Colorado Medical Society 
News for Colorado Physicians                                                                             October 20, 2012

COMPAC announces candidate endorsements

The Colorado Medical Political Action Committee, or COMPAC, has endorsed 82 candidates for state and federal office this year. Physicians and all friends of medicine are encouraged to consider these recommendations and, above all, be sure to vote. For help identifying the candidates running in your district, visit the "Who's my legislator?" link on the CMS home page.


COMPAC does not endorse based on political party. Instead, endorsements are made following a screening process that takes into account the views of the local medical community, the position of a candidate or incumbent on medical issues important to the medical society, the demographics of the district and a candidate's ability to win. Read the full candidate briefing document here.


COMPAC instituted the local physician screening process in the 2006 election cycle and several hundred physicians have participated in the process since then. This has proven instrumental in developing relationships between local constituent physicians and members of the Colorado Legislature.


For more insight into the CMS political process, be sure to read two articles from the upcoming issue of Colorado Medicine magazine. The Final Word written by COMPAC Chair Dave Ross, DO, and the Executive Office Update written by CMS CEO Alfred Gilchrist.


For more information about COMPAC click here.


UnitedHealthcare begins mailing TRICARE contract amendments

UnitedHealthcare (UHC) was awarded the Department of Defense contract to provide Managed Care Support Services in the TRICARE West Region as of April 1, 2013. In preparation for this transition, UHC has begun mailing contract amendments to their participating physicians who are part of the current TRICARE network. You are encouraged to review this information closely to be sure that you understand the program requirements and reimbursement as they differ from the existing UnitedHealthcare agreement.


If you take no action you will automatically become a participating physician under the UnitedHealthcare Military & Veterans network for TRICARE. If you do not wish to be part of the network you must advise UHC in writing that you do not wish to accept the addition of the TRICARE amendment to your existing UHC participation agreement within 30 days. UnitedHealthcare has provided this FAQ document for medical providers.


If you have specific questions be sure to call UnitedHealthcare Military & Veterans at 800-718-7572.


2013 E-prescribing penalty

Physicians who qualify for a hardship exemption to the Medicare E-prescribing payment adjustment will have another opportunity to apply. CMS announced that the Quality Reporting Communications Support Page will re-open beginning November 1, 2012 through January 31, 2013.  For more information click here.


Novitas Solutions visits Colorado

Effective November 19, 2012, Novitas Solutions will be the Medicare Administrative Contractor for processing of Medicare Part B claims. The week of October 22nd members of the Novitas Transition Team met with physicians and their staff in Grand Junction, Pueblo, Boulder and Fort Collins. This round of meetings was in addition to their earlier visit to Denver and Colorado Springs in August. All of the meetings were well attended and well received.


The Transition Team provided background information on their company, their transition plan, customer service contacts and some key things for the physicians/practices to do:

  • Be sure to send Novitas a current electronic funds transfer (EFT) agreement prior to the cutover date of 11/19/12. (Novitas recently announced that they will send an acknowledgement letter to confirm receipt of your EFT agreement, including those that have been received but not yet processed.)
  • If you use a billing service or clearinghouse to submit your claims, be sure they have tested with Novitas and are ready to begin transmitting claims to the new contractor.
  • Visit the Novitas transition website here for details and to review the Local Coverage Determination (LCD) policies that will be effective for dates of service beginning 11/19/12.

If you were unable to attend one of the Novitas meetings you can view their presentation here.


Medicare Recovery Audit Contractor (RAC) to begin 

auditing E & M services
The Centers for Medicare & Medicaid Services (CMS) has alerted the AMA that it has approved the Medicare Region C Recovery Auditor (RAC) Connolly to begin conducting audits of coding for E&M services in physician offices, specifically CPT code 99215.  We have been informed that in the next several weeks, Connolly will begin complex medical review of CPT code 99215, and will be permitted to extrapolate their findings based on a statistical sample of such claims.  Connolly is the Medicare FFS RAC contractor who conducts RAC audits in AL, AR, CO, FL, GA, LA, MS, NM, NC, OK, SC, TN, TX, VA, WV, Puerto Rico and the U.S. Virgin Islands.  However, it has not yet been announced if all or only a subset of these states will be under review.  These reviews are expected to begin imminently in Region C and, according to CMS, are likely to be approved in other Medicare regions in the near future. 


The AMA has sent a letter to CMS Acting Administrator Marilyn Tavenner strongly objecting to these audits and urging CMS to rescind approval of RAC review of E&M codes.  We also have alerted CMS staff that there will be significant opposition and questions about these audits among medicine and have requested that they provide briefings for state medical societies and specialty societies in the next few weeks to hear these concerns directly.  We have yet to confirm these briefings but will inform you of their status once confirmed.  Recently, however, there has been increased pressure on CMS to review physicians' coding of E&M services.  The HHS Office of Inspector General (OIG) issued a report here in May on this topic that specifically urged CMS to encourage its contractors to conduct these reviews and "if CMS determines that inappropriate claims have been paid, it should take steps to recover those overpayments."  The AMA will continue to keep the Federation informed of this development and of our advocacy on this front, and in turn we will alert you.  


Physicians and their staff can find more information and resources on audits on the AMA's Practice Management Center website here. In addition there is a recording of an earlier webinar on Medicare and Medicaid audits called "What physicians need to know" available here.  


November is the AMA's Heal the Claim month

This year the AMA campaign is focusing on patient payment at the time of service. Are you ready?Learn more here.

To comment on something you read in ASAP, send an e-mail to