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E-News for Office Staff  September 1, 2011

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Colorado Medical Society Health Care Financing Division

PHONE: (720) 858-6321

FAX: (720) 859-7509
HIPAA Version 5010:
The clock is ticking!

There are just 121 days until the HIPAA 5010 compliance date. Have you completed your testing yet?

All covered entities should conduct internal and external transaction testing within their organizations and with their billing partners - including payers, clearinghouses, providers and vendors - before the Jan. 1, 2012 compliance deadline.
Don't wait! A backlog in testing could result in practices having to file paper claims and delays in payments. For more information, see the Centers for Medicare and Medicaid Services' 5010 web page
CMGMA Fall Conference
Registration is open for the Colorado Medical Group Management Association will hold its fall conference: 

Mining for Knowledge


Sept. 22-23


Beaver Run Resort and Conference Center in Breckenridge


Presentations will include Kaiser Permanente's Approach to the Patient Centered Medical Home and Accountable Care Organizations, Washington Update, a payer panel discussion, and more.


For more information and to register, visit

the CMGMA website.

CIGNA eliminating paper EOPs 

(From AMA Practice Management Alerts)


Starting Sept. 2, 2011, CIGNA will no longer mail paper copies of Direct Deposit Activity Reports (DDARs) or Checkless Explanations of Payment (EOPs) to health care professionals who receive a payment via electronic funds transfer (EFT). 


Physicians not enrolled in EFT will continue to receive paper EOPs and checks via U.S. mail.


More information 

is available here.

CORHIO e-newsletter

The CORHIO electronic newsletter has valuable information for both primary care and specialist practices. The latest edition includes:  

  • Resources on HIPAA Privacy & Security
  • An update on the Medicaid Meaningful Use Incentive Program
  • And more!
Access it here.


Reminder: Use new ABN forms, instructions

Effective Nov. 1, the Centers for Medicare and Medicaid Services will require use of the revised Advanced Beneficiary Notice of Noncoverage (ABN) form. 


More information is available on CMS'   Revised ABN web page. 


For a quick download of the new form, click here. For instructions,

click here.

2012 eRx final rule offers more flexibility on exemptions 
The Centers for Medicare and Medicaid Services recently issued the final rule on its 2012 electronic prescribing (eRx) program. Among other changes, the final rule provides additional significant hardship exemptions. 

To avoid the 1 percent penalty for not successfully participating in the program in 2012, an eligible professional or group may demonstrate that the group or practice:
  • Is located in a rural area without high-speed internet access.
  • Is located in an area without sufficient pharmacies with eRx capabilities.
  • Is registered to participate in the Medicare or Medicaid electronic health record (EHR) incentive program, and has adopted certified EHR technology by Oct. 1, 2011.
  • Is unable to electronically prescribe due to local, state or federal law. (CMS clarified that physicians who mainly prescribe narcotics but due to certain limitations cannot submit these prescriptions electronically can apply for this exemption category). 
  • Has limited prescribing activity.
  • Insufficient opportunities to report the eRx measure due to limitations of the measure's denominator. (Physicians who do not e-prescribe on the service date, for example surgeons who only prescribe during the post-operative period, can apply for this exemption).
Physicians must apply for a hardship through a web-based tool no later than Nov. 1, 2011, but are encouraged to apply as soon as the web-based portal is available. They may apply for more than one exemption category if multiple categories apply.

More information is available here.
What the FAIR Health database means to physician practices  


Starting Aug. 1, 2011, a new public online database allows patients to make more informed decisions - and ask more pointed questions - about the costs of their medical care. 


The recent UnitedHealth Group UCR settlement established an independent, not-for-profit organization called FAIR Health  to create a database that uses a fair and open methodology for collecting and analyzing medical charges nationwide. 


Patients will be able to easily look up the average charge for specific medical services and procedures for their locality. 


The AMA has recorded an hour-long webinar hosted by Nancy Nielsen, MD, past president of the American Medical Association, and Robin Gelburd and Ray Agostinelli of FAIR Health. This webinar (recorded with a live audience) describes the kinds of questions patients might ask about your fees and highlights resources that can help you respond. The approximately 40-minute overview is followed by a 20-minute question-and-answer session.


Click here to watch this archived webinar.  

Medicare revalidation underway 

Practices should keep an eye out for letters from TrailBlazer regarding Medicare revalidation. 


In the continued effort to reduce fraud, waste and abuse, CMS implemented new screening criteria to the Medicare provider/supplier enrollment process beginning in March 2011. 


All providers and suppliers who enrolled in Medicare prior to March 25, 2011 will be required to revalidate their enrollment under new risk screening criteria. Between now and March 2013, TrailBlazer will be sending notices to individual providers/suppliers. 


Upon receiving the request, you will have 60 days from the date of the letter to complete enrollment forms. Failure to do so may result in the deactivation of your Medicare billing privileges. 


For more information, read this MedLearn Matters article

RAC errors leading to incorrect recoupments from physicians 
It has come to our attention that Connolly, the Medicare RAC (Recovery Audit Contractor) for Colorado and several other states, has incorrectly applied two audit issues in some billing cases. The two topics and the identified errors are:

1. Global period - minor surgery: Some CPT codes (e.g., dermatology) had their global periods changed from 10 days to 0 days in 2011. Connolly did not make these changes and practices were being asked for refunds for E&M codes that were billed correctly.  
2. E&M services during global surgery periods: In this case Connolly mistakenly applied the global surgery period to any assistant surgeon who billed for E&M visits within the follow up days and asked for refunds.    

Connolly and CMS are aware of the issue and Connolly is working to ensure money already inappropriately recouped will be refunded. If your practice has received a letter from Connolly on either of these issues, you should contact them for a correction. 

You can see a full list of the issues approved for RAC audits 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