Final Colorado workers' compensation medical fee schedule issued
The Colorado Division of Workers' Compensation (DOWC) recently issued final utilization standards and the final Colorado Workers' Compensation Medical Fee Schedule that affect all workers' compensation billing, and will go into effect Jan. 1, 2016. Among several significant changes are that these rules and regulations require payers to adopt Medicare's Resource-Based Relative Value Scale (RBRVS) method of payment. You should be aware of regulatory changes that will affect your billing, coding and processes, and make any necessary business adjustments now to ensure a smooth transition.
The DOWC set out to ensure that the transition to the new fee schedule and payment system would be budget-neutral overall; however, providers should examine the rules closely and analyze specifically how fee schedule changes may impact their payments for certain specialties. Read more in a DOWC bulletin.
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What you need to know on final meaningful use rulings
Last month the federal Centers for Medicare and Medicaid Services released the final rule for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. CORHIO released a report on what is and isn't changing as a result. What isn't changing: All eligible professionals and hospitals must reach all objectives using 2014 certified electronic health record technology, eligibility requirements remain the same, and Medicaid is accepting new providers for incentive payment (Medicare is not). Read more on CORHIO's website here; plus, download resources from their Health IT Boot Camp and access additional meaningful use resources. The federal CMS recently released three new FAQs, providing clarification on how to attest to certain measures for health information exchange, patient electronic access, and other objectives that require patient action.
- For the Health Information Exchange objective for meaningful use in 2015 through 2017, may an eligible professional, eligible hospital or critical access hospital count a transition of care or referral in its numerator for the measure if they electronically create and send a summary of care document using their certified EHR technology to a third-party organization that plays a role in determining the next provider of care and ultimately delivers the summary of care document? See FAQ 12817.
- If multiple eligible professionals or hospitals contribute information to a shared portal or to a patient's online personal health record, how is it counted for meaningful use when the patient accesses the information on the portal or PHR? See FAQ 12821.
- In calculating the meaningful use objectives requiring patient action, if a patient sends a message or accesses his/her health information made available by their eligible professional, can the other eligible professionals in the practice get credit for the patient's action in meeting the objectives? See FAQ 12825.
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ICD-10 transition moves forward
Now that ICD-10 has been implemented, the Centers for Medicare and Medicaid Services has been carefully monitoring the ICD-10 transition and has announced that claims have been processing normally. Between Oct. 1-27, 4.6 million claims per day were submitted and 10.1 percent were denied, in line with historical baselines. Find more information on the first month of Medicare Fee-For-Service (FFS) claims processing in this fact sheet. Please let the Colorado Medical Society know of any issues you experience by emailing [email protected].
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Novitas: Reminder on the correct process of returning medical review documentation requests
Novitas Solutions' Medical Review Department has noticed an increase in the improper submission of documentation in response to an Additional Documentation Request (ADR). Some providers submit redetermination forms in response to an ADR; redetermination forms should never be used to submit documentation or records requested by an ADR but should only be utilized if the provider disagrees with the initial claim determination. Novitas encourages all practices to take an opportunity to review the information provided in How to Correctly Submit Documentation for Additional Documentation Requests (ADRs).
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Connect for Health Colorado enrollment opened Nov. 1
Open enrollment for Connect for Health Colorado opened Nov. 1. The health insurance exchange is reporting that, in just the first two weeks, more than 21,000 Coloradans enrolled in health coverage for 2016 either through Connect for Health Colorado, Medicaid or Child Health Plan Plus (CHP+). Patients must complete enrollment by Dec. 1 to have coverage by Jan. 1. Open enrollment for Connect for Health Colorado runs through Jan. 31. The exchange is alerting customers to call a health plan they are considering to confirm their provider is in the network for a specific plan (EPO, PPO, HMO). They advise that tools on the exchange website can provide insight but "it's best to ask your health plan if your medical provider is in their network." Visit the Connect for Health Colorado website at connectforhealthco.com.
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Take Credit Cards? Is Your Practice Ready for the Oct. 15 EMV Deadline?
Important! What your practice needs to know about switching to EMV: Click here.
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Compliments of CMS: Reduce patient callbacks, HIPAA compliant, RX Savings up to 75%, click for free customization COLORADO DRUG CARD.
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2016 Medicare fee schedules now available from Novitas
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The Medicare Physician's Fee Schedule for 2016 is now available for download in PDF, Excel, and Text formats from the Novitas Solutions website. 2016 procedure codes will also be individually searchable through their Fee Lookup Tool beginning on Jan. 5, 2016. |
Healthy Transitions Colorado presents: "The Why's and How's of Medication Safety" Webinar: Nov. 20, 11 a.m. - 12 p.m. MT Hosted by the Center for Improving Value in Health Care Register here
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Health insurance exchange information
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