October 2016
Final MACRA rule issued

The Centers for Medicare and Medicaid Services issued a final rule implementing the Medicare Access and CHIP Reauthorization Act (MACRA). Initial analysis by the American Medical Association shows that the federal CMS responded to many of the concerns expressed by physicians about the proposed rule issued last spring. For example:
  • Details are provided about the 2017 transition period announced in September. The only physicians who will experience payment penalties in 2019 are those who choose to report no performance data next year, and those who report for at least 90 days will be eligible for positive payment adjustments.
  • The low-volume threshold that exempts physicians from all performance reporting has been increased from $10,000 in annual Medicare revenue and less than 100 Medicare patients to $30,000 in revenue or 100 patients. CMS estimates that this change will exempt 32.5 percent of physicians and other clinicians from the program.
  • Performance reporting requirements have been further reduced, and the resource use component of the Merit-based Incentive Payment System (MIPS) has been reweighted to zero for 2017.
Summaries, fact sheets and other resources are available on the agency's website. In the coming days, the AMA will make additional resources available on its MACRA web page, which can be accessed at www.ama-assn.org/go/medicarepayment.
Resource for notices of nondiscrimination

As the Colorado Medical Society reported in last week's ASAP newsletter, most health care providers must post and publish new mandatory nondiscrimination statements and taglines by Oct. 17. Covered physicians must:
  • By Oct. 17 post a notice of nondiscrimination and taglines in the top 15 languages in the state.
  • Designate a compliance coordinator and adopt grievance procedures (applicable to group practices with 15 or more employees).
  • Covered entities are encouraged to develop and implement a language access plan.
One company, CTS Language Link, can provide translation services for a fee. Visit their website at www.ctslanguagelink.com or call (855) 295-9177 for more information. According to their representative, the cost to use the firm's translation service is $1.60 per minute and there is no minimum monthly fee. Note that this does not represent an official endorsement by CMS.
Medicaid "Go Live" date has been postponed until March 1, 2017

The Colorado Department of Health Care Policy and Finance announced that the conversion date for moving to the new Medicaid Management Information System (MMIS), the Colorado interchange, has been postponed until March 1, 2017. This will allow more time for providers to complete the revalidation process, and allow additional time for training on the web portal as well as testing. The Department wants to ensure that providers are not adversely impacted by the system change.

If you haven't completed your revalidation use this link to find resources and get started. If you have completed your revalidation you are encouraged to begin the online training courses for use of the new web portal. If you missed a live session, the recorded sessions will be available later this month. Additional provider resources can be found here.
Novitas: Provider supplier revalidation information

Novitas has been asked by the Centers for Medicare and Medicaid Services to provide information on provider supplier revalidation. Please see the posted letter, here, on the Colorado Medical Society website. Any questions or concerns regarding this educational letter should be directed to Andrea King, Novitas Provider Outreach and Education, at andrea.king@novitas-solutions.com or 717-526-6392.
Physician Compare preview period now open

The Physician Compare 30-day preview period began on Oct. 12 and will end on Nov. 11. The preview period provides clinicians and group practice representatives an opportunity to preview their 2015 performance scores as they will appear on Physician Compare in late 2016.

To learn more about the preview period and which measures are targeted for public reporting later this year, select one of the following:
There are two final Physician Compare public reporting information sessions on Oct. 18 and 20. These webinars will present information about Physician Compare, public reporting, and how to preview your performance scores. Click here to register.

If you have any questions about public reporting or the preview period, please contact PhysicianCompare@Westat.com.
New electronic appeals system: MOD E-File available

The Medicare Operations Division Electronic Filing System (MOD E-File) launched on Oct. 1, allowing appellants to file electronic requests for review with the Medicare Appeals Council. Appellants, parties, and the public can also use MOD E-File to check the status of appeals. Visit the MOD E-File website, dab.efile.hhs.gov/mod, to learn more about MOD E-File and how to use it.
Billing for influenza: New CPT Code 90674

The American Medical Association issued a new Current Procedural Terminology (CPT) code for influenza vaccine Flucelvax, CPT 90674, effective Aug. 1, 2016 for Medicare claims. However, Medicare claims processing systems will not be able to accept the new code until Jan. 1, 2017. Until this time, you may hold claims containing CPT 90674. Alternatively, Medicare Administrative Contractors (MACs) may direct use of a Not Other Classified (NOC) code to allow billing for the vaccine for dates of service on or after Aug. 1 and before Jan. 1. Check with Novitas for this information and other interim billing instructions. Finally, if you bill institutional claims, note that code CPT 90674 will be implemented on Feb. 20, 2017.
CMGMA/CMS webinar on Medicaid changes - Oct, 26, 12 - 1 p.m.

Medicaid system change is coming! Colorado Medicaid is doing more than changing its name to Health First Colorado, the system is changing March 1, 2017. By demand, a second meeting has been arranged; please join us for a special webinar with members of the transition team. This is your opportunity to hear from representatives of the Hewlett Packard IT team and the Colorado Department of Health Care Policy & Finance. You will be given a preview of what to expect and how you can escalate any potential problems. Click here to register.
CME: Zika Virus Update webinar, Oct. 20

The Tri-County Health Department and Arapahoe-Douglas-Elbert Medical Society have teamed up to provide a CME-approved webinar opportunity, Zika Virus Update, on Thursday, Oct. 20, 2016, 12 - 1 p.m. It is open to all physicians. The Colorado Medical Society is offering CME credit to physicians who attend and complete an evaluation. Click here for more information and to register.
Connect for Health Colorado open enrollment starts Nov. 1

Open enrollment for 2017 health insurance plans purchased through the state health insurance exchange, Connect for Health Colorado, begins Nov. 1. New customers can buy plans and current customers can renew or change their plans. The enrollment period runs through Jan. 31, 2017. Health coverage can start as soon as Jan. 1, 2017 for consumers who sign up by Dec. 15, 2016.
Workers' compensation: Dates for fall listening and rule update seminars

The Division of Workers' Compensation has announced the dates, locations and times for the division's upcoming annual fall Listening and Rule Update seminars. The registration process is now online. Click here to sign up for any of the dates listed below. Each person attending must register online for the specific event they will be attending. As always, these seminars are free.

There will be two telephonic presentations this year: one geared toward the payer and one geared toward the providers. Be sure to sign up for the provider teleconference so DWC can address questions within the context of your role in the system.

Colorado Springs
Oct. 21, 1 - 5 p.m.
Memorial Administrative Center, Class Room B
2420 E. Pikes Peak, Colorado Springs, CO 80909

Oct. 28, 1 - 5 p.m.
Arapahoe Community College, Lecture Hall
5900 South Santa Fe Dr, Littleton, CO 80160

Nov. 4, 1 - 5 p.m.
Community College of Aurora, Rotunda
710 Alton Way, Aurora, CO 80230

Nov. 8, 1 - 5 p.m.
Medical Center of The Rockies, Longs Peak Room
2500 Rocky Mountain Av, Loveland, CO 80538

Provider Teleconference
Nov. 30, 2016, 1 - 5 p.m.
In This Issue

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