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AAPC Mar. 5, 2008
Edge Blast Header Issue #96
Top Stories

Auditors Cite Coding Errors

OP Payment for ESRD-Related Services

Google Puts Patients in Charge

CMS Revises 99231– 99239 Usage

Test Yourself - Earn 0.5 CEUs

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Renée  Dustman

Michelle Dick
EdgeBlast Editor

Top News

Auditors Cite Coding Errors

Improper Medicare payments of $371.5 million were corrected using recovery audit contractors (RACs) in the states of California, Florida, and New York for 2007 and a good part of the errors were because of bad coding, CMS says.

The RAC says the majority of the improper payments identified occurred when health care providers submitted claims not compliant with Medicare’s coverage or coding rules. Inpatient hospital claims constituted more than 85 percent of the overpayments collected and nearly all underpayments refunded by the RACs. Recovery for improper billing was corrected by collecting overpayments or providing underpayment refunds to health care providers and suppliers.

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OP Payment for ESRD-Related Services

CMS is changing the way physicians and practitioners are paid for managing patients on dialysis. These changes are a reflection of 2004 and 2005 physician fee schedule final rules that weren’t added to the on-line manuals. These changes are effective on March 24. The summary of changes for processing claims is contained in CR 5931. Chapter 8, section 140 of the Medicare Claims Processing Manual has been revised and reorganized to reflect these changes.

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Google Puts Patients in Charge

Google’s Chief Executive, Eric Schmidt, announced at the Healthcare Information and Management Systems Society (HIMMS) conference in Orlando, Fla. on Feb. 27 a plan to help patients get control of their personal medical records. Google has signed deals with doctors’ groups, pharmacies, labs and other firms, including; Quest Diagnostics, Aetna, Walgreens, and Walmart. Google has teamed up with the Cleveland Clinic to test secure ways of sharing sensitive health data.

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CMS Revises 99231 – 99239 Usage

CMS  transmittal 1460 revises Chapter 12, §30.6.9.2, in regard to physician payment policy for Subsequent Hospital Care visits during a global period, and the correct use of hospital discharge day management services for a final hospital visit by the attending physician and also for a death pronouncement. The instructions affect non physician practitioners and physicians and the use of codes 99231-99239. All services and visits that are part of global surgery payment under the Medicare physician fee schedule (MFPS) are included when surgical procedures may be fragmented.

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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.

Index # EB03012008A

1. The RAC says the majority of the improper payments identified occurred when health care providers submitted claims not compliant with the coverage or coding rules of whom?

Answer:

2. What is the definition of the hospital discharge day management service CPT® code 99238?

Answer:

3. What is Google working on??

Answer:

4. Which CPT® code range do you use to report for observation or inpatient care services (including admission and discharge services)?

Answer:

5. CPT® codes 90918-90925 were replaced by HCPCS what codes?

Answer:

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Copyright © 2008 AAPC
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