Ambulance and EMS Transport Medical Coding: Cheat Sheet and Tips

ambulance-coding-expertsEmergency situations call for unique medical coding of non-physician provider services

Ambulance codes and guidelines are uniquely applicable to non-physician providers. To make coding these services even more of a challenge, procedure codes relevant to emergency medical service (EMS) providers aren’t found in the CPT® codebook. Instead, coding guidelines for ambulance and EMS transport codes come primarily from Medicare transmittals and MedLearn updates.

Payers generally cover ambulance services, including fixed and rotary wing services, for patients whose medical condition is such that air transport is medically necessary. To assure transport is medically necessary, you must consider both the patient’s condition and the method of transportation. This can be a challenging process, which depends on the documentation paramedics and emergency medical technicians (EMTs) provide in the field.

Differentiate Emergency vs. Non-emergency Response

To prevent coding errors, use extreme care when differentiating emergency from non-emergency transports. This often requires additional education for ambulance providers to assure their documentation of a patient’s conditions accurately describes when an emergency condition existed, or when an emergency transport was required.

CMS defines an emergency response as, “responding immediately at the BLS or ALS1 level of service to a 911 call or the equivalent.” An immediate response is defined as a response by the ambulance supplier that begins as quickly as possible to the call. Emergency response is based on internal protocols, which consider the information received during the call. The call does not have to come through a 911 system.

All scheduled transports are considered non-emergency, and include routine transports to nursing homes, patient homes, and end-stage renal disease (ESRD) facilities.

Break Down Ambulance Services Categories

In the Ground Ambulance Services section of the ambulance fee schedule, there are seven categories of ground ambulance services (“ground” refers to both land and water transportation) and two categories of air ambulance services. The level of service is based on the patient’s condition, not the vehicle used. This is a challenge for many coders.

In addition to the HCPCS Level II procedure codes and standard set of modifiers (see Chart A), a unique set of modifiers (see Chart B) are required to identify the origin and destination, which are affixed to the procedure code. Mileage must also be calculated, which presents additional challenges if this information is not clearly documented (ambulance coders are all too familiar with programs that estimate mileage between pick-up and drop-off points to assure accuracy for mileage calculations).

Chart A: Common modifiers for ambulance services


Chart B: Specialty modifiers for reporting ambulance services (including origin and destination codes and their descriptions)



Ground Ambulance Services

A0425 Ground mileage, per statute mile requires documentation and/or calculation of mileage between sites.

A0426 Ambulance service, advanced life support, nonemergency transport, level 1 (ALS1) includes transportation by ground ambulance and medically necessary supplies and services. The response personnel are required to document an ALS assessment, or to provide at least one ALS intervention.

Advanced life support assessment is defined as:
1. Assessment performed by an ALS crew as part of an emergency response that was necessary; or
2. The patient’s reported condition at the time of dispatch was such that only an ALS crew was qualified to perform the assessment.  An ALS intervention includes procedures that are beyond the scope of an EMT-basic. Personnel qualified for ALS are trained EMT-intermediates or paramedics.

Often, the ALS assessment does not indicate that the patient required a level of service consistent with ALS, but that is only determined after the assessment is performed. Documentation is critically important to identify signs and symptoms that required the assessment and the results of the assessment, including the condition of the patient prior to and during transport.

  • A0427 Ambulance service, advanced life support, emergency transport, level 1 (ALS1 – emergency): The provision of ALS1 services as an emergency response applies. For ALS1, ALS2, and specialty care transport (SCT), the emergency condition is assumed, but documentation is critical to support these services.
  • A0428 Ambulance service, basic life support, nonemergency transport (BLS) defines transportation by ground ambulance vehicle, with medically necessary supplies and services, as well as BLS services. The ambulance must be staffed by a qualified EMT-basic consistent with state rules and regulations, which may vary from state to state. Coding for these services requires an understanding of state regulations and the ambulance provider’s assurance that providers meet the criteria for each level of transport. For example, only in some states is an EMT-basic permitted to operate limited equipment on board the vehicle, assist more qualified personnel in performing assessments and interventions, and establish a peripheral intravenous (IV) line.
  • A0429 Ambulance service, basic life support, emergency transport (BLS emergency) describes the provision of BLS services, but for response to an emergency. Emergency response is defined as immediate response to a 911 (or similar) call. A call is determined to be an emergency based on the information available to the dispatcher, who is expected to follow existing protocols. Be familiar with these protocols for ambulance providers to assure coding is consistent with dispatch and emergency criteria.
  • A0433 Advanced life support, level 2 (ALS2) requires three or more different administrations of medications by IV push/bolus or by continuous infusion, excluding crystalloid, hypotonic, isotonic, and hypertonic solutions (dextrose, normal saline, Ringer’s lactate), or medically necessary ground transportation, supplies and services, and the provision of at least one of the following ALS procedures:

• Manual defibrillation/cardioversion
• Endotracheal intubation including the monitoring and maintenance of an endotracheal tube that was inserted prior to the transport, which also qualifies as an ALS2 procedure.
• Central venous line
• Cardiac pacing
• Chest decompression
• Surgical airway
• Intraosseous line

  • A0434 Specialty care transport (SCT) is an interfacility transportation of a critically injured or ill beneficiary by a ground ambulance, including the provision of medically necessary supplies and services, at a level of service beyond the scope of the EMT paramedic. SCT is required when a beneficiary’s condition requires ongoing care that must be provided by one or more health professionals in an appropriate specialty area (e.g., emergency, critical care nursing, emergency medicine, respiratory care, cardiovascular care, or a paramedic with additional training).

Be cautious when using this code for chronic ventilator-dependent patients whose transport would not qualify for SCT unless their condition is considered acute or the patient has developed emergency signs and symptoms for other conditions.

Air Ambulance Services

The two categories of air ambulance services are fixed wing (airplane) and rotary wing (helicopter). The air ambulance mileage rate is calculated per actual loaded (patient onboard) miles flown, and is expressed in statute miles (not nautical miles).

  • A0430 Ambulance service, conventional air services, transport, one way (fixed wing). Fixed wing air ambulance (FW) is used when the patient’s medical condition requires immediate and rapid transportation that can’t be provided by ground ambulance either because the point of pick-up is inaccessible, the nearest hospital with appropriate facilities is far away, or the road is impassable due to heavy traffic or other obstacles. Mileage is identified with A0435 Fixed wing air mileage, per statute mile.
  • A0431 Ambulance service, conventional air services, transport, one way (rotary wing). Rotary wing air ambulance (RW) service is used when a patient requires rapid transportation due to medical condition, and there are transportation challenges applicable to fixed wing transportation (traffic, distance, etc.). Report mileage using A0436 Rotary wing air mileage, per statute mile.
  • A0888 Noncovered ambulance mileage, per mile (e.g., for miles traveled beyond closest appropriate facility). Report this code when the reason for the ambulance trip is not covered by Medicare, and you do not expect Medicare payment.

Non-covered Services

Effective Jan. 1, 2012, CMS allows ambulance providers to bill procedure codes for non-covered ambulance services. This does not include supplies associated with a covered ambulance transport. Per CMS Internet Only Manual (publication 100-04, chapter 15, section 30.1), those supplies are included in the base rate.
If the supplies are associated with a non-covered service, they are billable to Medicare with modifier GY Item or service statutorily excluded, does not meet the definition of any Medicare benefit or for non-Medicare insurers, is not a contract benefit. Procedure codes A0021-A0424 and A0998 Ambulance response and treatment, no transport are billable procedure codes and must include modifier GY; however, they are not payable by Medicare.
Effective for claims with dates of service on and after Oct. 1, 2013, payment for non-emergency BLS transports of individuals with ESRD to and from renal dialysis treatment facilities will be reduced by 10 percent. The reduced rate will be calculated and applied to HCPCS Level II code A0428 when billed with destination modifier code “G” or “J,” and the associated mileage (code A0425). A claim adjustment reason code of 45 Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement and group code CO Contractual obligation will be on the remittance advice notice.

Make sure your coding and billing staffs are aware of these changes. The 10 percent reduction applies to beneficiaries with ESRD who are receiving a non-emergency BLS transport to and from renal dialysis treatment.

A Medicare beneficiary receiving maintenance dialysis on an outpatient basis does not ordinarily require ambulance transportation for dialysis treatment, whether the facility is independent or part of a hospital. Ambulance services furnished to a maintenance dialysis patient are not payable unless documentation submitted with the claim shows that the patient’s condition requires ambulance services and the facility meets the destination requirements. Medical necessity must be documented for claims for non-routine round trip ambulance services to outpatient dialysis facilities. Medicare has discretion to override or reverse the reduction on appeal, if they deem it appropriate, based on supporting documentation.

Kaiser Daily Health Policy Report – March 21, 2014


5. Online Marketplace Reportedly Using Incorrect Guidelines To Calculate Subsidies

An article in the Philadelphia Inquirer notes the problem. In other implementation news, recent statements by a Treasury official are being touted by Republicans as evidence the Obama administration has overstepped its statutory authority.

Philadelphia Inquirer: A Glitch In Obamacare Marketplace No One Noticed
Nearly six months after the disastrous launch of, with the website
running smoothly and more than five million people signed up as open enrollment heads to a close, a new glitch has come to light: Incorrect poverty-level guidelines are automatically telling what could be tens of thousands of eligible people they do not qualify for subsidized insurance. The error in the federal marketplace primarily affects households with incomes just above the poverty line in states like Pennsylvania that have not expanded Medicaid. The mistake raises the price of their insurance by thousands of dollars, making insurance so unaffordable many may just give up and go without (Sapatkin, 3/21).

The Wall Street Journal: Republicans Challenge Administration’s Authority
Republicans are pointing to statements by a top Treasury Department official as evidence that the Obama administration overstepped its authority in delaying the health-care law’s requirement that employers offer coverage or pay a penalty. Mark Mazur, assistant Treasury secretary for tax policy, said in a January interview with staff from the GOP-led House Oversight and Government Reform Committee that he wasn’t aware of any examination of the legal basis for the administration’s authority to delay the employer mandate (Radnofsky, 3/20).

In other news coverage of implementation issues -

The Associated Press: Health Care Law Has Uneven Impact On Companies
Sarah Curtis-Fawley will have to offer insurance to her workers at Pacific Pie Co. because of the health care overhaul, and the estimated $100,000 cost means she may have to raise prices or postpone opening a third restaurant. … The Affordable Care Act, which aims to provide coverage for millions, is playing to decidedly mixed reviews in corporate America (Murphy, 3/20).

Modern Healthcare: Obamacare Insurance Mandate Could Be Toothless In 2014
The Obama administration has made the individual mandate its line in the sand for the Patient Protection and Affordable Care Act. Despite delaying or tweaking numerous provisions—most notably the requirement that businesses with more than 50 employees provide coverage. … The financial penalty isn’t particularly onerous in the first year. … But the individual mandate is likely to prove a paper tiger in 2014 for two other reasons: the availability of hardship exemptions and lax enforcement (Demko, 3/20).

6. Emanuel’s Book Suggests Health Law Could Create Shift From Job-Based Plans

Although Ezekiel Emanuel was a key White House adviser on the law, other Democrats dispute his view about transitions in how Americans get coverage. Meanwhile, in other articles looking at changes the overhaul will bring, the Associated Press examines some workers’ desire to leave jobs now that they can get insurance elsewhere, and the Fiscal Times explores premium costs in the future.

The New York Times: In Book, Architect of Health Law Predicts a Shift Away From Employer Coverage
Ezekiel J. Emanuel, who helped devise the Affordable Care Act, has a vision for how it will eventually work. Democrats hope it will not materialize anytime soon. Mr. Emanuel expects the law to produce an unadvertised but fundamental shift in where most working Americans get their health insurance — specifically, a sharp drop in the number of employers who offer coverage to their workers. … His former colleagues in the Obama White House say there is no evidence the law will bring “the end of employer-sponsored insurance,” as Mr. Emanuel puts it in his new book (Harwood, 3/20).

The Associated Press: With Health Law, Workers Ponder The I-Quit Option
But for Stephanie Payne of St. Louis, who already had good insurance, the law could offer another kind of escape: the chance to quit her job. At 62, Payne has worked for three decades as a nurse …. One of the selling points of the new health care plan, which has a March 31 enrollment deadline, is that it breaks the link between affordable health insurance and having a job with benefits. Payne believes she’ll be able to replace her current coverage with a $400- to $500-a-month
plan on Oregon’s version of the new insurance exchange system set up under the law. … Last month, congressional budget analysts estimated that within 10 years, the equivalent of 2.5 million full-time workers could be working less because of the expanded coverage. But is the new option a gamble? That’s a matter of debate (Johnson, 3/21).

The Fiscal Times: 4 Reasons Obamacare Premiums Will Rise Next Year
Now that the first open enrollment period under the Affordable Care Act is coming to a close, insurers they say are getting a better idea of what to expect next year—and that includes higher premiums. Early into Obamacare’s troubled launch—plagued with website problems, cancelled plans and numerous delays—several insurers were already warning that the rocky rollout would result in higher premiums in 2015. Aetna CEO Mark Bertolini first raised concerns over a potential rate shock in December, when he told investors that “n some markets,”individual-market premium increases ” could go as high as 100 percent” (Ehley, 3/21).

Meanwhile, CNN examines the issues at stake in next week’s Supreme Court case.

CNN: Justices To Hear ‘Hobby Lobby’ Case On Obamacare Birth Control Rule
Conestoga Wood Specialties was founded a half-century ago in a Pennsylvania garage. The Hahn family’s commitment to quality is driven in large part by their Christian faith, which in turn may soon threaten the company’s very existence. That financial and constitutional dynamic is now before the U.S. Supreme Court, in a high-stakes encore to the health care reform law known as Obamacare. The justices will hear oral arguments Tuesday in a dispute involving contraception coverage and religious liberty. The court will review provisions in the Affordable Care Act requiring for-profit employers of a certain size to offer insurance benefits for birth control and other reproductive health services without a co-pay. At issue is whether certain companies can refuse to do so on the sincere claim it would violate their owners’ long-established personal beliefs (Mears, 3/21).

7. Obama Presses Campaign For Health Law Enrollment

The president continues his many media appearances to help draw attention to the enrollment deadline at the end of March. Meanwhile, a new Pew poll finds that younger Americans are somewhat more interested in the law but support among Hispanics has dropped.

Los Angeles Times: Obama Enlists Help To Push Affordable Care Act
President Obama teased Ellen DeGeneres about the selfie she took at the Oscars and confessed to leaving his socks and shoes lying around while the first lady is out of town, but before the end of his Thursday appearance on her talk show, he got DeGeneres to put in a plug for the Affordable Care Act. That’s Obama’s deal with popular media these days as the president enlists help to boost healthcare sign-up numbers before the March 31 enrollment deadline for coverage this year. In recent days, Obama has filled out his March Madness brackets on ESPN, joked with comedian Zach Galifianakis and defended his “mom jeans” with radio host Ryan Seacrest — all with the agreement he’d get a moment to make his pitch (Parsons, 3/20).

Los Angeles Times: Younger Americans Warm Somewhat To Obamacare, Poll Shows
As the deadline approaches for enrolling in Obamacare health coverage this year, younger Americans have warmed somewhat to the president’s healthcare law, but Latinos remain closely split over it. Those findings from a large-scale Pew Research Center survey provide a glimpse at two groups that are major targets of the Obama administration’s push to get people to sign up before the March 31 deadline (Lauter, 3/20).

CBS News: Approval Of Obamacare Nosedives Among Hispanics
Four years after passage of the Affordable Care Act and less than a year into the implementation of the exchanges, the health care law’s popularity is taking a nosedive among Hispanics. Hispanics are split with 47 percent approving and 47 percent disapproving, according to a new survey by the Pew Research Center. In September, 61 percent of Hispanics approved of the law. Meanwhile, overall, more Americans disapprove of Obamacare: 53 percent of the 3,335 adults who responded disapprove of the law, while just 41 percent approve — a measure virtually unchanged since last September, before people could purchase coverage on the insurance exchanges (Kaplan, 3/20).

McClatchy: 53 Percent Disapprove Of Affordable Care Act, 43 Percent Approve, New Poll Finds
On the Affordable Care Act’s fourth anniversary, a new Pew Research Center poll released Thursday found strong disapproval of the controversial law. Fifty-three percent disapprove, while 41 percent approve. At the same time, the poll found, “when opponents of the health care law are asked about the law’s future, more want elected officials to try to make it work than to make it fail. In September opponents were more evenly divided over how they wanted elected officials to deal with the law” (Lightman, 3/20).

Several news outlets also looked a consumer issues with the law.

Kaiser Health News: The Sign-Up Deadline Is March 31: A Consumers’ Guide
Kaiser Health News staff writer Mary Agnes Carey reports: “With just over a week until the March 31 deadline to sign up for health insurance, backers of the health law — from President Barack Obama on down — are engaged in a full-force campaign to enroll eligible Americans, especially younger ones who tend to be healthier and less costly to insure. … Here’s a primer on how the law might affect you” (Carey, 3/21).

Kaiser Health News: A Reader Asks: After I Was In The Hospital, Can I Buy Insurance To Cover My Bills?
Kaiser Health News consumer columnist Michelle Andrews answers this reader’s question (3/21).

The Associated Press: Q&A: Am I Stuck In My $$$ Workplace Health Plan?
The new health care law helps some people, hurts others and confuses almost everyone. Hoping to simplify things a bit, The Associated Press asked its Twitter, Facebook and Google Plus followers for their real-life questions about the program and the problems they’re running into as the March 31 deadline approaches to sign up for coverage in new insurance markets (Woodward, 3/21).

Fox News: ObamaCare: Does It Really Cost Less Than Cell Phone Coverage?
In the midst of March Madness, the White House is making a full-court press of its own: a last-minute push to enroll more than 1.5 million young people in ObamaCare health plans by the end of this month. But in courting young people, President Obama is making a simple-yet-questionable pitch — that new health coverage basically costs the same as 4G cell coverage.  “You can at this point get health insurance for $100 a month or less, in some cases less than your cell phone bill or your cable bill,” Obama told Ellen DeGeneres this week (Doocy, 3/20).


8. Pelosi On Obamacare Anniversary: The Law Is ‘A Winner’ For Democrats

The House minority leader marks the anniversary of the law’s passage by expressing confidence that the law will help Democratic candidates this fall.

CNN: Pelosi: Obamacare A Winning Issue
Marking Sunday’s fourth anniversary of the Affordable Care Act, House Democratic Leader Nancy Pelosi brushed off any notion the controversial health care law was hurting Democrats politically, and predicted the measure would help those
running in competitive districts in the midterm elections this fall. “I believe that it’s a winner,” Pelosi replied when asked Thursday how the issue would play in swing districts. “That is a case we have to make,” she added and noted Democrats faced a similar dynamic when Social Security was passed in the 1930′s, saying “everybody has to spread the word as to what this is” (Walsh, 3/20).

The Associated Press: Pelosi Says Health Law A Winner For Dems 
“We just couldn’t be prouder” of the legislation, Pelosi told a news conference where she said the law already has resulted in “better coverage, more affordable, better quality” insurance for nearly 12 million people. The California Democrat’s appearance was timed for the fourth anniversary of the bill’s signing by President Barack Obama on March 23, 2010, an occurrence that few other congressional Democrats seem inclined to herald at a time when party strategists seek a strategy to blunt criticism from Republicans and their allies (Espo, 3/20).

Politico: Pelosi: Health Law Is A ‘Winner’ For Democrats 
Pelosi maintained that the Florida House special election last week, in which Democrat Alex Sink was defeated by a Republican in a race where the health care law was a major issue, showed that Democrats are “ready for the next putt” because the final results were close. … “And by the way, it’s called the Affordable Care Act,” she told a reporter, repeating the law’s name several times. “I know you didn’t intend anything derogatory, but it’s called the Affordable Care Act. I tell [Obama] the same thing I told you. Affordable — there’s a reason” (Cunningham, 3/20).

President Barack Obama also stressed the law’s benefits -

CBS News: Obamacare Anniversary Provides More 2014 Fodder
Mr. Obama on Thursday gave Democrats a blueprint for explaining the law on the campaign trail while tying it to other Democratic campaign themes, such as expanding women’s economic opportunities. “Before we passed Obamacare, it was routine for insurance companies to charge women significantly more than men for health insurance — it’s just like the dry cleaners,” Mr. Obama said at a Florida event focused on women’s economic issues. “You send in a blouse, I send in a shirt — they charge you twice as much. But the same thing was happening in health insurance. And so we’ve banned that policy for everybody” (Condon, 3/21).

Meanwhile, Republicans consider what alternatives they can present to voters -

Fox News: Republicans Drive To Replace ObamaCare — But With What?
All Republicans want to replace ObamaCare — but finding that ideal plan might not be so easy. For now, Majority Whip Kevin McCarthy, R-Calif., and GOP Conference Chairwoman Cathy McMorris Rodgers, R-Wash., are trying to come up with an outline of Republican health care ideas that 30 members can present to their constituents in town-hall type meetings in April. GOP leadership aides have been looking at the “policy overlap” from a half-dozen House Republican bills already made public (Emanuel, 3/20). 


9. Calif. Marketplace Reports Half Of Callers Hang Up Before Getting Help

Officials also said that the online insurance exchange is attracting more Hispanic customers, a key constituency for the marketing effort. Also, in Minnesota, officials announce an effort to boost enrollment of young adults.

Los Angeles Times: Half Of Callers To Covered California Give Up As Deadline Looms
Nearly half of callers to California’s health insurance exchange in February and March couldn’t get through and abandoned their call, state figures show. … Also Thursday, the Covered California exchange reported progress on another front: low enrollment among the state’s large Latino population. At its monthly board meeting, the exchange said 32% of health
plan enrollees in the first two weeks of March described themselves as Latino. That was up from 18% during the first three months of enrollment that ended in December (Terhune, 3/20).

Pioneer Press: MNsure Begins Final Enrollment Push Before March 31 Deadline
It’s crunch time at MNsure. If people don’t get health insurance by March 31, they could face penalties under the federal Affordable Care Act (Snowbeck, 3/20).

The Associated Press: Minnesota Exchange Launches Push For Young Adults
Leaders of Minnesota’s new health insurance exchange announced a final push Thursday to sign up so-called “young invincibles” by the March 31 deadline for open enrollment, targeting an underinsured group that’s key to keeping premium costs down. MNsure chief Scott Leitz announced a series of outreach events for the coming week aimed at young adults (Karnowski, 3/20). 

Minnesota Public Radio: Insurance With Your Beer? MNsure Courts Young Uninsured On Their Turf
People under age 34 are considered key to the long-term financial health of online insurance exchanges like MNsure. But its leaders aren’t waiting for young adults to come to them. They’re going to universities, breweries and bars — and buying television ads (Stawicki, 3/20).

The Star Tribune: MNsure Enlists Oscar Nominee Abdi In Enrollment Push
MNsure is bringing a bit of Hollywood into its final act. As part of its push to get uninsured Minnesotans enrolled in a health plan by March 31, the state’s online health exchange has turned to Oscar-nominated actor Barkhad Abdi and his “Captain Phillips” co-star, Faysal Ahmed, to make public appearances and pitches over the airwaves (Crosby, 3/20).

And in other states -

Reuters: South Carolina Lawmakers Fail In Attempt To Undo Obamacare
South Carolina lawmakers failed to derail implementation of President Barack Obama’s signature health care law in the state when a measure was defeated in the Republican-controlled Senate. Last year, the state House passed a bill that nullified the law by calling for criminal penalties for anyone who sought to enforce it. Late Wednesday night, however, Senators voted 33-9 to defeat an amendment regarding the Affordable Care Act, commonly known as Obamacare. The amendment would have banned state agencies and employees from helping to carry out the health care law. It would have required healthcare navigators who help people sign up for health insurance to be licensed by the state (McLeod, 3/20).

The Boston Globe: Mass. In Feud On Health Site Grant
The Obama administration’s hopes that Massachusetts would serve as a model for New England states enrolling residents in health insurance has collapsed in a bitter regional feud over tens of millions of dollars, a victim of the botched rollout of the state’s online insurance portal. Connecticut health care officials are now mounting a campaign to collect a portion of a $45 million federal innovation grant that was awarded to Massachusetts to build a state-of-the-art consumer platform for President Obama’s insurance program. The original idea was that the technical underpinnings of Massachusetts’ computer system could be shared with other New England states (Jan, 3/21).

10. Gov. Kitzhaber Sweeps Out Cover Oregon Leadership, Promises Reforms

An analysis of the state marketplace by First Data released Thursday found serious problems with management and communications.

The Oregonian: Kitzhaber Cleans House, Announces Reforms In Wake Of Cover Oregon Health Insurance Exchange Report
Gov. John Kitzhaber announced a major managerial house-cleaning Thursday in response to the state’s ongoing health insurance exchange fiasco. Among those departing is perhaps Kitzhaber’s closest and most important health care reform ally, Bruce Goldberg, the Oregon Health Authority director who’s led Cover Oregon since January. Kitzhaber said he also asked the Cover Oregon board to remove Triz DelaRosa, chief operating officer for Cover Oregon, and Aaron Karjala, Cover Oregon’s chief information officer. “We have made mistakes and we will learn from it,” Kitzhaber said, following the release of an independent report highly critical of the state’s work on the project (Budnick, 3/20).

The Oregonian: Republicans Pounce On Cover Oregon Problems, Point Fingers At Gov. John Kitzhaber
Opponents of Gov. John Kitzhaber were quick to paint the Democratic incumbent as out of touch and incompetent Thursday following the release of an investigation into the mishandled Cover Oregon project. The Republican Governors Association blasted out an email tying Kitzhaber to President Barack Obama’s healthcare plan, calling it “Oregon’s nightmare.” And the Republican frontrunner in the gubernatorial primary, state Rep. Dennis Richardson, piled on (Esteve, 3/20).

The New York Times: Health Care Exchange In Oregon Not Meeting High Hopes 
As the federal health care overhaul was rolled out over the last few years, Oregon was invariably the eager overachiever in the first row, waving a hand to volunteer. The governor, John Kitzhaber, a doctor who left the emergency room for politics, made health care his main issue. … Yet for all that, by some measures Oregon has among the most dysfunctional online insurance exchanges in the nation. … On Thursday, a grim-faced Mr. Kitzhaber released a new report, commissioned by the state with a private company, that underscored how systemic Oregon’s failure has been (Johnson, 3/20).

The Washington Post: After Disastrous Rollout, Oregon Considers Health Exchange Options 
Oregon Gov. John Kitzhaber (D) has fired the head of the state’s online health-care exchange — the second to leave the organization in three months — after chronic technical issues that left uninsured residents unable to purchase insurance mandated by the Affordable Care Act. Plagued by technical issues, breakdowns in supervisory management and shoddy work by an outside vendor that received tens of millions of dollars in state funding, Cover Oregon, the state’s online health insurance exchange has been one of the worst in the country (Wilson, 3/20).

11. State Highlights: Ark. Court Reverses $1.2B Medicaid Drug Judgement; Fla. Officials Overhauling Child Welfare Agency

The New York Times: Arkansas Court Reverses $1.2 Billion Judgment Against Johnson & Johnson
The Arkansas
Supreme Court reversed a $1.2 billion judgment against Johnson & Johnson on Thursday, finding that the state attorney general erred by suing under a law that applied to health care facilities, not drug companies. The judgment, one of the largest in history for a state fraud case, was imposed in 2012 after a jury concluded that Johnson & Johnson had improperly marketed and concealed the risks of Risperdal, an antipsychotic drug (Thomas, 3/2).

The Associated Press: Arkansas Court Tosses $1.2B Judgment Against J&J
The Arkansas Supreme Court tossed out a $1.2 billion judgment against Johnson & Johnson on Thursday, reversing a lower court verdict that found the drug maker engaged in fraudulent tactics when marketing the antipsychotic drug Risperdal. The high court ruled the state’s Medicaid fraud law, which formed the basis of Arkansas’ lawsuit, regulates health care facilities and that drug manufacturers, including Johnson & Johnson and its subsidiary, Janssen Pharmaceutical Inc., don’t fall under its scope (Bartels, 3/20).

The Wall Street Journal: Child-Abuse Deaths Prompt Lawmakers To Weigh Overhauls
In some cases, [Department of Children and Families] documents show the agency left kids with caregivers about whom it had logged multiple warning signs. The string of deaths triggered public outcry, plunged the state’s child-welfare system into crisis and led to the resignation of the DCF secretary in July. Now, the Florida Legislature has made overhauling the system one of its top priorities in the session that began earlier this month (Campo-Flores, 3/20).

The Wall Street Journal: Arizona ‘Abortion Pill’ Rule Faces Challenge
A federal court next week is set to hear a challenge to a new Arizona regulation that would require so-called abortion pills to be administered under a protocol that abortion-rights activists say is outdated and overly restrictive (Phillips, 3/20).

St. Louis Public Radio: Building A Pipeline Of Doctors To Help The Shortage In Missouri’s Rural Communities
For someone who was clueless about what he wanted to do after finishing high school, Luke Stephens has done quite well in life. He’s now Dr. Luke Stephens, with a degree in cell and molecular biology from Missouri State University in 2004, and a medical degree from the University of Missouri at Columbia. Stephens, who is in his early 30s, is a primary care doctor who specializes in rural medicine. He’s the product of a special University of Missouri program that trains more doctors to help Missouri plug some of the holes in its primary care system in rural communities (Joiner, 3/20).

The Seattle Times: $34 Million Saved In Effort To Cut Needless ER Visits
After a contentious beginning, the state Medicaid program and a coalition of doctors and hospitals together forged a plan that helped cut nearly $34 million from expensive, unnecessary emergency-room visits last year, both sides announced Thursday. The seven-point plan included connecting hospital emergency departments across the state so doctors can check if a patient is making multiple ER visits, perhaps getting duplicate scans and other tests, as they seek drugs or relief from a chronic condition better managed in a primary-care setting (Ostrom, 3/20).

Minnesota Public Radio: A Gap Opens In Rural Mental Health Care
A mental-health provider that served thousands of people in five counties shut down early this week, abruptly creating a gap in service to rural Minnesota. Riverwood Centers operated clinics in Milaca, Cambridge, Mora, Braham, Pine City and North Branch. Kevin Wojahn, Riverwood’s former executive director, told MPR News that the organization ran out of money (3/20).

The CT Mirror: CT Lawmakers, Wary Of Changing Health Care Landscape, Consider Restrictions On For-Profit Hospitals
With four of Connecticut’s 28 nonprofit hospitals facing potential acquisitions by a for-profit chain, legislators are under siege from competing interests. Hospital officials say the survival of some Connecticut hospitals depends on having the ability to convert to for-profits, something that requires a change in state law. Union leaders want sweeping protections for workers in case hospitals change hands. Some union leaders and consumer advocates want an outright ban on hospitals becoming for-profit. And so far, the proposals advancing through the legislature suggest the critics of for-profit health care have the upper hand (Becker, 3/21).


12. FDA Finds Medical Device Recalls Nearly Doubled In 10 Years

The Wall Street Journal says a report to be released today will spotlight the increasing number of problems.

The Wall Street Journal: Medical Device Recalls Nearly Doubled In A Decade
Recalls of defective medical devices nearly doubled in the decade from 2003 through 2012, according to a Food and
Drug Administration report due Friday. The total number of recalls rose to 1,190 in 2012, up from 604 in 2003. There was a sharp increase in recalls where the defective product carried a reasonable probability of death. In 2012, there were 57 of these so-called Class I recalls, up from seven in 2003 (Burton, 3/21).

Also, the Journal looks at the dilemma for patients when the government wants to end some studies.

The Wall Street Journal: Hard Choices In Pursuit Of Rare-Disease Cures
Late last year, the National Institute on Aging, which is part of NIH, said a long-running observational study of fibromuscular dysplasia and four other rare diseases was no longer collecting data or enrolling patients, and that the study’s goals had been met. Sufferers, arguing that fibromuscular dysplasia’s cause or cure still isn’t known, mobilized. … The fight to continue the study exemplifies tensions that often arise between researchers and patients over which efforts yield the most valuable science. … Both NIH and the Food and Drug Administration have said such studies are a critical early step toward drug development. But the studies are expensive and don’t always lead to new trials (Marcus, 3/20).


13. Research Roundup: New Medical Coding System; Choosing A Hospice; Revamping Medicare

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Health Affairs: Transitioning To ICD-10
On October 1, 2014, all health plans, health data clearinghouses, and health care providers that transmit health information electronically must use a new, significantly broader, coding system, called ICD-10, for diagnoses and inpatient procedures. The new system has the potential of improving the health care system, but its costs and complications have caused some to question whether the costs outweigh the benefits. … Given the political fallout from the data system problems encountered with implementation of the health insurance exchanges, the Obama administration will likely be extremely sensitive to any potential problems with claims processing due to the ICD-10 conversion. Extensive testing, both of the system’s connectivity and of coding accuracy, is needed to ascertain readiness for the conversion. As the implementation date approaches, CMS will have to decide if there has been sufficient progress to keep to the deadline (James, 3/20).

American Journal Of Hospice & Palliative Medicine: What Consumers Want To Know About Quality When Choosing a Hospice Provider
Despite the availability of endorsed quality measures and widespread usage of hospice, hospice quality data are rarely available to consumers. … This study drew on focus group and survey data collected in 5 metropolitan areas. The study found that consumers reported the hospice quality indicators we tested were easy to understand. Participants placed top priority on measures related to pain and symptom management. Relative to consumers with hospice experience, consumers without previous experience tended to place less value on spiritual support for patients and caregivers, emotional support for caregivers, and after-hours availability. The National Quality Forum-approved measures resonate well with consumers. Consumers also appear to be ready for access to data on the quality of hospice providers (Smith et al., 3/4).

Annals of Family Medicine: Staffing Patterns Of Primary Care Practices In The Comprehensive Primary Care Initiative
We undertook a descriptive analysis of [nearly 500 primary care practices involved in the Centers for Medicare & Medicaid Services (CMS) Comprehensive Primary Care (CPC) initiative]. … Consistent with the national distribution, most of the CPC initiative practices included in this study were small: 44% reported 2 or fewer full-time equivalent (FTE) physicians; 27% reported more than 4. Nearly all reported administrative staff (98%) and medical assistants (89%). Fifty-three percent reported having nurse practitioners or physician assistants; 47%, licensed practical or vocational nurses; 36%, registered nurses; and 24%, care managers/coordinators — all of these positions are more common in larger practices. … At baseline, most CPC initiative practices used traditional staffing models and did not report having dedicated staff who may be integral to new primary care models, such as care coordinators, health educators, behavioral health specialists, and pharmacists. Without such staff and payment for their services, practices are unlikely to deliver comprehensive, coordinated, and accessible care to patients at a sustainable cost (Peikes, March/April, 2014).

JAMA Psychiatry: Chronicity Of Posttraumatic Stress Disorder And Risk Of Disability In Older Persons
Little is known about the association between posttraumatic stress disorder (PTSD) and disability into later life. Most studies of late-life psychiatric disorders and function have focused on depression and generalized anxiety disorder. … This study provides evidence that persistence of PTSD in later life is a prominent predictor of disability in late life above and beyond other psychiatric disorders and medical conditions (Byers et al., 3/19).

The Kaiser Family Foundation: Visualizing Health Policy: What Americans Pay For Health Insurance Under The ACA
The March 2014 Visualizing Health Policy infographic shows examples of what Americans will pay for health insurance under the Affordable Care Act, using different scenarios for 40-year-old individuals living in different parts of the country (Cox et al., 3/19).

Texas A&M University’s Private Enterprise Research Center/National Center for Policy Analysis: Framing Medicare Reform
This paper identifies the effects of a reform that relies on two policy levers: raising the Medicare eligibility age (MEA) and means-testing the government’s Medicare contribution. … Raising the MEA and introducing means-testing can achieve the same baseline spending path as forecast under the [Affordable Care Act's] provisions. Admittedly these policy options come with their own concerns, but they must be weighed against the most likely alternatives (Liu et al., March 2014).

Here is a selection of news coverage of other recent research:

JAMA: Emergency Visits Up In Massachusetts After Reforms Enacted
States should expect more people to use emergency departments after the Affordable Care Act is fully implemented, say the authors of a new study reporting increases in emergency care visits in Massachusetts during and after the state’s own similar reforms went into effect. The study, published online today in the Annals of Emergency Medicine, analyzed all emergency department visits in Massachusetts between October 1, 2004, and September 30, 2009 (Voelker, 3/20). 

PBS NewsHour: Study Finds Dramatic Increase In Painkiller Prescriptions For ER Patients
Researchers at George Washington University have found a significant increase in prescriptions for opioid analgesics, such as Percocet, Vicodin, oxycodone and Dilaudid, despite only a modest increase in visits for painful conditions. The report, published Friday in the journal Academic Emergency Medicine, details the growing rate of painkiller prescriptions between 2001 and 2010. The trend concerns co-author Dr. Maryann Mazer-Amirshahi, given the increase in opioid-related overdoses in recent years (Myers, 3/17).

Reuters: Obesity Prevention Programs Might Help Lower Kids’ Blood Pressure
Programs designed to prevent obesity in children may help lower kids’ blood pressure, according to a new review of past studies. Researchers found that programs targeting both diet and physical activity were more effective than programs that focused on one or the other (Jegtvig, 3/19).

Reuters: You’re Not Alone: Medical Conspiracies Believed By Many
About half of American adults believe in at least one medical conspiracy theory, according to new survey results. Some conspiracy theories have much more traction than others, however. For example, three times as many people believe U.S. regulators prevent people from getting natural cures as believe that a U.S. spy agency infected a large number of
African Americans with the human immunodeficiency virus (HIV). J. Eric Oliver, the study’s lead author from University of Chicago, said people may believe in conspiracy theories because they’re easier to understand than complex medical information (Seaman, 3/18).

NPR: Screening Immigrants For TB Pays Dividends In U.S.
Hundreds of people with tuberculosis wishing to come to the U.S. have been stopped before they reached U.S. borders, says a new report from the Centers for Disease Control and Prevention. Physicians overseas picked up more than 1,100 cases in prospective immigrants and refugees prior to their arrival in the U.S. The cases include 14 people with multidrug-resistant TB, the CDC says (Neel, 3/20).

NPR: Flu Drugs Saved Lives During 2009 Pandemic
Drugs used to treat the flu really did save the lives of seriously ill people during the influenza pandemic of 2009-2010, a study in The Lancet Respiratory Medicine suggests. Adults who promptly received doses of Tamiflu, Relenza or related drugs were half as likely to die in the hospital as people who were not treated. The study analyzed 78 different studies from 38 countries to reach this conclusion. … There’s been a simmering controversy, particularly in Britain, over whether the billions of dollars spent on these drugs has been worthwhile. Some independent scientists have challenged the governments’ conclusions about the value of these medicines — in particular, they question whether the drugs actually prevent flu. This latest study is about treatment, not prevention (Harris, 3/18).

MinnPost: Unnecessary Headache-Related Brain Scans Are On the Rise Study Finds
Too many people who visit their doctor for a headache end up getting unnecessary — and potentially harmful — brain scans, according to a study published online this week in JAMA Internal Medicine. The study also found that the number of these unnecessary scans has increased significantly in recent years — despite several national guidelines that specifically instruct physicians to order brain scans for patients with headaches only in rare circumstances (Perry, 3/20).


14. Viewpoints: Predictions Of Rising Premiums in 2015; Anniversary Of Health Law

The Arizona Republic: Sebelius’ Latest “Glitch”: Slow-Rising Insurance Costs
No one challenges reality like Kathleen Sebelius, who assured the world on Sept. 30, 2013 that the Affordable Care Act website would be open for business the next day. “We’re very excited about tomorrow,” Sebelius said. “Shutdown or no shutdown, we’re ready to go.” The rollout was an epic catastrophe, of course. Even now, it is difficult to find a parallel to the enormity of the belly flop it made (Doug MacEachern, 3/20).

Forbes: 4 Reasons Why Obamacare Exchange Premiums May ‘Double In Some Parts Of The Country’ In 2015
As we reach the end of the first year of enrollment in Obamacare’s subsidized health insurance exchanges, we’ve been trying to solve a couple of mysteries. First: how many people who have signed up for coverage were previously uninsured? Second: will the botched rollout and design flaws lead to even higher health insurance costs next year? We’re starting to get indications from insurers that premiums on the exchanges will go up significantly in 2015 (Avik Roy, 3/20).

The New York Times’ Room For Debate: The Health Care Law’s Checkup 
Four years ago,
President Obama signed the Affordable Care Act into law. Is the law working? What needs to be fixed? And what is beyond repair? (3/20).

The Washington Post: The GOP’s Need For Creative Policy 
Over the past several years, increases in insurance premiums have averaged nearly 6 percent. Because of the rocky launch, age distribution and delayed provisions of Obamacare exchanges, insurance company officials expect far larger premium increases this spring — in the double digits, if not the triple digits, in many places. This is an administration that learns nothing. Rather than preparing people for increased premiums, and trying to explain the additional benefits of the new system, it says, in effect: If you like your current health insurance premium, you can keep your current health insurance premium (Michael Gerson, 3/20).

New England Journal of Medicine: Vivek Murthy For Surgeon General 
On February 27, a bipartisan group of senators on the Health, Education, Labor, and Pensions (HELP) Committee approved [Vivek] Murthy’s nomination for surgeon general and forwarded it for a vote by the full Senate. But now, astonishingly, the nomination appears to be in jeopardy and may be delayed or withdrawn altogether. How could this have happened to such a distinguished and highly qualified nominee? The answer lies with the National Rifle Association (NRA). It is of great concern to us and to many other members of the health care community that Murthy’s nomination is in jeopardy because of NRA opposition. The NRA opposes Murthy solely on the grounds that he has advocated reasonable and mainstream forms of gun regulation (Gregory D. Curfman, Stephen Morrissey, Debra Malina and Jeffrey M. Drazen, 3/20).

Roll Call: Why We Are Fighting For The Birth Control Benefit
As we approach March 25, when the Supreme Court will hear oral arguments in two cases challenging the birth control benefit, Planned Parenthood Federation of America is pressing the pedal to the metal to make sure every American knows that this benefit is basic health care for women (Dana E. Singiser, 3/20).

The Washington Post: Fox News’s Bret Baier Corrects Obamacare Mistake
Fox News anchor Bret Baier screwed up on Tuesday night’s edition of his acclaimed show, “Special Report.” As part of a “checkup” series on Obamacare, Baier took a close look at those who would remain uninsured after the March 31 enrollment deadline expires. … Among those who’d be left out of the party, Baier continued, were indigent folks in Republican-led states that had opted out of the Obama administration’s Medicaid expansion. Such individuals faced a certain double jeopardy, in Baier’s formulation: “For those people, they not only face the prospect of not having health insurance coverage despite Obamacare, but now they will have to pay a penalty because of it.” Untrue. The law provides a hardship exemption for those people. No penalty. To his eternal credit, Baier cleared up the matter on last night’s program (Eric Wemple, 3/20).

The Washington Post: Dueling Maps Of Abortion Protesters, Providers Push Battle Into Personal Territory
Is it fair to post an online database of names, photos, home addresses and telephone numbers of abortion protesters? A Maryland-based group, Voice of Choice, did just that: It created an online map of more than 150 protesters across the nation who target doctors and health centers that provide legal abortions, complete with all the personal information it could find on each one. The map is nearly identical to one that opponents of abortion rights have at, which pinpoints doctors and clinics. … The truth is, none of this should be handled this way (Petula Dvorak, 3/20).

Los Angeles Times: Three Genetic Parents — For One Healthy Baby
Since January, a new California law allows for a child to have more than two legal parents. But children are still limited to two genetic parents. That could change soon, if the Food and Drug Administration approves human clinical trials for a technique known as mitochondrial replacement, which would enable a child to inherit DNA from three parents. News of the pending application has caused a kind of panic not seen since Dolly the sheep was cloned, raising the possibility of a single genetic parent. But far from being the end of the human race as we know it, the technique might be a way to prevent hundreds of mitochondrial-linked diseases, which affect about one in 5,000 people (Judith Daar and Erez Aloni, 3/21).

Los Angeles Times: We Can’t Afford Not To Spend More Money On Alzheimer’s Research
A study by researchers at Rand Corp. and other institutions calculated that the direct cost of care for people with Alzheimer’s and other dementia in 2010 was $109 billion. In comparison, healthcare costs for people with heart disease was $102 billion; for people with cancer, it was $77 billion. Yet cancer research will be allocated an estimated $5.4 billion this year in federal funds, and heart disease will get $1.2 billion — while research on Alzheimer’s and other dementias comes in at only a fraction of that, at $666 million. It’s time to substantially increase that budget (3/19).

The New York Times: TV Lowers Birthrate (Seriously) 
In the struggle to break cycles of poverty, experts have been searching for decades for ways to lower America’s astronomical birthrate among teenagers. We’ve tried virginity pledges, condoms and sex education. And, finally, we have a winner, a tool that has been remarkably effective in cutting teenage births. It’s “16 and Pregnant,” a reality show on MTV that has been a huge hit, spawning spinoffs like the “Teen Mom” franchise. These shows remind youthful viewers that babies cry and vomit, scream in the middle of the night and poop with abandon (Nicholas Kristof, 3/19).

New England Journal of Medicine: Graded Autonomy In Medical Education — Managing Things That Go Bump In The Night
Traditionally, physician training has followed the apprenticeship model: students, residents, and clinical fellows participate in delivering medical services to patients under the supervision of accredited professionals. This hierarchical system offers trainees graded responsibility, enabling them to learn their trade by performing increasingly complex functions over time and experiencing gradual reductions in supervision. Whether by design or not, the middle of the night has historically been the time when trainees were able — and indeed required — to practice more independently. … This model … was called into question by the death of Libby Zion in a New York emergency department in 1984. … studies suggest that newer resident-training approaches entailing reduced work hours and curtailed autonomy may not achieve the goal of improving the safety of patients today (Scott D. Halpern and Allan S. Detsky, 3/20).

The Oregonian: Bruce Goldberg Goes, But Oregon’s Health Care Challenges Remain
If Bruce Goldberg’s resignation as Oregon Health Authority director wasn’t inevitable before this week, it certainly became so with Thursday’s release of a damning outside review of Cover Oregon’s technology debacle. This report identified Rocky King, Bruce Goldberg and Carolyn Lawson as the three key decision-makers in the state’s ambitious project to create a customized online health insurance exchange. King, the folksy head of Cover Oregon, and Carolyn Lawson, the hard-driving IT director imported from California, both resigned months ago. Goldberg, a respected figure in Oregon health care, was next. This housecleaning is a necessary part of holding state leaders accountable for bungling the rollout of a key government initiative (3/20).

You Can Pass The CPC Exam On The First Try –

Knowing how to prepare for the CPC exam and having an effective strategy for taking the exam is just as important as your medical knowledge and coding skills. There are a number of things you can do to make sure you pass on the first try.

Make sure you understand what will be included on the exam. There are 150 multiple choice questions that are broken down into roughly fifteen sections including medical terminology, pathology, anesthesia, etc. To pass, you need to achieve 70% overall (not 70% in each section). Also, make sure you understand basic coding concepts including who develops, maintains and updates CPT, ICD-9 and HCPCS and that you have a general understanding of HIPAA, reimbursement rules, CMS guidelines and audit procedures.

Plan your time. The fact that you have five hours and forty minutes to complete the exam does not mean you set aside two minutes, fifteen seconds for each question. Some questions will take much longer while there will be others you can answer on the spot. Answering the questions you know on your first pass, then going back for the harder ones, is always a good strategy.

Prepare your manuals. The CPC exam is open book (with an approved CPT, ICD-9 and HCPCS manual). If through your studies, you have not learned how to mark up your books with important notes, guidelines, reminders or use the “bubbling and highlighting” strategy, make sure you do so. Use tabs to help you locate certain sections in your manuals. You can also mark up your answer sheet such as crossing out wrong answers and marking questions you plan to answer later.

Learn how to remain calm and focused. Here are common mistakes that happen under pressure (and what you can do about them):

Choosing the wrong answer when you know the right one. This happens a lot so always double check. And be very careful when marking the answer grid.
Not understanding the question. Read each question and scenario carefully and look for key words to help you find the proper code or answer. And be aware, for example, that a scenario that talks about a 52-year old man doesn’t always mean that age or gender will be a factor in choosing the correct code.
Leaving a question blank. Even though you’re not sure, make your best guess. You have a 25% chance of getting it right.
Getting tense and losing focus. It’s a great idea to take deep breaths on a regular basis and it’s OK to lean back in your chair and close your eyes for a few moments to recharge.
Dreading a part of the exam. It’s important to note that even though you feel that there is a section (topic) that is a weak point for you, the questions in that section may come easy.

Look up the answers (codes) first for surgery questions. At first, this may seem an odd approach but it works well for specific coding questions, Rather than reading the scenario word for word, looking up the codes first allows you to eliminate one or more of the wrong answers. Then you can go back and ascertain the right answer.

Get a good night’s sleep and eat a good, light breakfast. Cramming the night before may do more harm than good. A good breakfast is important and you can bring water, snacks or candy (cinnamon disks are great for staying alert!) to the testing location.

Passing the CPC exam on the first try is within reach if you fully prepare for the exam and know how to make the best use of your time.

You Can Pass The CPC Exam On The First Try –

Knowing how to prepare for the CPC exam and having an effective strategy for taking the exam is just as important as your medical knowledge and coding skills. There are a number of things you can do to make sure you pass on the first try.

Make sure you understand what will be included on the exam. There are 150 multiple choice questions that are broken down into roughly fifteen sections including medical terminology, pathology, anesthesia, etc. To pass, you need to achieve 70% overall (not 70% in each section). Also, make sure you understand basic coding concepts including who develops, maintains and updates CPT, ICD-9 and HCPCS and that you have a general understanding of HIPAA, reimbursement rules, CMS guidelines and audit procedures.

Plan your time. The fact that you have five hours and forty minutes to complete the exam does not mean you set aside two minutes, fifteen seconds for each question. Some questions will take much longer while there will be others you can answer on the spot. Answering the questions you know on your first pass, then going back for the harder ones, is always a good strategy.

Prepare your manuals. The CPC exam is open book (with an approved CPT, ICD-9 and HCPCS manual). If through your studies, you have not learned how to mark up your books with important notes, guidelines, reminders or use the “bubbling and highlighting” strategy, make sure you do so. Use tabs to help you locate certain sections in your manuals. You can also mark up your answer sheet such as crossing out wrong answers and marking questions you plan to answer later.

Learn how to remain calm and focused. Here are common mistakes that happen under pressure (and what you can do about them):

Choosing the wrong answer when you know the right one. This happens a lot so always double check. And be very careful when marking the answer grid.
Not understanding the question. Read each question and scenario carefully and look for key words to help you find the proper code or answer. And be aware, for example, that a scenario that talks about a 52-year old man doesn’t always mean that age or gender will be a factor in choosing the correct code.
Leaving a question blank. Even though you’re not sure, make your best guess. You have a 25% chance of getting it right.
Getting tense and losing focus. It’s a great idea to take deep breaths on a regular basis and it’s OK to lean back in your chair and close your eyes for a few moments to recharge.
Dreading a part of the exam. It’s important to note that even though you feel that there is a section (topic) that is a weak point for you, the questions in that section may come easy.

Look up the answers (codes) first for surgery questions. At first, this may seem an odd approach but it works well for specific coding questions, Rather than reading the scenario word for word, looking up the codes first allows you to eliminate one or more of the wrong answers. Then you can go back and ascertain the right answer.

Get a good night’s sleep and eat a good, light breakfast. Cramming the night before may do more harm than good. A good breakfast is important and you can bring water, snacks or candy (cinnamon disks are great for staying alert!) to the testing location.

Passing the CPC exam on the first try is within reach if you fully prepare for the exam and know how to make the best use of your time.

You Can Pass the CPC Exam on Your First Try « Be Great!

With proper information about the CPC exam as well as knowing an active method for the exam is as significant as your medical awareness and coding efficiency. There are many things what should confirm that you can clear the exam with the opening attempt.

Make sure you understand what will be included on the exam-

About one hundred and fifty multiple choice questions are arranged in fifteen categories keeping pathology, medical technology, anesthesia etc. To successfully complete the exam you are required to obtain 70 percent marks in overall exam. You should also know and have proper knowledge in fundamental coding as well as developments, preserves and upgrades CPT, ICD-9 and HCPS also you should have common understanding of HIPAA, refund methods, guidelines of CMS and audit systems.

The matter is that you will get total 5 hours as well as forty minutes to finish the exam and this is not anything like that you will have two minutes fifteen seconds consistently for every question. Because some questions may take much longer time also you will get some questions which you can answer within very short time.So to answer the question the strategy of answering the easier question first and harder one later is good one. 

The CPC exam is an open book exam (the authorized books are CPT, ICD-9 and HCPCS manual). If you do not have proper knowledge of how to highlight the important notes, guidelines, prompts or unknown about the markup then you should think about these techniques to implement. You can also mark with cross the wrong questions as well as highlight those questions which you want to answer later.

Be informed that what the ways to stay focused and active are: 

At the time of the exam examinee may make mistake so to erase these mistakes what should be done are given below:Selecting the wrong answer when you are aware of the correct answer:

These sorts of things happen more frequently so you should be very watchful at the time of highlighting the answer.Not having proper knowledge of question:

Read every question carefully and find key words with which you will get the idea of perfect answer. To select the exact answer code experience and practicing the test sheet will help you a lot.

Leaving question without answering:

When you will have question that you are not really confirm about the answer in that situation when you guess the answer you must keep at least 25 percent chance to make it correct.

Having enormous pressure and in a process losing the concentration:

Sometimes it is a very good idea to get relaxed by closing your eyes and sitting in your chair in a relaxed fashion so that you can concentrate on the exam properly and pass to get higher medical billing salary.

At the beginning it would be better idea to go through the answer codes first rather than reading the question in details. With this method you can eliminate wrong answers first and this will help you to answer correctly.

Have a proper night sleep as well as a perfect dinner and standard breakfast: 

Light breakfast and sound sleep at night is really importatnt to have a good sound health for the exam. Also keeping drinking water and some light snacks or candy in the exam location is good idea.

To successfully complete the CPC exam in the very beginning attempt you should preapre yourself completely and also keep in mind about the proper time management.

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Athletic Trainer Salary: It's Nobody's Fault, but Our Own | Athletic …

Last week Twitter was abuzz due to a job posting on the NATA Career Center. Athletic Trainers on Twitter were up in arms over the posting – a full-time, temporary position with a starting salary of $8.00/hr.

Said many ATs:
Somebody needs to call the Head Athletic Trainer! Why? In most cases the Head Athletic Trainer has absolutely no say regarding salary of his or her assistants.
Call the school!  Why? The school simply needs a body to serve as a first responder and to cover its butt in case something does go wrong.
The NATA needs to ban such postings! Why?  Is the NATA some totalitarian and tyrannical organization designed to hold the hand of its members and dictate what they can and cannot do?
What an insult! An insult, maybe to the vast majority, but not to the several athletic trainers who do apply for the job.
How could this happen? Easy, we let it happen.

Before we go further and before Athletic Trainers start throwing rocks through windows; an $8.00 / hour salary is NOT just. It is a slap in the face. However, we need to take ownership. We as a whole made this bed and now have to sleep in it. Before we attempt to fix this mess from the outside (attacking schools, administrators, political committees, supervisors, etc.), we should look from within and ask,  “To what degree are we at fault?”

Let’s look at some data. The average annual salary according to the most recent NATA Salary Survey is $48,317 (link requires member log-in). It is alarming to look at the range of salaries for different positions. There are Athletic Trainers in colleges making less than your average administrative assistant. There are comparable health care professionals (physical therapists and counselors for instance) working at colleges making twice what some athletic trainers make. Have you seen the NATA’s “Examination of the Professional Degree Level” published in December? Athletic Training salary has grown at a rate less than inflation and the gap between Athletic Training and PT, OT, and PAs has widened.

While $48,317 looks decent on paper, this data is misleading. The median is $42,500, meaning the profession is bottom heavy. You can thank the top salary earners for skewing this data. 25% of the surveyed make less than $35,000. That is right, 1-in-4 make less than $35,000 and to add to that, the average income for this lower quartile population is $26,645. When you look at the average salary per district, most of my Athletic Training friends do not make the average annual salary. In fact, I know several Athletic Trainers working 50+ hours week, no benefits, with an annual salary around $25,000 per year.

Despite the fact this job announcement is a slap in the face and despite the moaning and groaning from Athletic Trainers, this position will get applicants. Not only will there be applicants, they will likely get a lot of applicants. If the school’s administration just wants a body to CYA in case of an emergency, what type of Athletic Trainer will they get? When that Athletic Trainer is on the field disseminating information to players and coaches is that individual representing the profession in the best possible light?

Do not misread what is being said here. Athletic Trainers must pass a very tough BOC examination and Athletic Trainers have a very high level of baseline knowledge. That said there is a large variance between those with baseline knowledge and the experts in our field. One could go to the NATA annual meeting, register, drink for three days and collect 24 CEUs. In reality the only education gained was how much alcohol one could consume, while remaining a functional human being. The BOC is in constant pursuit of improving our continuing education standards and has made great strides in this area.

Can the NATA improve salaries for athletic trainers? To a certain degree I will concede that they may be able to help. The NATA is our professional organization; however you are the NATA. The NATA can provide job listings that will provide professionals with the resources to find employment. They have tried to be the gatekeeper regarding these job postings, however anyone can post a job and there are times that jobs unrelated to athletic training slip into the NATA from the service that is used. We are responsible for improving our salaries.

How should we go about doing this? We, as a profession, need to learn the power of negotiation and utilize it for higher salaries. We need to stop settling for salaries that do not match our experience, education and abilities. If we continue to settle then we are ultimately hurting ourselves and our profession. Use the Salary Survey and understand what is appropriate, but don’t settle for the average or for less than what you are worth. All Athletic Trainers should hear Linda Mazzoli speak about self-value and self-worth.

Every Athletic Trainer needs to understand his or her worth and seek to demonstrate it. Collect data to demonstrate the value you provide to the organization. This can be through treatments, decreased school absence, and a number of other factors that are important. There are resources on the NATA website, at the annual symposium and through other professionals. 

Athletic Trainers are a prideful bunch and supremely passionate about their job. Unfortunately, this passion comes at a cost. We put so much stock in our job, that it supersedes our self-worth and life in general. If you are getting paid $30,000 per year and working 60 hours you need to say no. Why should you stay until 8pm, because football doesn’t get out of lifting until 7pm?  If you have worked 50 hours Monday through Friday, why should you travel with baseball’s weekend series?  Why cover off-season practice? Why work over Thanksgiving? Either they pay you more, or they hire an assistant. You don’t have to say yes. Be courageous, be armed with facts, make a stand and earn respect, eventually, they will respect your efforts and compensate accordingly. 

Let’s do a better job of not accepting insulting salaries. Have some self-value. Educators and mentors can instill a sense of worth into young professionals. Obtaining a higher salary is not the only part of the contract negotiation. If the employer is not receptive to financial negotiation, it is incumbent on you to negotiate your time.  If they are only willing to pay you $25,000 per year, negotiate what you will and will not do. Set regular athletic training room hours. Dictate which sports you cover. Identify which weekend events you will cover and which events you will travel to. Clarify the terms, otherwise, you will be taken advantage of.

How can a company or organization offer Athletic Trainers a salary of $8.00 / hr? Because they can! They will not change for us nor do they have to. It is up to you and me to influence change. Be proactive in contact negotiation and reactive to any disrespect of your professional self-worth. Athletic Trainers are doing this to a degree, but we need a greater, collaborative effort to influence lasting change.

I’d like to send a thank you to Ryan Wantz, ATC who collaborated with me on the writing of this blog. Ryan is an assistant athletic trainer at Lehigh University and serves as the NATA District 2 representative to the Governmental Affairs Committee. 
The views shared in this post are not necessarily those of the Government Affairs Committee or the NATA, but represent our collective opinion. You can find Ryan on twitter using the handle @WantzATC. 

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