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E-News for Office Staff  May 1, 2011

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Colorado Medical Society Health Care Financing Division

PHONE: (720) 858-6321

FAX: (720) 859-7509
Online directory helps ensure practice mgmt system 5010 compliance

With all of the talk about EHRs don't forget to consider what your practice management system needs to do for you. HIPAA Version 5010 & ICD-10 are coming, and your PMS software must be compliant with the 5010 standard.


AMA and CMGMA have made the software selection process easier by developing an online directory of vendors that helps physicians determine whether the vendors' systems are compliant with the 5010 standard (which will be required by Jan. 1, 2012).


A companion piece to the recently released Selecting a Practice Management System toolkit, the Practice Management System Software Directory provides detailed vendor profiles, enabling physicians to easily choose the software that best fits their needs. Click here to learn more and to access the directory.

FAIR Health to provide average procedure costs
Beginning this summer, patients will be able to look up average physician charges for procedures by zip codes.

A recent legal settlement between health plans and the state of New York stipulated that an independent, not-for-profit organization be formed to create a database, utilizing a fair and open methodology for collecting and analyzing health care provider charges nationwide.

This organization, now known as FAIR Health, will make data available to the public via a free website, allowing consumers to research charges for medical and dental services in advance of making the decision to go in- or out-of-network.

Learn more about FAIR Health by clicking here.
New contracting tips
(From Todd Welter, RT Welter & Associates Inc.)

A quick note about the latest managed care contracting "tricks":
  • It seems some commercial payers have come up with a plan to take advantage of the mid-year change to the 2010 Medicare Fee Schedule! If a payer switches their RBRVS base year to 2010, ask: "Which one?" The initial 2010 base year was 21 percent lower than the second 2010 base year!
  • The commercial payers are looking to drop the consultation codes, like Medicare did. If they do, the value for the consult codes (20 to 30 percent more than even a new patient code of the same level) must be factored into the new rate in order to stay even. Don't let them give you a huge hidden discount!   
New Medicare fact sheets

The Medicare Learning Network (MLN) has released several new fact sheets, most of which are available online:


 Signature Requirements:  

This fact sheet is designed to provide education on Signature Requirements to healthcare providers, and includes information on the documentation needed to support a claim submitted to Medicare for medical services.


Inpatient Rehabilitation Services 

This fact sheet is designed to provide education on Inpatient Rehabilitation Services to healthcare providers, and includes information on the documentation needed to support a claim submitted to Medicare for inpatient rehabilitation services.

2009 PQRS, eRx results

The Centers for Medicare and Medicaid Services has released results of the 2009 Physician Quality Reporting System and electronic prescribing incentive programs.


A summary of the report, available here, also includes information on how to participate and what you need to do to avoid penalties in coming years for not participating.

EHR Selection Summit
Selecting an electronic health record (EHR) can seem like a daunting process because of the vast array of products available. To help physicians across Colorado gain practical information about certified EHR technologies, CORHIO and the Colorado Regional Extension Center (CO-REC) are hosting an EHR Selection Summit May 20-21.

The Summit will provide physicians with the ability to participate in EHR demonstrations using clinical scenarios, such as complex patients with multiple chronic conditions, new patients and patients requiring proactive care management. The demonstrations aim to better equip clinicians to assess EHR products as they consider the option of working with a vendor.


There will be 12 products demonstrated by 11 EHR vendors at the Summit. All are CORHIO/CO-REC approved integration EHR Vendors that have gone through a rigorous evaluation process.

The Summit will be held at the Denver Marriott West in Golden. There is a registration fee of $40 per practice for up to 4 attendees and $15 for each additional attendee. There is a special discount available for solo practitioners of $20. The Denver Marriot West is offering significantly reduced room rates at $89/night for Summit attendees. Hotel reservations must be made before April 28th.


For more information and to register, click here

Start thinking now about ICD-10 
The healthcare industry will be required to use the ICD-10 code set beginning on Oct. 1, 2013. That may seem like a long way off, but it's important for practices to begin thinking about and preparing for this major shift now.

AMA has compiled multiple resources on its ICD-10 website. These include an ICD-10 timeline, which will take you through the various steps you will need to take to meet the compliance deadline, as well an ICD-10 checklist and information on the differences between ICD-9 and ICD-10. Access the website here.

The American Health Information Management Association (AHIMA) has recorded a free, on-demand webinar, titled "From Point A to ICD: Successfully Implementing ICD-10." It is available here.

Also, the Centers for Medicare and Medicaid Services will host a free provider call to discuss the conversion process currently taking place within CMS. The call is scheduled for May 18, from 11 a.m. to 12:30 p.m. Mountain (Colorado) time.

The agenda will include:

  • ICD-10 overview
  • Lab national coverage determination (NCD) conversion process from ICD-9-CM to 1CD-10-CM
  • Home health conversion
  • OASIS and procedure code reporting
  • Update on claims spanning the implementation data
  • National ICD-10 implementation issue
  • A Q&A session


For more information and to register, click here.
Medicare Shared Savings info

The Centers for Medicare and Medicaid Services has released proposed rules for the Medicare Shared Savings Program, also known as Medicare accountable care organizations (ACOs).  This program is scheduled to begin on Jan. 1, 2012, and CMS is accepting public comment on the proposed rule through June 6. The Medicare Learning Network® has released three new fact sheets related to this program:


"Summary of Proposed Rule Provisions for Accountable Care Organizations Under the Medicare Shared Savings Program" provides an overview of the proposed rule.  To access the fact sheet, click here.


"What Providers Need to Know: Accountable Care Organizations" provides information important to Medicare fee-for-service providers who may participate in the program.  To access the fact sheet, click here. 


"Federal Agencies Address Legal Issues Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program" provides information about CMS's coordination with the Office of Inspector General, the Federal Trade Commission, and Department of Justice, and the Internal Revenue Service regarding issues related to the Shared Savings Program. To access the fact sheet, click here.


AMA Tip: Save money with EFT

Want to save thousands of dollars per physician annually? Accepting electronic funds transfer (EFT) payments from health insurers and automating your payment process can help you experience significant savings and:

  • Speed up payment
  • Save time spent on manual processes such as depositing paper checks and making phone calls to health insurers
  • Reduce the risk of lost or stolen checks
  • Free time for revenue-enhancing functions such as ensuring correct payment

The AMA's new EFT Toolkit helps make the process of accepting EFT payments hassle-free. The toolkit outlines the steps to getting started, specific considerations for physician practices, and checklists of questions to ask your bank, health insurers, and your billing service or clearinghouse before signing an EFT agreement.  


The toolkit also provides an archived webinar with industry experts. Visit to access these free resources and start experiencing the savings in your practice.  

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About Us
The Colorado Medical Society is the largest organization of physicians in the state of Colorado. This newsletter is published by the CMS Health Care Financing Division, which works with physicians, practice managers and other office staff to help practices remain viable and thrive. If you have questions about practice viability, please visit our website or email