The Centers for Medicare & Medicaid Services (CMS) released a final rule in February requiring the reporting of payments made to physicians or teaching hospitals by applicable manufacturers of drugs, devices, biological, or medical supplies. The increased transparency reduces the potential for conflict of interest.
Bottom line? Beginning this summer, your peers and patients can easily learn if your providers accept gifts or payments from a drug or device manufacturer. Although such relationships are not assumed to be improper, they may raise questions regarding a provider’s independence or objective judgment.
The “Medicare, Medicaid, Children’s Health Insurance Programs; Transparency Reports and Reporting of Physician Ownership or Investment Interests,” more commonly known as the Physician Sunshine Act, requires manufacturers and group purchasing organizations (GPOs) to report any ownership or investment relationships between the manufacture or GPO and physicians or physicians’ immediate family members.
Applicable manufacturers and applicable group purchasing organizations must begin to collect the required data on August 1, 2013 and report the data to CMS by March 31, 2014.
The new rule, a requirement of section 6002 of the Affordable Care Act, was delayed for more than a year while various interest groups weighed in. As a result of those comments, CMS has exempted payments or other transfers of value provided as compensation for speaking at a manufacturer’s or GPO’s continuing education event, if certain conditions are met. The final rule has met with measured praise, and AMA President Jeremy Lazarus, MD said, “Physicians’ relationships with the pharmaceutical industry should be transparent and focused on benefits to patients.”
February 26th, 2013
By John S. Aaron, Jr., CPC
When submitting claims involving unlisted services or procedures, you may experience claim denials routinely, even when special reports are included. Very often, you can avoid these denials by knowing your payers’ specific requirements. For example, some payers have forms specifically for review of special reports when unlisted services or procedures have been rendered. This helps the payer to direct the claim properly.
You may receive an ambiguous denial, even when the payer requires very specific information. For example, your denial may state, “medical records needed.” You send the office notes associated with the visit, only to have the claim denied again because it was actually an X-ray report that was needed. Don’t get caught in that confusion: Ask the payer to explain exactly what’s needed.
Regardless of what your payer’s requirements are, follow them “to the letter” to make sure your provider is appropriately reimbursed—or at least to establish that the service/procedure has become an industry standard (more on this, later).
Know Necessary Requirements
Rendered services commonly require a special report because the CPT® and HCPCS Level II code sets do not specifically describe what was done. When submitting reports, consider highlighting or underlining the section that most identifies the procedure related with the unlisted code.
For example, Table A is a sample laboratory requisition in which the ordering physician has requested a prothombin time with international normalized ratio (PT/w INR) as a STAT. This will justify the use of CPT® 99199 Unlisted special service, procedure or report.
Table A: Laboratory Requisition
By highlighting this information and including it with your UB-04/CMS-1500, the payer is able to validate your reimbursement request. Consider also the category upon which the documentation requirements may fall, as shown in Table B.
Table B: Documentation Required for Codes
Make a Payment Suggestion
Because unlisted procedure or service codes are not assigned specific relative value units (RVUs), payers do not have a “standard” rate at which to reimburse them. Be sure to request a specific reimbursement amount, or you may be subject to accept what the insurance company has decided to pay. To justify your charges, include with your special report a comparison between the provided procedure or service and the “next closest” CPT® or HCPCS Level II code. Include relevant details such as:
- Was the claimed unlisted procedure more or less difficult than the identified comparison procedure?
- Did it take longer to complete (and if so, by how much)?
- Was there a greater risk of complication?
- How does post-operative care compare?
- If you’re providing durable medical equipment (DME) or drugs, what is the supply cost?
Such details can make a difference in the reimbursement you receive.
Special Services and Adjunct Codes
Health care providers may also need a way to report services above and beyond the basic services rendered. CPT® codes 99000-99091 fulfill this need. For example, I work under POS 81 Independent laboratory, where providers order specific tests under a STAT request. In addition to CPT® 99199 (found in the Medicine section under “Other Services and Procedures”) for the STAT, the claim will also include 99000 Handling and/or conveyance of specimen for transfer from the physician’s office to a laboratory for the pickup and transportation of the specimen.
Modifiers to Consider
As noted in the chart above, there are unlisted coding possibilities for DME and drug-related items. For orthotics and prosthetics, consider including modifier NU New equipment for any new DME not commonly billed (e.g., E0988 Manual wheelchair accessory, lever-activated, wheel drive, pair). This will help the payer when reviewing the documentation you included for reimbursement considerations.
Check with the payer before submission to see if they have dedicated forms for these claim types. This ensures the information will be routed to the personnel qualified to perform a review of your documentation.
Category III vs. Unlisted Procedure Codes
As you know, unlisted procedure codes in the CPT® codebook often end in 99 (e.g., 15999 Unlisted procedure, excision pressure ulcer) and appear last in a list of similar and/or anatomically related procedures (usually under the heading “Other Procedures”). But not all medical services absent a specific CPT® code should be assigned an unlisted procedure code.
If an unlisted procedure code has been submitted, the payer may deny your claim citing that a more appropriate service code is available. These codes may come from CPT® Category III, and are distinguished by a “T” suffix (e.g., 0221T Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone graft(s) or synthetic device(s), single level; lumbar). The “T” signifies the clinical efficiency and outcome of such emerging technologies has been considered temporarily.
When appropriate, report Category III codes (rather than an unlisted procedure code), not with the objective of reimbursement, but instead to further the cause of regular code assignment, and to aid in data collection and utilization reporting. This helps to prevent the temporary code from falling victim to the five-year sunset period. Consistent, appropriate reporting of Category III codes is key in the CPT® Editorial Panel’s consideration for permanent codes.
The Health Insurance Portability and Accountability Act (HIPAA) Version 5010 implementation guide advises that any procedure performed with “unlisted” included in the descriptor must include a corresponding description of the services rendered. With HIPAA 5010 formatting now in effect, check with your electronic health record (EHR) billing vendor to see if there is a way to upload this information upon claims submission. The objective is to remain HIPAA compliant and give payers no reason to deny your claims, or to request even more documentation. Although medical records are requested routinely, some payers will not accept amended information after a certain time. Keep this in mind and provide proper documentation the first time around.
John S. Aaron Jr., CPC, is a senior client billing representative for the Chicago Business Unit of Quest Diagnostics. He is president-elect for the Northbrook, Ill. local chapter and a member of Medical Billing Advocates of America, specializing in the area of patient advocacy.
December 1st, 2012
By Marcia Brauchler, MPH, CPC, CPC-H, CPC-I, CPHQ
The new year is nearly here. Time to get a fresh start on your payer contracts. Gather your year-end data and prepare yourself to approach payers for new agreements or rate updates.
Start with a High-level Perspective
After you’ve gathered the contracts and information from payer websites or their toll-free numbers (see Part 1, “Contracts: Start by Gathering Data,” October 2012, pages 34-36), summarize the information at a high level. I recommend a summary format similar to the one shown in Table 1.
In this example, the payer, Alpha, is contracted with the practice through an independent practice association (IPA). The fees are 130 percent of a fixed base year of 2007 Medicare resource-based relative value system (RBRVS). The contract has been effective since Jan. 1, 2008, and this payer represents 17 percent of the practice’s revenue.
You should gather similar information for each payer with whom you are contracted.
Next, Analyze Reimbursement Details
Using this high-level summary, you can easily determine the base years of Medicare RBRVS you’ll need to know to analyze current fees versus upcoming payer proposals.
The base years for this practice would be 2005 (non-Geographic Price Cost Indexed), 2007 (GPCI), 2012 (GPCI) Medicare RBRVS, and the 2011 state workers’ compensation fee schedule. The Medicare fee schedules are available on the Centers for Medicare & Medicaid Services (CMS) website (www.cms.gov/Medicare/Medicare-Fee-for-
With this data, complete a spreadsheet, which you can call the “Payer Resource Manual,” and use the base year allowable and the current contracted payer amounts for our hypothetical practice, as shown in Table 2.
Each payer will likely address lab, X-ray, and supply codes differently. If no RBRVS payment exists, you could contact each payer for your contracted allowed amounts or pull explanation of benefits (EOBs) to find the paid amount. If the practice is heavily dependent on revenue from HCPCS Level II codes (such as durable medical equipment (DME), supplies, or injectables), it’s worth gathering the invoices to know the acquisition costs.
Verify predicted payment on your Payer Resource Manual by code, and validate it against payer EOBs to confirm your spreadsheet is accurate. The confidence that comes with knowing as much as the payer does about your current contracted rates is the best way to start. In other words, don’t trust what an old, filed contract says your rates are: Verify the amounts against current payments.
Learn by Example
Here’s an example of how getting organized before you approach the payers pays off. Knowing what 100 percent of the RBRVS is for codes that matter to the practice gives you a powerful position to counter payer fee schedule “updates.”
In this client example, a radiation oncology practice was approached by a payer that represented a significant portion of the practice’s revenue. The payer wanted to update the contracted rates from a 2005 agreement, and proposed 2010 Medicare rates. A quick glance at the difference between 2005 and 2010 base year Medicare allowables for codes that were important to the practice enabled us to determine that 2005 was a much better paying base year (compared to 2010). Table 3 shows how the update would impact several codes commonly reported by the practice.
Learn from History: It’s the Best Predictor
You should know the most current period’s utilization data for each payer by CPT® code. In the above client example, we used the practice’s billing software to pull the past year’s utilization of procedure codes for the payer in question. With the frequency count for each of these codes, the current payer’s allowed amount, and the most current year (at the time) of Medicare, we could see how the payer’s attempt to “update” the practice using a more recent year’s Medicare fee schedule would cost the practice a lot of money: an average 15 percent reduction. Using actual utilization, based on historical data from the practice (which is the best predictor of future utilization), the weighted impact averaged out to a 22 percent loss (because some high-volume codes had large decreases under the proposed rate).
Such a comparison isn’t easy to set up in a spreadsheet, but having the data allows you to go back and forth as many times as necessary to convince the payer not to subject the practice to such a loss after being a loyal network provider for so many years. Using this method, we were able to correct what would have been a $33,000 loss to the practice and turn it into a $4,000+ annual gain. This $37,000 swing was well worth the time and effort to pull the data—and that was just one payer agreement!
Be Prepared for the Long Haul
When you have your current rates and past utilization defined, you’re almost ready to approach the payers and begin the contracting process. Negotiations are an endurance test with many important steps. If you start naively, with no idea of the scope of the critical tasks and phases of the process, you’re bound to burn out and give up. And any corners you cut in preparing will raise time-consuming issues later.
In the next installment of our contracts series, we will identify your practice’s counterparts at your payers’ and learn how to create an “alpha payer contact list” for your practice.
Marcia Brauchler, MPH, CPC, CPC-H, CPC-I, CPHQ, is the founder and president of Physicians’ Ally, Inc., a health care consulting firm and concierge billing company for specialty physician practices. She works with physicians on managed care contracts, reimbursement, and practice administration. Her experience includes hospital, health plan, and independent practice association administration. Her firm sells updated HIPAA policies and procedures and online staff training. She is a published researcher and a frequent public speaker.
By Mary A. Inman, JD, and Timothy P. McCormack, JD
As Medicare-managed care health plans (Medicare Advantage (MA) plans) expand—especially in the past five years—providers are more regularly affected by “risk adjustment.” When done properly, the risk adjustment model has great potential to enhance the quality of patient care. Unfortunately, risk adjustment is also susceptible to fraud by the proverbial “bad apple.”
Risk Adjustment Basics
Risk adjustment is a modified version of the traditional capitation system. Under traditional capitation, a managed care organization or provider group is paid a fixed amount per member per month (PMPM) to pay for all services the member requires during that period. Traditional capitation sets the PMPM rate based on demographic factors such as the member’s age, gender, and geographic location.
Risk adjustment enhances traditional capitation by adding payments for patients who are being actively treated for certain diseases and conditions known to be expensive to treat. Risk adjustment classifies patient sickness using hierarchical condition categories (HCCs), which are groups of related diagnosis codes. HCCs are similar to diagnosis-related groups (DRGs) or ambulatory payment classifications (APCs) used for hospital reimbursement, but they are based on diagnosis codes rather than procedure codes. Individual patients may fall into multiple HCCs. For each additional HCC, the MA plan is paid an extra amount.
Unlike traditional managed care, where there is a strong financial incentive to seek out only healthy members, the risk adjustment model rewards managed care organizations and provider groups to care for sick members, as well. They can see a significant financial reward if they actively manage those sick members to reduce health care costs.
Risk Adjustment Fraud: “Upcoding” DxCodes
The current design of the risk adjustment system largely relies on MA plans to police themselves. MA plans are responsible for determining which diagnosis codes its members were treated for in the prior year, using a combination of traditional claims data and other medical documentation (such as the patients’ medical charts). The plan then submits the diagnosis codes to the Centers for Medicare & Medicaid Services (CMS) to get the increased risk adjustment capitation payments.
Unethical MA plans and vendors take advantage of the system’s structure to essentially “upcode” the diagnoses they submit to CMS. They do this by submitting a risk adjustment claim to CMS for a diagnosis the member either did not have or was not treated for in the year in question. In such cases, “risk adjustment” may be offered as an explanation for why patient medical records should be changed or “supplemented” (sometimes a year or more after the patient was treated). Or the MA plan, or its vendor, may suggest that a provider call a patient in for an office visit so certain diagnosis codes can be “captured” for “risk adjustment purposes” (regardless of whether the patient actually needed any medical treatment).
CMS rules are clear that a risk adjustment claim may be submitted only if the diagnosis meets ICD-9-CM standards and there is documentation in the medical record that the member was treated face-to-face by a qualified provider in the year questioned.
Common schemes used to upcode diagnoses for risk adjustment purposes include the following:
Coding from Problem Lists: CMS rules explicitly state that a “problem list” may be used only to code a diagnosis if it is “comprehensive and show[s] evaluation and treatment for each condition that relates to an ICD-9-CM code on the date of service.” It is improper to submit risk adjustment claims for diagnoses that are merely mentioned in the member’s problem list if the diagnoses were not treated or considered by the provider during that visit.
Improper Linkages: The risk adjustment system pays MA plans a higher capitation rate when certain conditions are “linked.” For example, a patient may have both diabetes and nephropathy. CMS will pay the MA plan more if the diabetes caused the nephropathy because diabetes with renal complications is generally significantly more severe than diabetes without complications. Diabetes without complications, which falls within HCC 19, has an average value of $1,500 per year. In contrast, diabetes with renal manifestations, which falls within HCC 15, is valued at over $4,500 per year.
For an MA plan to submit a linked diagnosis code to CMS, the provider must document the linkage between the two conditions in the medical record. It is improper for an MA plan or vendor to assume the two conditions are linked.
Coding from Test Results or Prescriptions: CMS prohibits the submission of risk adjustment claims based solely on laboratory or radiology test results, drug prescriptions associated with particular diagnoses, or durable medical equipment (DME) services. Nonetheless, certain MA plans and vendors include diagnosis codes in their risk adjustment submissions even though they appear only on those invalid sources of documentation.
Chronic Conditions: While it is true that some conditions (such as Parkinson’s) never go away, this does not mean that the diagnoses can be submitted to CMS every year. Risk adjustment rules explain that a condition may only be submitted for reimbursement if it is actively treated (or affects other treatment) in the year in question. It is not enough that the patient was diagnosed or treated for the condition at some point in the past.
Targeted Coding: Some organizations pressure coders to focus on identifying high-value diagnoses, rather than coding just what is in the medical record. Some common high-value targets include:
- Cachexia/Malnutrition (HCC 21) – value of $7,800 per year
- Old myocardial infarction (MI) (HCC 83) – $2,200 per year
- Diabetes with complications (HCC 15) – $4,600 per year
- Major depression (HCC 55) – $3,200 per year
Know the Red Flags
If a coder involved in chart reviews or an audit related to risk adjustment sees any of these activities, there is a strong likelihood the coder is dealing with fraud. If someone tells a coder to use a diagnosis code that doesn’t meet ICD-9-CM standards and says it is OK because “risk adjustment coding is different than regular coding,” that is a major red flag indicating the health plan or vendor is engaged in fraud.
At its core, risk adjustment coding is “regular coding,” but stricter. Even where a diagnosis meets traditional ICD-9-CM standards, it may not be submitted for risk adjustment purposes unless the diagnosis is: (1) documented by the provider in the medical record as having been treated or as affecting the patient’s treatment; (2) made during a face-to-face encounter; (3) submitted to the MA plan from a qualified provider type; and (4) made during the specified calendar year.
Risk Adjustment Fraud and the False Claims Act
At a May 31, 2012 MA compliance conference, federal prosecutor Robert Trusiak noted that MA fraud—in particular risk adjustment fraud—is a “hot button issue” for the Department of Justice (DOJ). Trusiak further noted that MA plans face potential liability under the federal False Claims Act (FCA) for false risk adjustment claims, even when the upcoding or other fraud was perpetrated by a vendor on the plan’s behalf.
The FCA says any person who submits a false or fraudulent claim to the United States or causes someone else to submit a false or fraudulent claim may be liable for three times the amount of the false claim, plus an additional penalty of up to $11,000 for each false claim. To encourage whistleblowers to report fraud, the FCA contains a qui tam provision awarding whistleblowers 15-30 percent of what the government recovers as a result of whistleblower lawsuits they file against individuals and entities committing fraud.
The government has already begun enforcement against unscrupulous MA plans attempting to game the risk adjustment system. In United States v. Janke, the government sued an MA plan under the FCA for submitting upcoded (or non-existent) diagnosis codes for risk adjustment payments. The DOJ settled with the MA plan and its owners for $22.6 million in November 2010.
Be Cautious and Speak Up
As Trusiak cautions, the FCA targets not only the person or organization submitting a false claim, but also anyone who “causes the submission” of a false claim. This means that MA plans are not the only ones who face potential liability under the FCA for false or fraudulent risk adjustment claims. Hospitals or physician groups could be liable, as well, if they submit false information about their MA patients’ diagnoses to MA plans and that false information is used to submit a false risk-adjustment claim to CMS.
To avoid this risk, you should ask to review rules used by vendors when those vendors are identifying “new” diagnoses. Don’t hesitate to speak up if the standards being used by an outside reviewer don’t line up with the established CMS coding rules your organizations are using. Providers should insist on reviewing any code submissions made for their patients—especially when an MA plan or vendor has reviewed the providers’ medical record and identified new diagnoses—to ensure the patient actually had that particular diagnosis and was treated for it during the visit. Coders, administrators, and providers can all take steps to prevent or stop risk-adjustment fraud.
Mary A. Inman, JD, and Timothy P. McCormack, JD, are partners at Phillips & Cohen LLP, a law firm representing whistleblowers (www.phillipsandcohen.com). Whistleblower cases brought by the firm involving Medicare and Medicaid fraud, and other types of fraud against the government, have returned more than $8.5 billion in civil settlements and related criminal fines to federal, state, and local governments.
October 1st, 2012
By Susan M. Edwards, CPC, CEDC
Correct coding and billing for durable medical equipment (DME) raises many questions, such as:
- What constitutes DME?
- Besides the order and physician signature, what other information do I need to submit a claim?
- Are there modifiers?
To shed some light on ambiguous areas, we’ll answer these questions and more.
What Is DME?
Per Centers for Medicare & Medicaid Services (CMS) guidelines, DME is “medically necessary durable medical equipment, prosthetics, orthotics, and disposable medical supplies (DMEPOS), which includes oxygen and related supplies, parenteral and enteral nutrition, and medical foods.”
DME is also medical equipment that:
- Can withstand repeated use
- Is primarily and customarily used to serve a medical purpose
- Is generally not useful to a person in the absence of illness or injury
- Is appropriate for use in the home
- May include a rigid or semi-rigid device
- May be designed to support weak or deformed body part by eliminating motion
- May be used to immobilize a part to decrease pain and inflammation
- May be rented or purchased
What Do I Submit with Claims?
Providers must submit DME claims in accordance with Healthcare Common Procedural Coding System (HCPCS) Level II coding guidelines and national and local coverage determinations (NCDs and LCDs). Providers may only bill for the actual number of medical necessary units dispensed or delivered to a patient, regardless of the number of units allowed by policy and/or prior authorization.
Orders are required for any DME equipment to be covered under Medicare. To bill Medicare for DME, the ordering physician must be a Medicare enrolled physician.
Requirements on the orders include:
- Dispensing order
- Description of item
- Name of beneficiary
- Name of ordering physician and signature
- Date of order
- Quantity delivered
- Item brand name and serial number (if not custom)
Documentation should include detailed descriptions of the item, as well as any accessories and upgrades that will be used. Written orders for custom fabrications must specifically state “custom fabrication,” or the brand name being used. Custom fabrication involves more than trimming, bending, or making other modifications to a substantially prefabricated item. Prefabricated items are factory processed without a patient in mind, but may be altered to fit the patient.
Products and services must be medically necessary, safe, and appropriate for the course and severity of the condition using the least costly and equally effective alternative to meet the recipient’s needs. For all DME items, refer to your state’s Medicare policy.
To support medical necessity, include chart notes, surgery notes, and all supporting documentation for the product. You will need to verify that:
- The patient is eligible and meets the coverage criteria.
- Ask the patient about the items being dispensed. For example, “Have you had a wheelchair before?” or, “Do you receive any diabetic supplies from anyone else right now?”
- There is a supporting diagnosis.
- The beneficiary has signed and dated the forms.
- The physician has signed and dated the forms.
- The physician has provided his or her National Provider Identifier (NPI) number.
Note that some DME services or items will require prior authorization. It is critical to submit complete and accurate clinical documentation on prior authorization requests.
When a claim is received, Medicare will determine if the ordering/referring provider is required for the billed service. If the provider is not on the claim, Medicare will not pay. If the ordering/referring provider is on the claim, Medicare will verify that the ordering/referring provider is in Medicare Provider Enrollment, Chain, and Ownership System (PECOS) and eligible to order and refer.
Modifiers are frequently used on DME claims. The most common include (Note: These are not the full descriptions.):
RT/LT – Right/left
NU – New equipment
GY – Non-covered item
KX – Required for knee and ankle-foot orthoses
RR – Rental
UE – Purchase of used equipment
CG – May or may not have a specific LCD in place
GA – Does not meet medical necessity and ABN signed
GZ – Does not meet medical necessity and ABN not signed
GY – Item statutorily not covered
RA – Replacement of DME, orthotic, or prosthetic item
EY – No physician order
Use a Form to Be Sure You’ve Got All Relevant Information
Perhaps the best way to ensure you’ve documented all the necessary information is to use a specialized DME intake form. You can find a sample DME Intake Form at Noridian Administrative Services (NAS): www.noridianmedicare.com/dme/forms/docs/intake_form.pdf.
Any person in the office can use the form to ensure all the right questions are asked.
Lastly, remember to always check your DME Medicare administrative contractor (MAC) websites often for LCD revisions. Educating your physicians of documentation requirements and coverage guidelines will help you as the coder/biller make submitting claims for DME an easier process.
Ask the Patient to Sign an ABN if Coverage Is in Doubt
When ordering DME, determine whether you should ask the patient to sign an Advanced Beneficiary Notice (ABN). The ABN is a standard form to inform a patient that Medicare may deny coverage for a recommended or desired item or service. It explains why Medicare may deny the item or service, provides a cost estimate for the item or service, and notifies the patient of his or her responsibility to pay for the non-covered item or service if he or she chooses to receive it. In many cases, a provider cannot seek payment from the patient for unpaid Medicare services if he or she did not properly issue an ABN.
The ABN must be verbally reviewed with the beneficiary or his or her representative and any questions raised during that review must be answered before the patient signs and dates the ABN. CMS requires the provider present the ABN “far enough in advance that the beneficiary or representative has time to consider the options and make an informed choice.” A copy of the completed, signed form must be given to the beneficiary or representative, and the provider must retain the original notice on file for seven years.
When filing your claim, apply modifier GA Waiver of liability statement issued as required by payer policy, individual case on file when the provider believes the service is not covered and the office has a signed ABN on file.
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 applies when Medicare excludes the item or service from coverage. When you report modifier GY, Medicare will generate a denial notice that the beneficiary may use to seek payment from secondary insurance, for instance.
If the provider fails to issue an ABN for a potentially uncovered service, append modifier GZ Item or service expected to be denied as not reasonable and necessary to the claim. This indicates the provider cannot hold the patient financially responsible if Medicare denies the service, but will reduce the risk of fraud or abuse allegations for claims deemed “not medically necessary.”
The ABN CMS-R-131 form and instructions may be downloaded from the CMS website: www.cms.gov/BNI/02_ABN.asp.
Susan Edwards, CPC, CEDC, is a coding specialist at Copley Hospital in Morrisville, Vt. She is the president of the Newport, Vt. chapter, and she teaches Medical Terminology at the local adult learning center. Ms. Edwards is Northeast region one representative for AAPCCA, and secretary on the Board of Directors. She is also on the AAPC Ethics Committee.
July 1st, 2012