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E-News for Office Staff  July 1, 2011

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Colorado Medical Society Health Care Financing Division

PHONE: (720) 858-6321

FAX: (720) 859-7509
UHC / Pacificare name changes in the works
As of May 1 UnitedHealthcare began changing the PacifiCare brand name to UnitedHealthcare for
its Commercial business. The SecureHorizons and Evercare brands for the Medicare business will change in 2012. Some plans may still include the SecureHorizons name, but the insuring brand will be
UnitedHealthcare for all Medicare Advantage plans starting Jan. 1, 2012.

This will mean some changes to website addresses, provider manuals and ID cards. Read more here. 
Register now: July 12 webinar on mandatory compliance programs 
The Patient Protection and Affordable Care Act requires that all physicians enrolled in Medicare, Medicaid, and CHP+ have an operating compliance program, regardless of the size of the physician group. This presentation discusses how to cost-effectively implement a well-functioning compliance program for small to medium-sized physician groups.

Presented by: Jim Miles, Esq., Miles & Peters, Attorneys at Law

Tuesday, July 12, noon to 1 pm

For more information click here. To register, click here.
Medicaid no longer covering circumcision
Effective for dates of service on or after July 1, Medicaid will no longer reimburse claims for circumcision. The following CPT codes will no longer be reimbursed: 54150, 54160, and 54161. This change does not affect the CHP+ Program. Please contact Dana Batey at or at 303-866-3852 with any questions.
Medicare enrollment help 
The Medicare Learning Network has produced several fact sheets on how to enroll in the Medicare Program and maintain enrollment information using internet-based PECOS. They include:
To see a full list of available enrollment-related products, click here.
Centura joins Colorado's health info exchange

Centura Health, Colorado's largest health system, has announced its commitment to join CORHIO's health information exchange (HIE). Centura's 12 hospitals are expected to be on the HIE by September.

To learn more about the HIE, read CORHIO's most recent newsletter.  

Recent payer newsletters



PPACA preventive benefits

A provision of the Patient Protection and Affordable Care Act aimed at providing preventive care without co-pays or coinsurance seems, in many cases, to instead be causing headaches for many practices.


As explained in this recent American Medical News article,  the new rules apply to policies that took effect after Sept. 23, 2010. The article also explains some exceptions to the rules, and offers recommendations for practices to help clear up some of the confusion regarding when to collect.


Some payers, such as UnitedHealthcare and Anthem  have issued information on how they are handling the new provisions.


Medicare issued this Medical Learning Network notice. TrailBlazer also provided this information listing when co-pays and coinsurance are waived, based on CPT/HCPCS codes.

HIPAA 5010 - check your PMS
With all the focus of late on electronic health records (EHRs), it would be easy to overlook the changes to your practice management system (PMS) that may be necessary to comply with the upcoming HIPAA Version 5010 deadline.

In a recent MGMA study, more than 50 percent of respondents said the new standards would require them to upgrade their PMS. About 43 percent said their vendor planned to charge them for the upgrade -- at an average cost of $16,575 per physician.

What does this mean to you? If you have not yet begun preparing for 5010, start now by reading the AMA 5010 website and contacting your vendor.

Note that among the key changes with 5010 is that

In 5010, the billing provider must be a provider of health care services and can no longer be a billing service or clearinghouse. Also, the billing provider address must be a street address and can no longer be a PO Box or lock box. Read more in "What's Different in Version 5010."


Delay in implementation of new Medicaid provider rates

To help balance the state budget, FY 2011-12 Medicaid provider rates will be reduced effective July 1. (More details about the cuts were in the June provider bulletin).


Although the effective date is July 1, 2011, the state needs to wait for an official approval from the Centers for Medicare and Medicaid Services (CMS), to implement the change for all reductions, except for Home and Community Based Services.


Once approval is received, reimbursement for services on or after July 1 will be retroactively applied. Read more in the most recent Medicaid provider newsletter. 

Medicare reprocessing high volume of claims due to PPACA
As we reported earlier, the Centers for Medicare and Medicaid Services is recrocessing an unprecedented volume of claims, due to the passage last March of the Accountable Care Act. In some cases, these reprocessed claims have been for as little as 20 cents.

According to TrailBlazer, in the majority of cases, providers will not have to request adjustments because the Medicare claims administration contractors will automatically reprocess claims.

TrailBlazer has posted this notice and a Q&A with more information. 

Medicare annual wellness visits

(From the Centers for Medicare and Medicaid Services)


The new publication titled "Annual Wellness Visit" is now available in downloadable format from the Medicare Learning Network® by clicking here. 


This brochure is designed to provide education on the Annual Wellness Visit and providing Personalized Prevention Plan Services, at no cost to the beneficiary, so beneficiaries can work with their physicians to develop and update their personalized prevention plan.

Work comp outreach seminars
The Colorado Division of Workers Compensation has scheduled a series of regional outreach seminars. Events are scheduled for July 15 in Greeley, Aug. 12 in Pueblo and Sept. 29 and 30 in Grand Junction. Topics vary by seminar but include:
  • Health Care Documentation: What is Necessary and What Can It Do For You?
  • Undocumented Workers: What Workers Comp rights do they  have?
  • Updates to the fee schedule
  • Coverage enforcement 

For more information and to register, click here.

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