October 2014
Ebola: What physicians
and practice staffs need to know
To help keep physicians and their staffs informed on the latest in the 2014 Ebola epidemic, the Colorado Medical Society has put together an Ebola resources page on our website, CMS.org. Click here to view it.

The Ebola epidemic is affecting multiple countries in West Africa and impacting countries around the world. One travel-associated case was diagnosed in the United States on Sept. 30; the patient, Thomas Eric Duncan, died at Texas Health Presbyterian Hospital in Dallas on Oct. 8. A second case, Nina Pham, an ICU nurse who treated Mr. Duncan, was identified on Oct. 12. And today, Oct. 15, news agencies are reporting that another health care worker in Dallas has tested positive for the virus.

Click here for more information on signs and symptoms, transmission, travel restrictions and screening, and an extensive list of resources for physicians that includes current recommendations from the Centers for Disease Control and Prevention, American Medical Association, the U.S. Department of Health and Human Services, the American Hospital Association, and more.

As a reminder, the likelihood of coming in contact with other viruses that can be "deadly" is much higher than the risk of Ebola. It's important to be vigilant in practicing basic hygiene: Wash your hands with soap and water or an alcohol-based hand sanitizer and avoid contact with blood and body fluids. Health care workers should wear protective clothing, including masks, gloves, gowns, and eye protection, and practice proper infection control and sterilization measures.

CMS makes first wave of drug and device company payments to physicians public
On Sept. 30, the Centers for Medicare and Medicaid Services (CMS) released the first round of Open Payments data to help consumers understand the financial relationships between the health care industry, and physicians and teaching hospitals, as part of an ongoing effort to increase transparency and accountability in health care, according to a CMS press release.

This information release is part of the Open Payments program, created by the Affordable Care Act, and lists consulting fees, research grants, travel reimbursements, and other gifts the health care industry - such as medical device manufacturers and pharmaceutical companies - provided to physicians and teaching hospitals during the last five months of 2013. The data contains 4.4 million payments valued at nearly $3.5 billion attributable to 546,000 individual physicians and almost 1,360 teaching hospitals. Future reports will be published annually and will include a full 12 months of payment data, beginning in June 2015.

Click here to read more.

CMS 1500 Claim Form transition effective Dec. 1
Currently, Colorado Medicaid providers submit professional claims via the Colorado Medical Assistance Program Web Portal or through the Colorado 1500 (CO-1500) paper claim form. In preparation for the ICD-10 implementation, the Colorado Department of Health Care Policy and Financing is transitioning all professional paper claim submission to the OMB-0938-1-1197 Form 1500 (02-12) (CMS 1500) paper claim form, effective Dec. 1, 2014. All CO-1500 claim forms received after Dec. 1, 2014 will be denied.

Providers are encouraged to submit claims electronically; any provider who submits professional claims by paper will need to purchase the form online or through an available retailer.

Click here to read a fact sheet on this change. Click here to view available online training presentations.

CMS releases Quality and Resource Use Reports for Medicare physicians
The Centers for Medicare and Medicaid Services (CMS) made available the 2013 Quality and Resource Use Reports (QRURs) on Sept. 30 to group practices and solo practitioners who met two criteria: (1) at least one physician billed under the TIN in 2013 and (2) the TIN had at least one eligible case for at least one of the quality or cost measures included in the QRUR. CMS did not release 2013 QRURs for group practices or solo practitioners participating in the Medicare Shared Savings Program, the Pioneer ACO Model or the Comprehensive Primary Care Initiative.

Authorized practice representatives can access the QRURs at https://portal.cms.gov using a valid Individuals Authorized Access to the CMS Computer Services (IACS) User ID and password. To learn more, click here to go to CMS's QRUR webpage.

Get information from CMS on impending Medicare penalties
and get help from Telligen
Ready or not, the pieces of payment and delivery reform are rapidly moving into place in Colorado and elsewhere. And if you're not among the physicians who are prepared for this significant change in health care, you're already behind the curve. Aligned programs like the Value-Based Payment Modifier (VBPM), Meaningful Use (MU) and the Physician-Quality Reporting System (PQRS) will soon shift in their effect - fundamentally altering how services are delivered and how physicians are compensated for these services.

Click here to read complete coverage on how Medicare incentives are turning into penalties in the September/October issue of Colorado Medicine. It includes a special two-page Medicare payment and delivery reform timeline. This story is the first in a series of articles about Medicare's approach to cost containment and quality improvement.

And click here to find out how you can access help on these programs at no cost from the Telligen Quality Innovation Network - Quality Improvement Organization (QIN-QIO).

ICD-10 logo ICD-10 compliance date: Oct. 1, 2015
The U.S. Department of Health and Human Services (HHS) issued a rule officially finalizing Oct. 1, 2015 as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10. The rule requires the use of ICD-10 beginning Oct. 1, 2015. It also requires HIPAA-covered entities to continue to use ICD-9-CM through Sept. 30, 2015. Visit the Colorado ICD-10 Training Coalition website for resources to help you prepare: www.cms.org/icd-10.

Medicaid providers: HCPF releases list of covered stimulant medications
The Colorado Department of Health Care Policy and Financing would like to share important updates regarding prescription stimulant medications covered by Medicaid. The attached document (click here) describes Medicaid's Brand Name Preferred and Generic Preferred medications, as well as age guidelines and maximum daily dose. Please note that effective Oct. 1, 2014, claims for drugs that are marked Brand Name Preferred will be paid without a prior authorization.

If you have any questions regarding this information, please contact Chris Ukoha at (303) 866-3588. If you prefer to email, you can contact Robert Lodge at [email protected].
Physicians must register
with the PDMP by Nov. 30
A bill passed during the 2014 regular session of the Colorado General Assembly made modifications to the electronic prescription drug monitoring program (PDMP), including mandating registration of physicians and other providers to the PDMP. The bill does not require use of the system. CMS supports greater use of the PDMP as one of many strategies to reduce opioid abuse and misuse, and supports the efforts of the Colorado State Board of Pharmacy to make the PDMP more user-friendly for physicians.

The Colorado Department of Regulatory Agencies (DORA) Division of Professions and Occupations Healthcare Branch has announced the due dates for mandatory practitioner PDMP user account registration.
  • Pharmacists and DEA-registered Advanced Practice Nurses: Sept. 30, 2014
  • DEA-registered Dentists, Veterinarians, Optometrists and Podiatrists: Oct. 31, 2014
  • DEA-registered Medical Board licensees: Nov. 30, 2014
While these are the respective due dates for each profession, all pharmacists and DEA-registered prescribing practitioners may and are certainly encouraged to register a user account with the PDMP at anytime between now and their deadline.

Click here to go to the Colorado PDMP webpage and complete your registration.

In This Issue
Sponsors

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Events
Overview of the 2013 Quality and Resource Use Reports
Thursday, Oct. 23, 12:30 - 2 p.m. MT
On Sept. 30, CMS made 2013 Quality and Resource Use Reports (QRURs) available to group practices and physician solo practitioners nationwide. This MLN Connects National Provider Call will provide an overview of the 2013 QRUR and explain how to interpret and use the information in the report. Register here.

Introduction to the ACC Medicare-Medicaid Program
Tuesday, Oct. 28, 12 - 1 p.m. MT
Join the Colorado Department of Health Care Policy and Financing for a webinar to teach providers more about the new Accountable Care Collaborative (ACC) Medicare-Medicaid Program and how it will help Medicare and Medicaid work together better for patients. Register here.

Transitioning to ICD-10
Wednesday, Nov. 5
11:30 a.m. - 1 p.m. MT

HHS has issued a rule finalizing Oct. 1, 2015 as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10. During this MLN Connects National Provider Call, CMS subject matter experts will discuss ICD-10 implementation issues, opportunities for testing, and resources. A question and answer session will follow the presentations. Space may be limited; register early. Register here.


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

Revalidation for Jurisdiction H (JH) Providers and Suppliers
Novitas began Revalidation Request Mailings on Oct. 14, 2014. They will continue through Nov. 11, 2014. Providers are urged not to ignore them and to respond promptly.

These mailings comprise approximately 10,000 providers/suppliers. The Centers for Medicare and Medicaid Services will publish the listing of providers/suppliers included in these mailings on their website approximately 3-4 weeks after all contractors have provided their mailing information for the months of October - November. You may also use the Provider Enrollment Status Inquiry Tool to determine if a revalidation notice was issued. If you have questions related to the revalidation initiative, please visit the Novitas Enrollment Center for more information.

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