April 2015
Participate in AMA provider survey on use of virtual payments
To support ongoing advocacy efforts on provider payment issues, the American Medical Association (AMA), American Dental Association (ADA) and Medical Group Management Association (MGMA) are conducting a provider survey seeking information regarding health plan usage of virtual credit cards and Automated Clearing House Electronic Funds Transfers (ACH EFT).

The survey will allow physicians and their staffs to share electronic payment issues and concerns and will be used to support ongoing advocacy efforts on provider payment issues. It will take fewer than five minutes to complete, and all responses will be kept strictly confidential. Click here for more information and to access the survey.
HCFP: Enhanced primary care rates now available
Effectively immediately, the enhanced payment rates for evaluation and management (E&M) and vaccination codes for Medicaid beneficiaries are available and the difference for all claims submitted since Jan. 1 will be retroactively paid, the Colorado Department of Health Care Policy and Financing announced.

It was announced last year that Colorado Medicaid will reimburse covered office visit (E&M) and vaccine administration procedure codes at a rate equal to 100 percent of the December 2014 Medicare reimbursement rate from Jan. 1, 2015 to June 30, 2016. This adjustment was previously delayed as HCFP awaited approval by the Centers for Medicare and Medicaid Services before being able to load the enhanced rates into their claims processing system.

The new rates are now available to all enrolled providers who submit fee schedule claims for office visits or vaccine administrations; providers are not required to attest to providing primary care.

Click here to read more on CMS.org.
Draft rule would ease EHR program demands
The Centers for Medicare and Medicaid Services intends to give more flexibility to hospitals, office-based physicians and other health care providers to meet federal targets for the meaningful use of electronic health records, according to a proposed rule the agency issued last week.

Chief among the changes in the 210-page draft rule is a proposal to standardize the 2015 reporting period for the EHR incentive-payment program to 90 consecutive days of achieving meaningful-use criteria. Under the current rules, some providers risk losing incentive payments or face Medicare reimbursement penalties if they fail to meet meaningful-use targets for a full calendar or fiscal year.

Click here to read more from Modern Healthcare.
Mark your calendar for Colorado Payer Day - May 14
Join Pikes Peak PAHCOM and CMGMA for the 2015 Colorado Payer Day, May 14, 10 a.m. - 2 p.m., at Cielo at Castle Pines in Castle Rock. This collaborative event will feature presentations and Q&A sessions with Colorado's top insurance payers. The keynote speaker is Colorado Insurance Commissioner Marguerite Salazar.

Take advantage of this opportunity to network with key representatives from each of the payers. The cost to attend is $25 for PP-PAHCOM members and staff, and $25 for CMGMA members and staff. It is $50 for nonmembers. Click here for more information.
WEDI launches industry standard for practice management system vendors
The Workgroup for Electronic Data Interchange (WEDI) has announced the launch of the Practice Management System Accreditation Program (PMSAP), collaboratively developed with the Electronic Healthcare Network Accreditation Commission (EHNAC).

PMSAP offers the first and only evaluation of practice management system vendors in the areas of privacy, security, mandated standards and operating rules, and key operational functions. Additionally, the accreditation process assesses health information and oversight for meeting privacy and security, HIPAA and ACA requirements, as well as focuses on technical performance, business processes and resource management. Plus, the program provides the PMS vendor readiness to support and implement ICD-10 and therefore a level of assurance to the provider community.

The new program is guided by a volunteer advisory committee, which represents every major health care association as well as representatives of some of the biggest PMS vendor names in the industry. Click here to read more.
Feds conduct successful Medicare FFS ICD-10 End-to-End Testing Week
From Jan. 26 through Feb. 3, 2015, Medicare Fee-For-Service (FFS) health care providers, clearinghouses, and billing agencies participated in the first ICD-10 end-to-end testing week with all Medicare Administrative Contractors (MACs) and the Durable Medical Equipment (DME) MAC Common Electronic Data Interchange (CEDI) contractor. The Centers for Medicare and Medicaid Services reports they accommodated all volunteers, which represented a broad cross-section of provider, claim, and submitter types.

"Approximately 660 providers and billing companies submitted nearly 15,000 test claims," the agency said in a news bulletin. "This successful week of testing continues to put us on course for successful implementation of this important initiative that better reflects modern practice of medicine by Oct. 1, 2015."

Click here to read more on CMS.org.
Resource: Payment for Chronic Care Management Services
Beginning Jan. 1, 2015, Medicare pays separately under the Medicare Physician Fee Schedule (PFS) under AMA CPT code 99490 for non-face-to-face care coordination services furnished to Medicare beneficiaries with multiple chronic conditions.

CPT 99490, chronic care management services, is defined as at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional per calendar month. The provider must manage two or more chronic conditions expected to last at least 12 months or until the death of the patient; the patient must be at significant risk of death, acute exacerbation/decompensation or functional decline due to the conditions; and the physician must have a comprehensive care plan established, implemented, revised or monitored.

Click here to access a comprehensive fact sheet on the newly payable chronic care management (CCM) service, including background, eligible providers and patients, and Medicare PFS billing requirements.
Medicare Learning Network offers suite of products and resources for billers and coders
The Medicare Learning Network has made available a suite of more than 50 products - edited from the comprehensive MLN Catalog of products - geared to provide health care reimbursement professionals with information about new and changing Medicare Program policies and procedures.

MLN products can help physicians and their staffs understand how to submit claims correctly the first time, and strengthen knowledge of Medicare Program basics, business requirements, benefits and coverage, and federal initiatives and incentives.

Click here to open a listing of the products, then roll your cursor over one of the titles and click to be linked to a product. You can download information, listen to a podcast, research an article through MLN Matters, or even sign up for a web-based training course that offers continuing education credits.
In This Issue

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Webinar: Chronic Health Issues Affecting Hispanic Patients
Wednesday, April 22, 12-1 p.m.

Hosted by the West Virginia Medical Institute

Click here to register

COPIC HR programs
  • HR Roundtable, Tuesday, May 19 at COPIC
  • Employment Case Law-Post-Mortem, Wednesday, Aug. 19 at COPIC
  • Creating a Professional Work Environment, available to be held on-site at medical practices and facilities by request
Click here to register.

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

Health insurance exchange information
Latest bulletins
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Denver, CO 80230