Colorado Medical Society 
News for Colorado Physicians                                                                                     March 11, 2013
For your information:
King Soopers evaluating physicians' prescribing patterns

King Soopers/City Market and its parent company, The Kroger Co., have implemented procedures requiring increased review of all Schedule II prescriptions. They have alerted the physician community that they will "review prescriptions and quantities of controlled substances purchased and dispensed at particular pharmacies as well as the prescribing practices of certain practitioners."

The review may include calling prescriber offices more frequently to obtain "additional documentation" for oxycodone prescriptions written for large quantities, which Marla Frawner, RPh, King Soopers and City Market Pharmacy director, defined in the notification letter as specific diagnosis for the oxycodone prescription, patient prescription history, level of care, or controls that the prescriber may have in place to avoid patient diversion.

This comes in response to recent action by the Justice Department to revoke or suspend the controlled substances licenses of several pharmacies in Florida, including certain CVS and Walgreens locations, and pharmaceutical distribution centers.

Frawner also wrote that they will be collecting certain information from patients as well and using the Colorado Prescription Drug Monitoring Program to ensure patients aren't using multiple prescribers to obtain Schedule II narcotics.

One CMS member received a denial letter in December 2012 from Kroger's law department stating that their company would no longer be able to fill controlled substance prescriptions from the physician.

"To the extent we identify quantities, doses and/or other prescribing practices that raise concerns, we may take various actions including not filling controlled substance prescriptions written by certain providers. At this time we must unfortunately let you know that we intend to cease filing controlled substance prescriptions prescribed by you immediately."

Colorado has the second highest rate of non-medical prescription drug abuse in the nation and the Colorado Medical Society has made the issue of prescription drug abuse a high priority. CMS encourages members to go to to access "The Opioid Crisis: Guidelines and Tools for Improving Chronic Pain Management," developed specifically to educate Colorado physicians and other authorized prescribers on best practices and universal precautions for treating chronic pain. The course qualifies for two CME credits and COPIC points.

Sequestration provision takes effect, AMA says cuts cause "real pain"

The failure of Congress to reach an agreement on the budget means the sequestration provisions will take effect as a result of the Budget Control Act. The American Medical Association released a statement from AMA President Jeremy Lazarus, MD, of Denver saying that the cuts cause "real pain" to Medicare patients and physicians "at an already difficult time for the nation's economy." AMA found in a recent report that up to 766,000 health care and related jobs could be lost by 2021 as a result of the 2 percent cut in Medicare physician payments.

"Physicians continue to face drastic cuts from the SGR, and an additional 2 percent cut coming from sequestration further threatens access to care for patients and prevents needed improvements in Medicare," Dr. Lazarus said. "Creating a larger gap between Medicare payment rates and the cost of delivering care will stifle innovation, reduce access to care and increase dysfunction within the Medicare program."

"...Physicians need to make investments in their practices to help design, lead and adopt new models of care delivery that can increase quality and reduce costs now and in the future. Further cuts are counterproductive and stifle important progress while placing an unsustainable burden on physician practices."

The Colorado Medical Society and other physicians' groups repeatedly urged Congress to come to an agreement on the budget and halt the sequestration provision. CMS says physicians will begin seeing the 2 percent Medicare cut beginning April 1. Click here to read the full AMA statement.

AMA's check-up series: Access interactive resource to simplify the claim audit and appeals process

CMS invites members to participate in the latest in the AMA Practice Management Center's "Prescription for a Healthier Practice" check-up series. Launched in January, these check-ups help your practice examine the health of your everyday administrative processes in areas that include automating your practice, fair contracting, ensuring accurate payment, physician efficiency and clinical quality issues. 

Prescription for a healthier practice: Take an active approach to the appeals process

The next prescription to help your practice stay healthy focuses on simplifying the claim audit and appeals processes. This interactive resource can help reduce the administrative burden by delivering a step-by-step course of action to appeal an underpaid, delayed or inappropriately denied claim.

AMA members can access the National Managed Care Contract Database to look up state laws and regulations, which may need to be cited or quoted directly in an appeals letter. Also refer to the issue brief, "Overpayments and underpayments" for additional information.

Click here to access the PDF.

Medicaid rule clarification expands eligibility for bonus
All Medicaid providers should check to see if they are eligible to complete attestation to receive Medicaid bonus

Changes to Medicaid reimbursement were enacted as part of the Affordable Care Act (ACA). Eligible physicians will receive supplemental payments for services rendered between Jan. 1, 2013, and Dec. 31, 2014, that raise Medicaid reimbursement to Medicare rates. A recent study shows that for many Colorado physicians this change would represent an estimated 32% fee increase on average.

The statute specifies that higher payment applies to primary care services delivered by a physician with a specialty designation of family medicine, general internal medicine, or pediatric medicine. It also specifies that specialists and subspecialists within those designations as recognized by the American Board of Medical Specialties (ABMS), the American Osteopathic Association (AOA) or the American Board of Physician Specialties (ABPS) also qualify for the enhanced payment. Under the regulation, "general internal medicine" encompasses internal medicine and all subspecialties recognized by the ABMS, ABPS and AOA. Click here for more information on covered specialties.

To be eligible for the supplemental payment, physicians must self-attest as having a specialty in family medicine, general internal medicine, and/or pediatric medicine, or as having a subspecialty within those specialties recognized by ABMS, ABPS and AOA. Only physicians can complete this form (staff or other representatives are not allowed).

Make sure that you are eligible for these increased payments by visiting the Colorado Department of Health Care Policy and Financing attestation page here. Learn more about ACA enhanced payments for Medicaid primary care physicians here.

Register today for CMS Spring Conference: May 3-5 in Vail
Learn to leverage practice transformation to improve your bottom line

Register today for CMS' Spring Conference, May 3-5, 2013, at the Sonnenalp in Vail, Colo. Titled "Assembly Required: A User-Friendly Blueprint for Practice Transformation," attendees of the conference will learn what you need to do to improve the care experience and provide greater value for the premium dollar through an inter-connected compilation of hands-on practice transformation sessions.

Physicians commonly understand the fundamentals of practice transformation - and their importance - but they often lack the technical and practical support and mentoring to initiate and implement them. With narrow margins and unprecedented external pressures, most physicians cannot afford the luxury of trial and error experimentation. National and regional experts who have "been there, done that" and who have "caught the arrows" of practice transformation will share what works and in what settings and circumstances, giving you the knowledge to take your practice to the next level.

Click here to download a form and register today. For more information and a full agenda, go to

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