 Colorado Medical Society Health Care Financing Division
PHONE: (720) 858-6321
FAX: (720) 859-7509
[email protected] |
HIPAA 5010: Only 58 days to ensure compliance!
| The HIPAA Version 5010 compliance deadline is fast approaching. All covered entities must conduct internal and external transaction testing within their organizations and with their billing partners - including payers, clearinghouses, providers and vendors - by Dec. 31, 2011 to ensure 5010 compliance.
Beginning Jan. 1, 2012, all electronic claims must use Version 5010. Version 4010 claims will no longer be accepted.
The following resources are now available:
- On Nov. 9, from 11:30 a.m. to 1 p.m. Mountain time, the Centers for Medicare and Medicaid Services will hold a free HIPAA 5010 National Provider Call. More info and link to registration may be found here.
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CMS releases 2012 Medicare physician fee schedule final rule
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The Centers for Medicare and Medicaid Services (CMS) has released thel 2012 Medicare Physician Fee Schedule final rule. Unless Congress intervenes, the rule implements a 27.4 percent reduction in Medicare physician payments based on the SGR formula.
Colorado Medical Society will continue to advocate to repeal the flawed SGR formula; stay tuned for updates in the LiveWire, ASAP electronic updates and Colorado Medicine magazine.
For more information on the 2012 schedule, see the CMS press release or this link to the final rule.
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Volunteers needed for free PQRS assistance
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The Colorado Foundation for Medical Care (CFMC) is recruiting a select group of providers to participate in a project funded through the Centers for Medicare and Medicaid Services (CMS) through 2014 that is focused on helping practices use their electronic health record to report data to the Physician Quality Reporting System (PQRS).
Benefits Include: free on-site consultation for report generation, care management techniques, process re-design and assistance with electronic reporting. If successful the practice will receive a 0.5% incentive payment based on Medicare Part B allowable charges.
The practice must choose 3 of the following 6 measures to track and provide quarterly reports of the numerators and denominators: Influenza immunization for Patient 50 and older, pneumonia vaccination for patients 65 and older, screening mammography for women 40-69, colorectal cancer screening for people 50-79, tobacco Use screening and cessation, or Blood pressure measurement,.
There is NO COST to participate. Please contact Terrey Currie at 303-784-5732 or [email protected] with any questions or if you are interested in signing up.
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ICD-10 Coding Corner
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ICD-10 is coming! Watch this spot of upcoming editions of the LiveWire for more details on ICD-10 training and resources.
For today, though, we share this brief video clip - just to make you smile!
(Who said there's no such thing as coding humor? Warning: this link includes music. You may want to turn down the volume on your computer).
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New deadline to file hardship,
avoid 2012 eRx penalty
| Beginning Jan. 1, 2012, eligible professionals who have not successfully met the requirements of the eRx incentive program or qualified for a significant hardship exemption will see Medicare payment rates reduced by 1 percent of allowable Medicare Part B charges.
The deadline to request a hardship exemption has been extended to Nov 8. You must apply online, via this web-based portal.
To qualify for the hardship exemption, 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 may apply for more than one exemption category if multiple categories apply).
CMS originally set a Nov. 1 deadline for eligible professionals to file for a hardship exemption. After hearing from AMA that some physicians were having difficulty accessing the web-based portal, however, CMS extended the filing deadline.
If you have problems accessing the site, the QualityNet Help Desk may be reached at 1-866-288-8912 or email at [email protected] from 7am to 7pm CT, Monday through Friday. Due to the high volume of calls there may be a waiting period. More information is available here. |
Medicare revalidation update
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As we reported in an earlier LiveWire, the Centers for Medicare and Medicaid Services recently launched an effort to revalidate the enrollment of every provider and supplier by March 2013 pursuant to the program integrity screening provisions of the Affordable Care Act (ACA).
Recently, CMS announced the effort will be pushed back, with the deadline now 2015. Physicians will be among the last to revalidate.
Practices should still keep an eye out for letters from TrailBlazer regarding Medicare revalidation. If you receive a letter, you must submit complete enrollment application(s) and supporting documentation within 60 calendar days. (Click here to see a sample letter).
For more information see this MedLearn Matters article or the TrailBlazer Part B Getting Started web page.
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OIG releases 2012 work plan
| (From AMA's Practice Management Alerts)
The HHS-OIG, the federal agency responsible for protecting the Medicare program from fraud, has just released its Work Plan for 2012.
The OIG will be paying particular attention to whether: (1) physicians who have opted out of Medicare are actually complying with opt-out requirements; (2) physicians are following Medicare assignment rules or are billing Medicare patients more than Medicare allows; (3) physicians are receiving high cumulative payments, i.e., unusually high payments made to an individual physician over a specified period; (4) physicians are properly coding site-of-service when performing services are provided in ambulatory surgical centers and hospital outpatient departments; and (5) physicians are properly billing "incident-to" services.
Physicians should carefully review their compliance efforts to see if their practices have any vulnerabilities in these areas.
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Workers comp 2012 seminars
| Save the Date: The Colorado Department of Labor and Employment will hold seminars on the 2012 Medicaid fee schedule. Attendees are encouraged to bring current issues with documentation for discussion during the seminar.
- Jan. 12 in Fort Collins
- Jan. 18 in Colorado Springs
- Jan. 25 in Denver
The seminars are free but space is limited. Click here to access registration forms and more information about the seminars.
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About Us
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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 [email protected].
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