CMS-backed legislation to standardize prior authorization of drugs goes into effect Jan. 1, 2015. Click here for a fact sheet and begin learning how to use the new law to the advantage of your patients and practice.

The true administrative simplification of the prior authorization process for prescription drugs will not be realized until health information technology can allow for a completely integrated process for ordering, authorization and dispensing of medications.

Until such technology is available and in use, Colorado's new law, C.R.S. 10-16-124.5, should be used in obtaining prior approval from carriers for coverage of drug benefits -- it is intended to improve the communication surrounding prior authorization by requiring that information on any specific requirements for medications, as well as the process itself, be readily available to the prescribing provider. In addition, timeframes have been established for processing of the authorization. Please reply to ASAP if more information is needed.

The National Council for Prescription Drug Programs (NCPDP), the organization responsible for creating and maintaining prescription drug electronic standards, is seeking input from the health care industry to help set priorities for the creation of a real-time prescription benefit inquiry (RTPBI) transaction. An RTPBI transaction is intended to provide patient-specific prescription benefit information at the point of care. The purpose of the survey is to determine the scope of content for a future RTPBI transaction. The survey contains use cases which identify specific content areas possible for the RTPBI.

Click here to access the survey. Responses are not limited to NCPDP members. Please feel free to forward the survey to other interested parties. The survey will close at 10 a.m. MST on Thursday, Dec. 18, 2014.

We encourage you to participate in this survey. Strong provider participation will ensure that your need for accurate, patient-specific prescription benefit information at the point of prescribing is heard.

Over the past few years, physician practices have struggled to respond to the increased use of medical audits by federal, state and private health care payers seeking reimbursement of payments often erroneously attributed to inappropriate billing. These audits are disruptive to physician practices and often cause substantial financial hardship as many payers delay or cease payments to the audited practice until audits are complete or recoup alleged overpayments before any ruling on appeal.

To educate and arm physicians with information and tools relating to medical audits, the Physicians Advocacy Institute (PAI) and the American College of Emergency Physicians (ACEP) have joined together to develop a toolkit for physicians facing medical audits.

Click here to read more on CMS.org and to access the toolkit.

The Centers for Medicare and Medicaid Services is in the process of implementing ICD-10. All covered entities must be fully compliant on Oct. 1, 2015. CR8858 instructs all Medicare Administrative Contractors (MACs) and the Durable Medical Equipment MAC Common Electronic Data Interchange (CEDI) contractor to promote ICD-10 Acknowledgement Testing with trading partners during three separate testing weeks, and to collect data about the testing. The first testing week was held Nov. 17-21, and two additional weeks are scheduled March 2-6, 2015, and June 1-5, 2015.

Click here to read more on CMS.org.

Colorado's Prescription Drug Monitoring Program (PDMP) provides prescribers and pharmacists a secure database with immediate access to their patients' history of controlled substance prescriptions. The state Board of Pharmacy, which has oversight over the PDMP, protects the confidentiality of patient medical records and information.

Click here to read more about privacy protections in the PDMP, including provisions from a law passed in 2014.

Beginning Jan. 1, 2015 Medicare will pay for Chronic Care Management (CCM) services, CPT� code 99490 under Part B fee for service. The CPT� definition is:

"Services are provided when medical and/or psychosocial needs of the patient require establishing, implementing, revising, or monitoring the care plan. Patients who receive chronic care management services have two or more chronic conditions or episodic health conditions that are expected to last at least 12 months , or until the death of the patient, and place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline."

Per CPT� 99490 billing requirements include:

• At least 20 minutes of clinical staff time directed by a physician spent in chronic care management services;
• Can only be billed once per month/per patient, AND by only one physician;
• Comprehensive care plan is established, implemented, revised or monitored.

Additional Medicare billing requirements were identified in Table 33 of the 2015 final physician fee schedule rule and include:

• Use of an EHR
• Beneficiary notification and consent - identify CCM services and obtain written agreement to have the services provided, including authorization for the electronic communication of his/her medical information with other treating providers (NOTE: Medicare pays for the service at 80 percent and the patient is liable for the 20 percent co-insurance.)
• Providing patient a written or electronic copy of the care plan

To view the complete table, click here.

As part of the American Medical Association's continued effort to educate physicians on the Health Insurance Portability and Accountability Act (HIPAA) standard electronic transactions, the AMA is offering a free webinar to detail physician rights, health plan responsibilities, and enforcement options under HIPAA standard electronic transaction regulations.

The webinar, "HIPAA Standard Transaction Compliance: Physician Rights and Enforcement," will review the standard transactions, detail the various physician rights and health plan responsibilities created by the regulations, and provide information on how physicians can exercise their rights and seek enforcement of these regulations. Registration for the webinar, which will be held on Thursday, Dec. 18 at 10 a.m. MST (noon EST), is now open.

For additional information on standard electronic transactions, please visit the AMA's Moving to Electronic Transactions website.