Not displaying correctly? Click here
To ensure future delivery of the AAPC EdgeBlast add info@aapc.com to your Address Book or Known Senders list.
AAPC October 17, 2007
Edge Blast Header

Issue #87

Top Stories

Time is Running Out to Claim Your Share of BCBS Settlement

Get a Sneak Peek at What the OIG Will Be Up to in 2008

No National Determination Coverage for Pulmonary Rehabilitation

2008 Payment Limits for Splints and Casts Increase by 2.7%

CMS Revises 2008 Payment System for Ambulatory Surgical Centers

Transition of the Medigap Crossover Process to the COBC is Complete

Looking for Kudos!


Test Yourself - Earn .5 CEUs
Michelle Dick

Michelle Dick
EdgeBlast Editor

Renée  Dustman

Renée Dustman
EdgeBlast Author

Top News

Time is Running Out to Claim Your Share of BCBS Settlement

In a recent class action suit against Blue Cross Blue Shield (BCBS), physicians, physician groups, and physician organizations across the nation won a $131 million settlement. The American Medical Association (AMA) urges physicians who provided covered services to anyone enrolled in a BCBS plan between May 22, 1999 and May 31, 2007 to claim what is rightfully theirs!

More

Back to Top

Get a Sneak Peek at What the OIG Will Be Up to in 2008

It looks like it will be a busy year for the Office of Inspector General (OIG). In the OIG 2008 Work Plan, under the Medicare heading Medicare Physicians and Other Health Professionals, the OIG says it will investigate place of service errors, evaluation and management services during global surgery periods, payments for psychiatric and selected physician services, payments for polysomnography services … and the list goes on.

More

Back to Top

No National Determination Coverage for Pulmonary Rehabilitation

The Centers for Medicare and Medicaid Services (CMS) has determined that a national coverage determination (NCD) for Pulmonary Rehabilitation (PR) isn'’t necessary at this time. In the Decision Memo for Pulmonary Rehabilitation (CAG-00356N), CMS states that "… the Social Security Act (SSA) does not expressly define a comprehensive Pulmonary Rehabilitation Program as a Part B benefit."

More

Back to Top

2008 Payment Limits for Splints and Casts Increase by 2.7%

The 2008 payment limits for splints and casts will be based on the 2007 limits, with an increase of 2.7 percent. The increase is in keeping with the percent of change in the consumer price index for all urban consumers for the 12-month period ending June 30, 2007.

More

Back to Top

CMS Revises 2008 Payment System for Ambulatory Surgical Centers

The Centers of Medicare and Medicaid (CMS) recently reaffirmed the NCD for percutaneous transluminal angioplasty (PTA) of the carotid artery. In the CMS Manual System, Pub 100-03 Medicare NCD, Transmittal 77 released Sept. 12, CMS clarifies coverage of PTA. The NCD states that PTA coverage continues to be limited to procedures performed by certified facilities using Federal Drug Administration (FDA) approved carotid artery stents and embolic protection devices.

More

Back to Top

Transition of the Medigap Crossover Process to the COBC is complete

Effective Oct. 1, 2007, the Centers for Medicare and Medicaid Services (CMS) completed the transition of the Medigap crossover process to the Coordination of Benefits Contractor (COBC). How does this affect you?

Participating providers should now enter COBA Medigap claim-based identifiers (ID) within the NM109 portion of the 2330B loop of the incoming HIPAA ANSI X12-N 837 professional claim form. Providers granted a billing exception under the Administrative Simplification Compliance Act (ASCA) should enter the COBA Medigap claim-based ID within block 9-D of the incoming CMS-1500 claim.

More

Back to Top

Looking for Kudos!

Have you performed your 100th prospective claims audit at your practice? Did you trek across Africa on safari? Have you recently filed appeals that brought in an extra $50,000 in revenue for your facility? We’d love to hear about it! Please submit your Kudos to our editors at kudos@aapc.com.

More

Back to Top

Test Yourself - Earn .5 CEUs

By answering the following questions, you can earn .5 continuing education units to apply toward your annual AAPC CEU renewal every two years. Simply answer the questions and list this as one of your itemized CEUs on your CEU form. If you are chosen for verification, we will then ask you to send in a copy of your work.  Please 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. Providers should only include the new 5-byte ID for the purpose of triggering crossovers to those Medigap insurers that have been assigned a COBA Medigap claim-based ID between what range?

Answer:

2. In addition to the procedure code for a splint or cast, which type of code should you submit for splint or cast supplies?

Answer:

3. Respiratory therapy services are identified as covered services under which benefit memorandum?

Answer:

4. The physician indicates a 100 mg dosage of the drug Dolasetron Mesylate by injection. The HCPCS code is J1260. Under the revised ASC payment system, how many units should you report to receive proper payment?

Answer:

5. According to the OIG 2008 Work Plan, what percentage of chiropractic services didn’t meet Medicare coverage criteria and why?

Answer:

Back to Top

AAPC Anaheim National Conference

2008 Coding Updates Audio Conferences

Ingenix Essentials 7th Annual Conference

PhySourceEdu offers AAPC-approved CEU programs

BC Advantage - Medical Billing and Coding magazine

Career Opportunities: Office Based Certified Medical Coder

Copyright ©2006 AAPC

CPT® codes copyright 2006 American Medical Association. All Rights Reserved.
CPT® is a trademark of the AMA.
CPC® is trademark of AAPC
No fee schedules, basic units, relative values or related listings are included in CPT®.
The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS Restrictions Apply to Government Use.


The AAPC EdgeBlast is offered as a benefit to our members. We hope you find the information useful. However, if you'd rather not receive future EdgeBlast issues, please log in to our members area and change your EdgeBlast preferences.

AAPC
2233 S Presidents Dr.
Salt Lake City, Utah 84120