 Colorado Medical Society Health Care Financing Division
PHONE: (720) 858-6321
FAX: (720) 859-7509
[email protected] |
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Reduce costs, gets paid faster with AMA's prior authorization toolkit
| The hassle of manually obtaining prior authorizations can keep you from spending more time caring for patients.
Learn how to spare your practice from this time-consuming process, while getting faster payer responses.
This new AMA webinar and its related toolkit show you how to streamline your practice by managing referral authorizations and prior authorizations electronically. Learn how these electronic transactions can help your practice:
- Receive faster responses from health insurers
- Reduce staff time and resources devoted to manual processes, such as waiting on hold
- Free up time for revenue-enhancing functions such as ensuring correct payment
- Cut costs of transactions by over 80 percent
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TrailBlazer begins cross-claims medical review
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(From TrailBlazer)
To increase consistency in Medicare reimbursement, effective Nov. 1, TrailBlazer implemented A/B cross-claim data analysis and claim review of services billed with certain Diagnosis-Related Groups (DRGs).
The related Part B services (procedure and evaluation and management services) reported to Medicare will be evaluated for reimbursement on a postpayment basis. We intend to use A/B cross-claim analysis to better understand and prevent errors.
For more information:
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Medicare revalidation letters in the mail
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The Centers for Medicare and Medicaid Services recently posted a list of all providers who have been sent a request to revalidate their Medicare enrollment information. The listing contains the name and National Provider Identifier (NPI) of each provider sent a letter, as well as the date the letter was sent.
To see the listing, click Revalidation Phase 1 Listing in the "Downloads" section of the Medicare Provider Supplier Enrollment Revalidation Page.
(Note: Providers must widen each column in the spreadsheet to view the contents.) CMS will be updating this list monthly.
Providers who are listed and have not received the request should contact TrailBlazer.
As we've reported in previous LiveWires, CMS launched an effort to revalidate the enrollment of every provider and supplier pursuant to the program integrity provisions of the Affordable Care Act (ACA).
Recently, CMS announced the effort will be pushed back, with the deadline now 2015.
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.
For more information see this MedLearn Matters article.
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ICD-10 coding corner: Under Construction
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ICD-10 is coming! And as you
can see in this video, there is truly a code for everything!
Watch this spot of upcoming editions of the LiveWire for more details on ICD-10 training and resources.
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HIPAA 5010 enforcement delayed;
Jan. 1 compliance deadline remains
| The Centers for Medicare and Medicaid Services on Thursday announced a 90-day grace period for enforcement of HIPAA Version 5010 compliance, though the Jan. 1, 2012 deadline for practices to begin submitting claims using 5010 remains intact.
CMS has not said whether it will allow 4010 claims between Jan. 1 and March 31 (the date at which it may initiate enforcement action). We expect an update from CMS in coming weeks, and will keep you updated in future newsletters.
Meanwhile, practices should do their part to be ready - working under the assumption that 4010 claims will not be allowed - but also prepare for the worst. AMA offers these suggestions to protect your cash flow in January:
- Submit as many transactions as possible before Jan 1, 2012;
- Decrease expenses before Jan 1, 2012, to increase cash reserves;
- Consider establishing a line of credit with a financial institution;
- Research payers' advance payment policies and
- Consider using manual or paper processes to complete transactions until the electronic transactions are fixed.
Remember: To be considered complaint, 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.
Also: P.O. boxes will no longer be permitted in billing provider address in 5010. If you submit claims electronically, you will be required use only a street address or physical location as the billing provider address.Continuing to report a P.O. Box in the billing provider address field will cause your claims to reject. Practices that wish to continue having payments sent to a P.O. Box or lock box will report this address in the "pay-to" address field.
For more information visit 5010 websites from AMA and the Centers for Medicare and Medicaid Services.
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Highmark named new Medicare contractor for Colorado
| The Centers for Medicare and Medicaid Services recently awarded Highmark Medicare Services (HMS) the contract for administration of Part A and Part B fee-for-service claims in the newly created Jurisdiction H, which includes Colorado. The formation of a new jurisdiction is part of CMS' ongoing effort to consolidate from 15 jurisdictions to 10 by 2016.
Highmark is expected to take over administration of Colorado claims by July 2012. However, the likelihood is that TrailBlazer will challenge the award and if they do this date would change. CMS expects few if any disruptions of service for beneficiaries and providers. We will monitor the award and keep you advised as more details become available.
For more information, visit the CMS website.
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Sales and use tax reminder
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All physician practices - particularly those that buy supplies over the Internet and/or sell products in their offices - should be aware of state and local laws regarding sales and use taxes. Recently, some cities have started doing audits; doctors who have not properly filed paperwork and paid taxes risk being fined and asked for back payments.
Not sure what's required of your practice? The Colorado Department of Revenue has copies of recent slide presentations on the topic on its website. (Click on "Sales/Use Tax Part I and Part II).
The Department of Revenue also will hold a Colorado Use Tax webinar on Nov. 30 from 1 to 4 p.m. Click here for more information and a link to register. |
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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AMA analysis of Medicare 2012 Physician Payment Final Rule
| On Nov. 1, the Centers for Medicare & Medicaid Services (CMS) released the 2012 Medicare physician payment schedule final rule. The 1,235-page 2012 Medicare Physician Payment Schedule Final Rule contains far more information than can be covered in a brief analysis. Below are a few notable items from AMA. To see the 2012 specialty impact table, click here.
Sustainable Growth Rate (SGR): The final rule indicates that, absent congressional action, payments will be cut by 27.4 percent on Jan. 1, 2012, instead of 29.5 percent as stated in the proposed rule. There are several reasons for this change. The 2012 cut represents accumulated cuts over a number of years that have piled up one upon the other as Congress has passed short-term SGR patches. The 2012 component of the total cut was projected to be -6.1 percent but dropped in the final rule to -3.3 percent. However, organized medicine continues to advocate for action in Washington to stop this cut. Keep an eye out for updates in LIveWire, Colorado Medicine magazine, and other communications, in coming weeks.
E-prescribing: CMS finalized its proposal for the 2012 and 2013 incentive and 2013 and 2014 penalty programs. Despite continued AMA opposition, as with the 2012 penalty physicians will need to report 10 times during the first six months of 2012 and 2013 to avoid application of e-prescribing penalties in subsequent years.
Physician Quality Reporting System (PQRS): CMS finalized its proposal to provide interim feedback reports for physicians reporting individual measures and measure groups through claims-based reporting for 2012 and beyond. These reports will be a simplified version of annual feedback reports that CMS currently provides and will be based on claims for the first three months of each program year. The interim feedback reports will be provided to physicians during the summer of each program year. Despite strong opposition from the physician community, CMS finalized its proposal to use 2013 as the reporting period for the 2015 PQRS penalty. If CMS determines that a physician or group practice has not satisfactorily reported quality data for the 2013 reporting period, then its 2015 payments will be reduced 1.5 percent.
Lab Test Signatures: CMS has retracted the requirement for physicians to sign lab requisitions, a policy change the AMA strongly and successfully opposed. The rule marks the final step in the agency's retreat from this mandate, which began with postponing implementation from Jan. to April 2011 and then agreeing not to enforce it. CMS has now reinstated its previous policy that physician signatures are not required on requisitions for Clinical Lab Fee Schedule services.
Annual Wellness Visit (AWV): CMS is increasing the relative values for the AWV codes to recognize additional resources associated with adding a health risk assessment to the service's requirements, but is continuing its policy of not covering a physical exam as part of these services.
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AMA's 'Heal that Claim' month
| November is AMA's Heal that Claim month - when AMA urges physicians to take action against inaccurate payments from private health insurers.
"The AMA's goal is to significantly reduce the administrative costs of processing claims from 14 percent to 1 percent and allow doctors to focus on caring for patients, instead of battling health insurers over delayed, denied or shortchanged medical claims," said AMA President Cecil B. Wilson, M.D.
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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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