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AAPC Jan. 2, 2008
Edge Blast Header Issue #92
Top Stories

Bill Includes Fee Cut Reprieve to July

CMS Extends Participation Decision Period

New Instructions Limit Identity Theft and Fraud

CMS Updates TOS for New Codes

Stakes Rise for Medicare Appeals

Test Yourself - Earn 0.5 CEUs

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Renée  Dustman

Renée Dustman
EdgeBlast Editor

Top News

Bill Includes Fee Cut Reprieve to July

President Bush signed the Medicare, Medicaid and SCHIP Extension Act of 2007 into law Christmas week, and it includes a gift for providers worried about an expected 10.1 percent cut to payments.

The Medicare, Medicaid and SCHIP Extension Act of 2007 provides for a 0.5 percent increase to the physician fee schedule conversion factor for dates of service beginning January 1 through June 30, 2008, instead of the -10.1 percent that was scheduled to take place.  Effective for dates of service on and after July 1, 2008, the -10.1 percent update to the physician fee schedule will go into effect. The new fees will be posted on your local contractor’s website as soon as possible.

Since there is a change to the 2008 Medicare Physician Fee Schedule rates, CMS is extending the Participation Decision Period an additional 45 days.  The participation decision period now runs through February 15, 2008, instead of ending on December 31, 2007.  All participating status changes will be effective January 1, 2008.

Watch your EdgeBlast and Cutting Edge for more information about the Medicare Physician Fee Schedule and how it will affect your coding and billing.

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CMS Extends Participation Decision Period

Prior to Congress passing the Medicare, Medicaid and SCHIP Extension Act of 2007 on Dec. 19, physicians had until Dec. 31, 2007 to change their status to participating (PAR) or non-participating (Non-PAR) physician in 2008. As this recent legislation postpones the 10.1 percent cut in Medicare physician payments until June 30, 2008, however, the Centers for Medicare and Medicaid Services (CMS) has decided to extend the Medicare participation decision period. Physicians now have until Feb. 15, 2008 to notify carriers if they want to change status. Decisions are retroactive to Jan. 1, 2008.

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New Instructions Limit Identity Theft and Fraud

CMS says the current policy for Medicare Summary Notices (MSNs) permits identity theft and fraudulent claims. To better protect the personal health information (PHI) of Medicare beneficiaries and prevent Medicare fraud, CMS instructs contractors not to include the Health Insurance Claim Number (HICN) on MSNs.

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CMS Updates TOS for New HCPCS Codes

CMS has updated Type of Service (TOS) for HCPCS Level I (CPT®) and Level II codes to accommodate the 2008 additions and changes. Announced just before Christmas, use of these new indicators goes into effect Jan. 7, 2008.

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Stakes Rise for Medicare Appeals

For 2008, the amount in controversy (AIC) threshold amounts for administrative law judge (ALJ) hearing requests will rise to $120 and the AIC threshold amount for judicial review will rise to $1,180. The AIC threshold amounts for ALJ hearings and judicial review under the Medicare appeals process are adjusted annually, in accordance with the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA).

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Test Yourself - Earn 0.5 CEUs

By answering the following questions, you can earn 0.5 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 Level II manuals.

1. What is the cutoff date for physicians to change their Medicare participation status?

Answer:

2. To protect a beneficiary's PHI, contractors shall replace the first five numerals of the HICN on all MSNs with what?

Answer:

3. Which Act requires the AIC threshold amount for ALJ hearings and judicial review to be adjusted annually?

Answer:

4. Which TOS indicator should you report with surgical services billed with an assistant-at-surgery modifier (80-82, AS)?

Answer:

5. Surgical services billed with the ASC facility service modifier SG must be reported with which indicator?

Answer:

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