July 2014
CMS releases 2015 proposed fee schedule

The Centers for Medicare & Medicaid Services (CMS) released the 2015 Proposed Fee Schedule rule on July 11, 2014. To view the CMS fact sheet on proposed policy and payment changes to Medicare's physician fee schedule for calendar year 2015 click here. The proposed rule includes changes for 2015 to Physician Quality Programs and the Physician Value-based Payment Modifier and separate fact sheets are available by using the links below. Comments on any of the proposed rules are due by September 2, 2014.


CMS fact sheet on changes for calendar year 2015 Physician Quality Programs and other programs click here.

CMS fact sheet on proposed changes for the Physician Value-based Payment Modifier in calendar year 2015 click here.

New remittance advice codes for PQRS claims-based reporting

Are you a PQRS eligible professional participating in claims-based reporting this year? Effective July 1, 2014, you will have to use the updated Remittance Advice Remark Codes (RARCs) for PQRS claims-based reporting that went into effect on April 1, 2014. CMS has released a new FAQwith information about the updated codes.


What are the New Codes and What Do They Mean?

  • Eligible professionals who bill on a $0.00 Quality-Data Code (QDC) line item will receive the N620 code, which replaces the current N365 code. Also, eligible professionals who bill on a $0.01 QDC line item will receive the CO 246 N572 code.
  • The new RARC code N620 will be your indication that the PQRS codes were received into the CMS National Claims History (NCH) database.
  • The new RARC N572 with the Claim Adjustment Reason Code 246 (with Group Code CO or PR) indicates that the procedure is not payable unless non-payable reporting codes and appropriate modifiers are submitted. 

Remember: The new codes were effective on July 1, 2014. The old codes will be deactivated on the same date.


The above information was taken from the CMS MLN Weekly Provider eNews. You can sign up to receive this newsletter directly here.

Want to learn more about how the CMS Value-Based Payment Modifier is tied to PQRS?

The CMS Medicare Learning Network has posted a You Tube video that provides an overview of the value-based payment modifier and how it relates to PQRS reporting. The video is intended to help Medicare physicians understand how the value modifier can effect Medicare reimbursement starting in 2015. You can view the video here.

Colorado's Transparency Initiatives are gaining momentum  

Colorado's APCD which is administered by the Center for Improving Value in Healthcare (CIVHC) is expanding the data it is sharing with the public. They recently released an analysis of Cesarean deliveries in Colorado.


Additional facility data is currently being analyzed and will be released in the coming months. APCD staff are working with physicians and the Colorado Medical Society concerning what type of physician quality and cost reporting would make sense for consumers and providers alike. The APCD has targeted the release of this type of information in 2015.


The APCD website has been in place for some time, but this press release demonstrates how they envision using the information they have been gathering. The APCD currently houses claims data from 2009 through 2012 for commercial payers' individual and large-group fully-insured lines of business and Medicaid. They will be adding data from Medicare and self-insureds in the future.

ICD-10 Coalition main image
ICD-10 specialty specific webcasts are now available

CMS Road to 10: The Small Physician Practice's Route to ICD-10 has released a number of webcasts on specialty specific documentation and coding concepts. Click here to access recordings on family practice & internal medicine, obstetrics & gynecology, orthopedics, cardiology and pediatrics.


In-person training on Thursday, August 28

The same consulting group, Noblis, that developed the CMS Road to 10 website is currently touring the states and providing in-person training for physicians and their staff. On Thursday August 28, 2014, they will be in Colorado. The Colorado ICD-10 Training Coalition is partnering with the Denver Regional Office of the Centers for Medicare & Medicaid Services to bring this training opportunity to Colorado physicians and practice staff. Take advantage of the extension and begin, modify or finalize your transition plan by joining us for an in-person meeting.

  • Thursday, August 28 at noon in the Mile High room of the COPIC building at 7351 E. Lowry Blvd., Denver, CO 80230, hosted by the Colorado Medical Society.For a description of the program and to register click here.

ICD-10 is just the vessel. The real cargo? Data!

Denny Flint, Director of Business Development, Assistive Coding, LLC - Denny Flint is a member of the Colorado ICD-10 Training Coalition and the following article was published in the July/August 2014 issue of Colorado Medicine.


Stop focusing on ICD-10! The real elephant in the room is the rapid proliferation of diagnosis-based reimbursement. The role of ICD-10 (if and when it actually comes to pass) needs to be re-evaluated. ICD-10 will merely be the language by which your public face (coding profile) is expressed to the outside world. ICD-10 is a vehicle for capturing more specific, detailed data, nothing more and nothing less. To read the entire article click here.


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In This Issue

ICD-10 In-person training 

August 28, 2104, Noon in Denver. 

Learn more here.


Save the date - Thursday September 11, 2014,

 Protect Yourself by Understanding Healthcare Fraud Learn more here.

Tuesday August 26, 2014 12:00 to 1:00 MDT you are invited to participate in an upcoming FREE webinar, Fifty Shades of Pay - Industry Experiences Since the January 1st Compliance Date of the ACA-Mandated EFT / ERA Operating Rules. Register here.

Take WEDI ICD-10 survery
WEDI is conducting a brief ICD-10 survey as part of a series of periodic surveys to determine how well the industry is moving towards the Oct 1, 2015 implementation date. We appreciate your participation in our continuing efforts to track and update industry progress on this important initiative. Link to survey here.

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

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