April 2014

Under the Affordable Care Act, if a patient who receives an advance premium tax credit does not pay his or her health insurance premiums in full, he or she enters a 90-day "grace period." During the first month of the grace period, the patient continues to have health insurance coverage, and the patient's health insurer will pay claims for health care services provided to the patient during that time. However, if the patient enters the second or third month of the grace period, the health insurer may pend claims for services provided to the patient during that time, presenting a potentially serious cash-flow issue for physician practices.

The American Medical Association has created a toolkit to help practices navigate this issue to minimize any potential non-payments from health insurers that are due to cancellation of coverage at the end of the grace period. It includes a step-by-step guide to the grace period, a collections policy checklist, model financial agreement language for patients receiving the advance premium tax credit, and a sample letter to patients.

To help your practice navigate this potential issue, the AMA has created a number of resources to take you step by step through key aspects of the grace period. Go to www.ama-assn.org/go/graceperiod to access this resource.

The bill that stopped a scheduled 24 percent Medicare pay cut to physicians also delayed the transition to the ICD-10 code set for at least an additional year. The U.S. House of Representatives passed H.R. 4302, the "Protecting Access to Medicare Act of 2014," on March 27. The Senate passed an identical version of the bill on March 31 and President Obama signed the legislation into law on April 1.

The current delay measure states, "The Secretary of Health and Human Service may not, prior to Oct. 1, 2015, adopt ICD-10 code sets as the standard for codes sets." The Colorado ICD-10 Training Coalition recognizes that physicians, payers, vendors and academic programs have already invested great resources in planning your transition, and that many may be frustrated by another delay.

The coalition encourages practices not to lose momentum. Those ready for implementation can access archived webinars on their website, www.cms.org/icd-10, to refresh and improve your skills, and those who need another year can increase your readiness through proactive education, practice and testing.

Use this postponement to increase your knowledge, review and adjust documentation quality and clinician education, and adjust coding and billing procedures - without the weight of the 2014 deadline. The coalition will continue to hold webinars and post resources on their website and provide more information on the delay as it is available.

Physicians in small to mid-sized practices can conduct their own risk assessments using a free security risk assessment (SRA) tool available from the U.S. Department of Health and Human Services. Click here to access this tool.

The SRA tool is designed to help practices conduct and document a risk assessment to evaluate potential security risks in their organizations under the Health Insurance Portability and Accountability Act (HIPAA) Security Rule. Conducting an SRA also is a core requirement for physicians seeking payment through the federal meaningful use program for electronic health records.

Physicians can watch a tutorial and other videos about risk analysis and contingency planning to provide further context. The assessment tool is available through the Apple App Store (search for "HHS SRA tool") for use on iPads, and can be downloaded onto computers running Windows operating systems.

HIPAA regulations were updated last year in what were called the "most sweeping changes" since the law was implemented. The American Medical Association offers free resources to help physicians ensure their practices are HIPAA-compliant, including a new HIPAA toolkit and an associated continuing medical education activity. Click here to access these resources.

Effective April 1, 2014, Medicare is no longer accepting paper claims on the old CMS 1500 claim form with a date of 08-05 in the lower right-hand corner. The new form has a date of 02-12. Qualifiers to identify an ordering, referring or supervising role should be entered to the left of the dotted vertical line on item 17. Additional information regarding this initiative can be found in the CMS Medicare Learning Network (MLN) Matters: MM8509; and in a published article by the National Uniform Claim Committee (NUCC), which gives a quick list of updates and claim form order information.

Physicians who wish to participate in the 2014 Physician Quality Reporting System (PQRS) program as a group practice can now register for the group practice reporting option (GPRO). The registration system will be open from April 1 to Sept. 30, 2014. Groups that are ready to register can access the PV-PQRS Registration System at https://portal.cms.gov. Registration requires a valid IACS User ID and password to choose the group's reporting mechanism. Additional information about the 2014 GPRO registration is available on the federal CMS website.

The 2012 PQRS and E-prescribing Experience Report summarizes the reporting experience of eligible professionals in these two programs in 2012, historical trends and preliminary results for the 2013 program year. More than $167,000,000 PQRS incentive payments were paid by the federal CMS for the 2012 program year, which reflects successful participation of  nearly 30,000 practices that included 367,000 eligible professionals (EPs). 2014 is the last year EPs can earn a PQRS incentive. EPs who do not successfully participate in the 2014 PQRS program will be subject to a negative two-percent payment adjustment in 2016.

In 2012, 227,447 EPs (representing 55,000 practices) earned more than $335,000,000 in e-prescribing incentive payments. The average incentive payment was $1,474 per EP and $6,095 per practice. The number of EPs who received a penalty in 2012 was 59,995, a significant drop from those who received a cut in 2011, 135,931. 2013 was the last year EPs could earn an e-prescribing incentive.

In This Issue

Colorado ICD-10 Training Coalition webinar - Tuesday, May 20, 12 - 1 p.m.

Denny Flint, CEO of Complete Practice Resources, will present "ICD-10: What to do with the 'gift of time'." More information and registration will be available soon on the coalition website, www.cms.org/icd-10.


RT Welter & Associates ICD-10 Coder Academy

June 11-13 in Thornton

Click here for more information and to register. Colorado ICD-10 Coalition members can receive a $50 discount off the Coder Academy registration fee. Simply print the registration form, write "Colorado ICD-10 Coalition Member" on it and return through the instructions at the top of the form.


Colorado Medical Group Management Association

March, April, May - Three-part series on LEAN for Private Physician Practices, Kearin Schulte

CMGMA webinars are free for active CMGMA members, $50 for non-members. Click here for more information on the CMGMA website.

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Submit your event by e-mailing [email protected].

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American Medical Association

Connect for Health Colorado

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Aetna

Anthem

Colorado Medicaid

Kaiser Permanente of Colorado

Novitas

Rocky Mountain Health Plans

United