March 2016
Medicare provider enrollment revalidation: What's next?

The Affordable Care Act established a requirement for all enrolled providers/suppliers to revalidate their Medicare enrollment information under new enrollment screening criteria. Failure to respond to the revalidation requirement will result in the Medicare provider number being deactivated. If that happens, the provider is required to reapply. Any services provided to a Medicare beneficiary during the period of deactivation is the provider's liability. Learn more here.

The federal Centers for Medicare and Medicaid Services has completed the initial round of revalidations and will resume regular revalidation cycles in accordance with 42 CFR 424.515. To streamline the revalidation process and reduce provider/supplier burden, the agency has implemented several revalidation processing improvements. Learn more about these improvements by accessing the archived slides and audio from a March 1 national provider call here. Learn more about revalidations on the federal CMS website here.
All Medicaid providers must revalidate this year

Additionally, all providers who serve Colorado Medicaid and CHP+ beneficiaries (even those providers who do not submit their own claims or are not currently enrolled directly with Medicaid) have to revalidate and enroll this year. They are encouraged to do so as soon as possible through the Online Provider Enrollment (OPE) tool. The Department of Health Care Policy and Financing is launching its new claims management system, the Colorado interChange, on Nov. 1, 2016. Starting on that date, claims and encounters submitted by providers who have not enrolled and/or revalidated will be denied.

Find more information online at and
2015 EHR Meaningful Use hardship exemption deadline extended

The deadline to apply for a Meaningful Use (MU) hardship exemption has been extended to July 1, 2016 from its original deadline of March 15. The AMA is encouraging ALL physicians who participated in the 2015 Medicare MU program to apply for the hardship.

The application and additional instructions are available on the federal CMS EHR Incentive Programs website. The AMA has made available step-by-step instructions for completing the hardship exception application; click here to access it.

Submission of a hardship exception application does not prevent providers from attesting and receiving an incentive payment if meaningful use requirements are met. In essence, the hardship exemption will act as a safety net. Therefore, physicians who believe that they met the MU requirements for the 2015 reporting period should still apply for the hardship protection.

Note that the program operates on a two-year look-back period, meaning that physicians who are granted an exception for the 2015 program will avoid a financial penalty for 2017. The federal CMS has stated that it will broadly accept hardship exemptions.
New look coming to Medicaid in May, Medicaid cards in March

Starting May 2016, Colorado Medicaid will change its name to "Health First Colorado". The new name and logo aims to better represent Colorado's fresh approach to public health care coverage.

Beginning as early as March 20, 2016, cards printed from will have the Health First Colorado name and logo. In June 2016, all hard copy cards sent to newly enrolled members will reflect the Health First Colorado name and logo. Current cards are still valid; members do not need to request new cards. As a reminder, members are only required by the department to furnish their photo ID at appointments; Health First Colorado cards are not required to receive services. Providers should verify a member's identity and eligibility at each appointment. Please ensure that all front desk and billing staff are aware of this change. Learn more about Health First Colorado at
Medicare to test new payment models for Part B drugs

Last week the Centers for Medicare and Medicaid Services released a proposed rule to test different payment models for reimbursing Medicare Part B drugs administered in physician offices and hospital outpatient departments (HOPDs). Currently, the federal CMS pays practices and HOPDs the average sales price (ASP) of the drug plus a 6 percent "add-on" payment. Later this year, Medicare would pay ASP plus 2.5 percent and a flat payment of $16.80 per day per drug payment to physician practices and HOPDs in certain geographic areas to determine whether this change affects prescribing incentives.

CMS is also proposing to test additional drug payment models starting in 2017, such as eliminating patient cost-sharing and establishing reference prices. Stakeholders may submit comments on the proposed rule through May 9, 2016. View the federal CMS's news release for more information.

Last chance: Attend the MGMA/AMA Collaborate in Practice Conference March 20-22 in Colorado Springs

It's not too late to plan to join the American Medical Association and the Medical Group Management Association for the MGMA/AMA Collaborate in Practice Conference, March 20-22, at the Broadmoor Hotel in Colorado Springs, Colo.

Leaders must start doing things differently to affect positive change in medical organizations. MGMA has partnered with the AMA to create a unique learning environment that focuses on the partnership between practice administrators and physicians to pave the way for future success, promoting better communication and respect of individual talents.

Register today.
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