Save the date for the CMS Spring Conference
The 2015 CMS Spring Conference will be held May 1-3 at the Sonnenalp Hotel in Vail. This year's theme is "Breaking Down Barriers," drawing parallels between the fall of the Berlin wall in its 25th anniversary year and efforts to dismantle barriers in health care between patients and physicians.
The purpose of the conference is to create unity among physicians, attract new faces to CMS, develop ideas to address the critical issues facing physicians, and broaden the view of attendees on relevant policy matters by bringing in outside experts.
We hope you'll plan to join us in Vail May 1-3. Stay tuned for more details.
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Reminder: Colorado will extend ACA primary care bonus
For most states, the Affordable Care Act's two-year raise for primary care physicians who see Medicaid patients will expire on Jan. 1, but Colorado is one of a handful of states that chose to continue the Medicaid pay boost using state funds. Specialists will see modest increases in Medicaid payment as well following action taken by the Colorado General Assembly last session and advocated for by the Colorado Medical Society. Click here to read more in an article from Kaiser Health News.
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2015 Medicare Physician Fee Schedule available by Jan. 20
The 2015 Medicare Physician Fee Schedule (MPFS) final rule was published in the Federal Register on Nov. 13, 2014. To correct technical errors, the Centers for Medicare and Medicaid Services is currently developing MPFS update files, anesthesia conversion factors, abstract files, and the ambulatory surgical center fee schedule files (ASCFS and ASCPI). Novitas Solutions said in an email bulletin that the federal CMS expects to deliver the updated MPFS files to Medicare contractors soon.
In preparation for the revised 2015 MPFS, Novitas has removed the original 2015 MPFS from their website. The updated 2015 MPFS will be available on Novitas websites as soon as directed by the federal CMS, no later than Jan. 20, 2015.
More information regarding the 2015 MPFS will be available in an upcoming edition of the MLN Connects Provider eNews.
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Department of Health Care Policy and Financing statement regarding billing of Medicaid members
HCPF reminds physicians that Medicaid members cannot be billed for any service covered by Medicaid whether or not Medicaid has paid the provider, whether claims are rejected or denied by Medicaid due to provider error, or whether the provider is enrolled in the Colorado Medical Assistance Program. The law applies even if a Medicaid member agrees to pay for part or all of a covered service.
Click here to read more on CMS.org.
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Sign up for the ACC Chronic Pain Disease Management Program
The Colorado Department of Health Care Policy and Financing will launch the ACC Chronic Pain Disease Management Program (modeled after Project ECHO programs) in March 2015. The program has been designed to improve primary care providers access to pain management specialists and to best practice treatment guidelines. Medicaid-accepting primary care providers or practices can select the best element(s) from the Chronic Pain Disease Management program for their practice.
Click here to read more on CMS.org, including how to sign up.
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Prior Authorization of Drugs - Jan. 1, 2015
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 this email if more information is needed.
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Reminder: Review Sunshine Act data by Dec. 31
The Physician Payments Sunshine Act requires manufacturers of drugs, medical devices and biologicals that participate in U.S. federal health care programs to report certain payments and items of value given to physicians and teaching hospitals.
The Centers for Medicare and Medicaid Services has been charged with implementing the Sunshine Act and has called it the Open Payments Program. As part of this program, manufacturers now are required to submit reports on payment, transfer and ownership information.
Reports on 2013 data were released to the public Sept. 30 and are available at cms.gov/openpayments. Physicians have until Dec. 31, 2014 to file disputes regarding their 2013 data. Click here for more information from the AMA.
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Colorado awarded $65 million health care innovation grant
The state of Colorado has been awarded a federal grant to create a coordinated, accountable system of care that gives Coloradans access to integrated primary care and behavioral health. Gov. John Hickenlooper announced on Dec. 16, 2014 that the state will receive $65 million in State Innovation Model (SIM) funding. Colorado will use the funding over the next four years to further develop a State Health Care Innovation Plan with a focus on improved integration of physical and behavioral health services.
Click here to read more on CMS.org.
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COPIC Insurance Company is Colorado's leading medical liability insurance provider. Three out of four physicians choose COPIC for this critically important coverage. CMS members receive a 10 percent premium discount from COPIC.
For more information, call (720) 858-6000 or visit www.callcopic.com.
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Physicians: Access practical resources for facing medical audits
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Medical audits by federal, state and private health care payers seeking reimbursement of payments often erroneously attributed to inappropriate billing are disruptive to physician practices and often cause substantial financial hardship. 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.
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Medicare participation selections due Dec. 31
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The decision period for physicians to change their Medicare participation status for 2015 ends Dec. 31, 2014. There are three Medicare contractual options for physicians: Participating, non-participating, and private contracting. Physicians can use the AMA's Medicare Participation Kit to help them evaluate their participation options and choose the direction that is suitable for their practice. The kit contains a detailed explanation of physician options, a calculator and various sample materials for communicating with patients. Click here to access the kit and for more from the AMA.
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