 Colorado Medical Society Health Care Financing Division
PHONE: (720) 858-6321
FAX: (720) 859-7509
[email protected] |
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Providers must use new ABN form Jan. 1
| All providers must use the revised advanced beneficiary notice (ABN) form effective Jan. 1, 2012.
The new form is available for download here. For more information visit the Centers for Medicare and Medicaid Services' website.
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Medicaid HIPAA 5010
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The Colorado Department of Health Care Policy and Financing (the Department) has made significant changes to the HIPAA Version 5010 implementation timeline.
Due to the Department's efforts, all dates have been moved closer to the January 1, 2012 compliance date.
For updated implementation information, please refer to the current HIPAA 5010 Implementation Fact Sheet (11/11) located in the Provider Services Specifications section of the Department's Web site located at colorado.gov/hcpf.
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2012 PQRS resources
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The Centers for Medicare and Medicaid Services has posted educational products for the 2012 Medicare Physician Quality Reporting System (PQRS) and electronic prescribing (eRx) programs.
To access the 2012 PQRS System educational products, along with measure specifications, visit the Spotlight page. Further information on the 2012 PQRS may also be found on AMA's website, located at www.ama-assn.org/go/PQRS.
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Updated CDPHE credentialing form
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CFMC launching Cardiovascular Learning and Action Network
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Sign up now for CFMC's Cardiovascular Learning and Action Network! The Colorado foundation for Medical Care (CFMC) is recruiting a select group of practices to work on a project funded through the Centers for Medicare and Medicaid Services through 2014.
CFMC will convene medical experts, community partners and physician offices in a Learning and Action Network (LAN) to improve data collection and patient management in four cardiac health measures - smoking cessation, low-dose aspirin therapy, blood pressure control, and LDL control.
Providers must agree to attend three LAN meetings per year that includes at least one face-to-face meeting per year with the remainder occurring through webcast, conference calls, etc., and provide (with free assistance as needed) quarterly reports of numerators and denominators for the above measures.
There is no cost to the practice/provider to participate. Please contact Devin Detwiler at 303-875-9131 or [email protected]for more information or to sign up. |
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Save time and money with AMA's worker's comp electronic billing toolkit
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(From AMA Practice Management Alerts)
By sending and receiving electronic health care transactions, physicians can free their practice staff to perform other revenue-enhancing functions. |
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ICD-10 coding corner
| ICD-10 is coming -- and who says we can't have a sense of humor about it?
As you can see in this new 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, including an ICD-10 webinar coming in January.
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| Information on holding of Medicare claims under 2012 fee schedule | |
(From the Centers for Medicare and Medicaid Services)
The negative update under current law for the 2012 Medicare Physician Fee Schedule is scheduled to take effect on Jan 1, 2012 - eight business days from today. Consequently, as on numerous occasions in the past, CMS will instruct its Medicare claims administration contractors to hold claims containing 2012 services paid under the Medicare Physician Fee Schedule for the first 10 business days of January 2012 (i.e., Sun Jan 1 through Tue Jan 17).
The hold should have minimal impact on provider cash flow because, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt.
Medicare Physician Fee Schedule claims for services rendered on or before Dec. 31 are unaffected by the 2012 claims hold and will be processed and paid under normal procedures and time frames.
The Administration is disappointed that Congress has failed to pass a solution to eliminate the sustainable growth rate (SGR) formula-driven cuts, and has put payments for health care for Medicare beneficiaries at risk. We continue to urge Congress to take action to ensure these cuts do not take effect.
CMS will notify you on or before Jan. 11, 2012, with more information about the status of Congressional action to avert the negative update and next steps regarding the claims hold.
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HIPAA 5010: 12 days until deadline!
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(From AMA)
Jan. 1, 2012 marks the compliance deadline for use of the new version of the standard electronic Health Insurance Portability and Accountability (HIPAA) transactions. Version 4010 has been in use since 2003 and the Centers for Medicare and Medicaid Services (CMS) is requiring all HIPAA "covered entities," which includes physicians who conduct any of the transactions named in HIPAA electronically (i.e. claims or remittance advice), to begin using Version 5010 starting on January 1, 2012.
The AMA has been extremely proactive in educating physicians and continues to make a wealth of easy to understand resources available for free on our website at www.ama-assn.org/go/5010. Despite significant efforts by many in the health care industry, including physicians, there remains a considerable amount of work that needs to be done before everyone will be able to use the new standards. For example, many practices have not had their practice management system (PMS) software upgraded by their vendor and have not been able to conduct testing with key trading partners. If your PMS vendor has not yet updated your system to accommodate the use of version 5010 you are strongly encouraged to contact them to obtain the necessary software upgrades.
CMS Announces Enforcement Flexibility
CMS is the federal agency charged with oversight of HIPAA standards. AMA and others advocated to CMS that overall lack of industry readiness should not compromise physician cash flow following the January 1, 2012 compliance date. For this reason, CMS has indicated they will not levy any enforcement actions for the first three months of 2012 while HIPAA covered entities continue to work towards compliance. What this means is that the HIPAA 5010 compliance date remains January 1, 2012 and all physicians and other HIPAA covered entities should continue to make every effort to comply with the use of the new standards, but that CMS will not take any enforcement action during this period.
Medicare's Plans
Medicare, as the largest insurer that is required to comply with HIPAA requirements, has indicated that they are continuing to work with those who submit claims directly to them (Submitters). Submitters" include clearinghouses, third party billers, and physicians who submit claims directly (without the use of a third party or clearinghouse) to Medicare. Every submitter is required to test with Medicare before claims can be processed using the 5010 format. Medicare remains focused on ensuring all Submitters have tested successfully and that claims processing is not interrupted.
What this means for physicians
Direct Submitters:
If you are a physician who sends claims directly to Medicare ("Submitters") without the use of a billing service or clearinghouse:
- If you HAVE NOT tested by December 31, 2011: You are required to submit a "transition plan" to your Medicare contractor that details your plans for moving to 5010 and when you think you will be able to test with Medicare. You will have 30 days to do this once you have been contacted by your Medicare contractor.
- No prescribed format for transition plan: It can be sent via letter, email, or fax and can be a brief explanation of your transition plans.
- Keep evidence plan was submitted: Submittersare strongly encouraged to retain evidence that a plan was sent (i.e. return receipt email, fax transmission confirmation, copy of an email).
- All submitters must test: Unless submitters have tested with their Medicare contractor, even if you submit compliant 5010 transactions, your claims will be rejected.
- If you HAVE tested successfully by December 31, 2011: You will be contacted by Medicare and told you have 30 days to move over to use of the 5010 standards. Submitters that have not yet tested with Medicare prior to the compliance date will be contacted and asked to submit the transition plan described above.
Physicians who use a clearinghouse or billing service to submit their claims
Physicians who rely on a billing service or clearinghouse to submit their claims to Medicare are NOT required to file a transition plan to Medicare. The entity they use to submit their claims is the Submitter and is the one required to submit a transition plan. These physicians should contact their billing services or clearinghouses to determine their ability to generate the physician's claims and other transactions using the Version 5010 format.
For More information
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New interactive portal to help with EHR "meaningful use"
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The Colorado Medical Society and CO-REC (Colorado Regional Extension Center) have developed a free, self-guided educational tool to help practices with many of the resources needed to achieve "meaningful use" of electronic health records (EHRs).
The online portal takes physicians and their staff through step-by-step training and educational modules to help them select, implement and meaningfully use certified EHR technology. The portal is available to all Colorado physicians or practice staff members.
The portal contains interactive tools including an EHR readiness assessment, EHR selection criteria assessments, EHR contract considerations, and pre-implementation checklists necessary for successful implementation. It also includes links to statewide resources and information on critical success factors and the most common "failure modes" that drive EHR/HIE implementation, detailed privacy and security requirements.
For more information click here. To access the portal, click here.
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Free access to coding resources
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Say good-bye to outdated coding books, multiple websites ad scattered sources and save $500 to $1,500 or more each year, with CMSCodingToday.
Produced and managed by the PRS Network, CMSCodingToday is offered to all Colorado Medical Society members and their office staff FREE of charge.
This customized resource tool offers powerful search engine technology to navigate pertinent and up-to-the-minute coding resource information from 10 major databases. User-friendly scrubbing tools are also included to take the stress out of bundling research and to ensure the accuracy of your physician claims submissions.
Visit www.CMSCodingToday.com or call 800-972-9298 for your free access today.
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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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