November 2014
Just for a laugh: 10 ICD-10 codes to be thankful for this Thanksgiving
Advanced MD presents their top 10 ICD-10 codes that might make their way into your private practice during Thanksgiving 2015. W61.42 - Struck by Turkey, perhaps? Click here to see the full list.

AMA: 10 Medicare payment policy revisions you need to know
Chances are you haven't been able to read through the nearly 1,200 pages that constitute the 2015 Medicare Physician Fee Schedule final rule released Oct. 31 and published last Thursday in the Federal Register. The American Medical Association presents the 10 top payment policy changes discussed in this mammoth document that physicians and their staffs need to know about.

Among the policy changes discussed in the top 10 list are:
  • The sustainable growth rate formula calls for a 21.2 percent cut to physician payments, effective April 1.
  • Continuing medical education will not be reported under the Physician Payments Sunshine Act.
  • Proposed penalties under the value-based payment modifier will be scaled back.
  • The timeline for submitting new codes and revaluations of services will shift.
Click here to view the full list on the AMA's website. From here you can download the AMA's full summary or view fact sheets from the Centers for Medicare and Medicaid Services.

ICD-10 logo
New Medicare Learning Network educational products
The Medicare Learning Network announced four revised educational products on ICD-10 in their Oct. 30 issue of MLN Connects Provider eNews.

"ICD-10-CM/PCS Billing and Payment Frequently Asked Questions" fact sheet addresses top questions and answers on billing and payment.

"ICD-10-CM/PCS The Next Generation of Coding" fact sheet addresses the ICD-10-CM/PCS compliance date, use of external cause and unspecified codes in ICD-10-CM, continued use of Current Procedural Terminology codes, ICD-10-CM/PCS examples, and structural differences between ICD-9 and ICD-10.

"ICD-10-CM/PCS Myths and Facts" fact sheet responds to myths on ICD-10-CM/PCS, and lists resources.

"ICD-10-CM Classification Enhancements" fact sheet addresses similarities and differences between ICD-9 and ICD-10, new features in ICD-10-CM, and additional changes.

AMA: Regulatory penalties tsunami could cut doctors' pay by 13 percent
Physicians providing care to Medicare patients could face a "tsunami" of regulatory penalties over the next 10 years, potentially seeing payments cut by more than 13 percent by the end of the decade. The AMA urged the Centers for Medicare and Medicaid Services to streamline the competing laws and regulations that threaten access to care in a letter sent in late October.

Click here to read more on the AMA's website.

As a reminder, the deadline to file a hardship exception application to avoid a Meaningful Use penalty in 2015 is Nov. 30, 2014. The AMA also wants to clarify that physicians may file for a hardship AND file for an incentive. The day to attest for a 2014 incentive is Feb. 28, 2015. Click here to read more on the AMA's website.

OIG releases 2015 work plan
The HHS Office of Inspector General (OIG) has released its work plan for Fiscal Year 2015, which summarizes new and ongoing reviews and activities that OIG plans to pursue with respect to HHS programs and operations during the current fiscal year and beyond.

The work plan describes the primary objectives and provides for each review its internal identification code and the year in which they expect one or more reports to be issued as a result of the review.

Click here to access the work plan.

Federal CMS announces ICD-10 acknowledgement testing weeks
To help physician practices prepare for the transition to ICD-10, the Centers for Medicare and Medicaid Services offers acknowledgement testing for current direct submitters (providers and clearinghouses) to test with the Medicare Administrative Contractors (MACs) and Common Electronic Data Interchange (CEDI) anytime up to the Oct. 1, 2015 implementation date.

Acknowledgement testing weeks give submitters access to real-time help desk support and allows the feds to analyze testing data. Registration is not required for these virtual events. Mark your calendar:
  • Nov. 17-21, 2014
  • March 2-6, 2015
  • June 1-5, 2015
How to participate: Information is available on your MAC website or through your clearinghouse (if you use a clearinghouse to submit claims to Medicare). Any provider who submits claims electronically can participate in acknowledgement testing.

What you can expect during testing:
  • Test claims with ICD-10 codes must be submitted with current dates of service (i.e. Oct. 1, 2014 through Nov. 17, 2014), since testing does not support future dated claims.
  • Test claims will receive the 277CA or 999 acknowledgement as appropriate, to confirm that the claim was accepted or rejected in the system.
  • Testing will not confirm claim payment or produce a remittance advice.
  • MACs and CEDI will be staffed to handle increased call volume during this week.
Click here to read more information on acknowledgement testing and how to participate in MLN Matters� Article MM8858, "ICD-10 Testing - Acknowledgement Testing with Providers."

Ebola webinars on demand from CMS and AMA
The Colorado Medical Society hosted a webinar on Nov. 4, "Ebola Preparedness in the Outpatient Setting," on Tuesday, Nov. 4, at 6 p.m. All physicians - member or non-member - were encouraged to participate. Physicians can earn up to 1 AMA PRA Category 1 Credit™ from the live or on-demand recorded version.

CMS President Tamaan Osbourne-Roberts, MD; Connie Savor Price, MD, chief of infectious diseases and medical director of infection prevention at Denver Health and Hospital; and Lisa Miller, MD, state epidemiologist, led the CMS webinar and answered questions. Click here to view the webinar.

The American Medical Association hosted Arjun Srinivasan, MD, an expert from the Centers for Disease Control and Prevention (CDC) and captain in the U.S. Public Health Service, at their Interim Meeting in Dallas on Nov. 9. They have made a recording of his 90-minute address available; click here to watch it on YouTube. He discussed how physicians can prepare for and manage Ebola patients in hospital and ambulatory care settings. Slides of the presentation (click here; AMA log in required) also are available for download.

For more information on Ebola preparedness, click here to go to CMS's Ebola resource page or click here to go to the AMA's Ebola Resource Center.

Reminder: Physicians must register
with the PDMP by Nov. 30
The Colorado Department of Regulatory Agencies (DORA) Division of Professions and Occupations Healthcare Branch reminds physicians that they must register a PDMP user account by Nov. 30, 2014.

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

In This Issue

Transcription Outsourcing, LLC is the leading U.S. provider of medical transcription services. We provide physicians with the ability to be more productive and more profitable. To learn more, call 720-287-3710, visit or email [email protected].

First Healthcare Compliance is a comprehensive compliance program management solution, saving time and money and mitigating risks for health care providers in private practices, or those associated with hospital provider networks and health systems. To learn more, visit:, call 888-54-FIRST or email [email protected].

CO Drug Card

Compliments of CMS: Reduce patient callbacks, HIPAA compliant, RX Savings up to 75%, click for free customization COLORADO DRUG CARD.

National Jewish Health invites your health care providers to the 51st Annual Clinical Diabetes and Endocrinology Conference in Snowmass, January 23-27, and the 37th Annual Pulmonary and Allergy Update in Keystone, February 4-7. To learn more, call 800.844.2305 or visit or email [email protected].

Webinar: Physical and Behavioral Healthcare Integration for Consumers with Mental Illness
Wednesday, Nov. 19, 12-1 p.m. MT
Hosted by the Center for Improving Value in Health Care
Click here to register.

National Provider Call: 2015 Physician Fee Schedule Final Rule - Changes to Physician Quality Reporting Programs
Tuesday, Dec. 2, 11:30 a.m. - 1 p.m. MT
Register here.

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

National Drug Code (NDC) Requirement on Outpatient Claims UPDATED - effective Jan. 1, 2015
Anthem previously sent out billing instructions on how to bill for drugs administered in a physician office or outpatient facility setting that they realized caused inconsistencies with those used by Medicaid. They have re-evaluated the original billing requirements and have made necessary changes to be more consistent with requirements used by Medicaid. Click here to read a letter from Anthem that gives updated instructions.

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 submissions 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 an updated fact sheet on this change.

Notification: PQRS penalty to start Jan. 1, 2015
On Monday, Nov. 10, the Centers for Medicare and Medicaid Services began sending letters to eligible professionals (EPs), including group practices, subject to the 2015 Physician Quality Reporting System (PQRS) negative payment adjustment. Beginning on Jan. 1, 2015, the feds will apply a negative PQRS payment adjustment of 1.5 percent to payments under the Medicare Physician Fee Schedule for individual EPs and group practices who did not meet the criteria for satisfactory reporting in the PQRS for the applicable reporting period.

The PQRS is part of the effort to transform the health care delivery system by linking Medicare reimbursements to the quality of care delivered to Medicare beneficiaries. To do this, individual EPs and group practices are required to participate in reporting quality metrics in order to help the federal CMS evaluate the quality of care they deliver. Those that do not participate in one of the quality reporting initiatives will see a negative payment adjustment beginning in 2015.

Health insurance exchange information
Latest bulletins
Join Our Mailing List
Stay Connected

Twitter   LinkedIn
Colorado Medical Society | [email protected] |
7351 E. Lowry Boulevard
Denver, CO 80230

Copyright � 2014. All Rights Reserved.