-Cache National Forest in northeastern Utah.

But it won't work out that way.

"I can no longer bear the pain and it's time I get on with my life," she said.


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Does the Latest NPI Guidance Affect You?

Centers for Medicare & Medicaid Services (CMS) announced on April 2, 2007 that it is implementing a contingency plan for covered entities (other than small health plans) who will not meet the May 23, 2007, deadline for compliance with the National Provider Identifier (NPI) regulations under the Health Insurance Portability and Accountability Act (HIPAA) of 1996.

"The enforcement guidance released today clarifies that covered entities that have been making a good faith effort to comply with the NPI provisions may, for up to 12 months, implement contingency plans that could include accepting legacy provider numbers on HIPAA transactions in order to maintain operations and cash flows." said CMS Acting Administrator Leslie V. Norwalk, Esq. in the CMS press release.

For more information view the CMS press release and the detailed contingency plan.

Source: www.cms.hhs.gov

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Test Yourself

By answering the following questions you can earn .5 continuing education units to apply toward your annual AAPC certification renewal. Simply answer the questions and send in a copy of your work when submitting your CEU package. Put the number of each EdgeBlast included in your submission. The number is available at the top of the page.

Answers to the questions are not always found directly (word for word) in the EdgeBlast in which they appear. While often related to the EdgeBlast content, they require additional resources such as your ICD-9-CM, CPT® and HCPCS manuals.

1. Explain the difference between an acute condition and a chronic condition.

Answer:

2. What is meant by "health care transparency" as it relates to federal health care programs?

Answer:

3. Why is it important to standardize the language of claims attachments?

Answer:

4. The surgeon uses an open approach to repair a traumatic rupture of the patient's rotator cuff (left shoulder), which occurred accidentally when he was tackled during a football scrimmage with his high school buddies. What are the codes for the procedure and diagnosis (including the E code)?

Answer:

5. Code the administration of cortisone to relieve shoulder pain (subacromial cortisone injection, 80 mg.)

Answer:

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