January 2017
Federal CMS clarifies void of PQRS penalties due to ICD-10 update

Late last year, the Centers for Medicare and Medicaid Services announced that the 2018 PQRS penalties will not apply to any eligible professional (EP) or group practice "that fails to satisfactorily report for CY 2016 solely as a result of the impact of ICD-10 code updates on quality data reported for the 4th quarter of CY 2016."

A new set of FAQs  outline additional clarifications, including that EPs and group practices should continue to report 2016 PQRS quality measures regardless of whether they believe they will be impacted by the ICD-10 code updates. Once the 2016 PQRS reporting period is closed, the federal CMS expects to determine which EPs and groups were negatively impacted by the coding changes prior to the release of PQRS feedback reports.

According to the agency, most of the diagnosis codes that impacted 2016 PQRS measures were associated with diabetes, pregnancy, cardiovascular, oncology, mental health and eye disease, although the impacted PQRS measures "may be different depending on the reporting mechanism." The agency reiterated that those receiving a payment adjustment who believe it is due to ICD-10 code updates will have the option to submit a request for an informal review in 2017.

DEA reverses announced change to registration renewal process

The Drug Enforcement Administration (DEA) reversed a decision to change is registration renewal process, as was initially reported in the December Livewire. The DEA had previously announced that effective Jan. 1, 2017, they would no longer allow a grace period for registrants who failed to file a timely renewal application. At the urging of the American Medical Association, the DEA reversed its decision and posted a notice that it is retaining its current policy and procedures, with one minor change, regarding registration renewals.

Read more on CMS.org.
Colorado Medicaid's new system - interChange - goes live March 1st. Are you ready?

Click here for important information on the Medicaid transition including:
  • Online training
  • Web portal registration
  • Claims filing dates/deadlines
  • Payment dates/deadlines
  • PARs dates/deadlines
SIM office to release cohort 2 RFA

The SIM team will release a request for applications (RFA) next month for primary care practices to participate in the second cohort of SIM. Click here for more information on the cohort 2 RFA.

SIM will hold webinars in February and March for practices to learn more about SIM, the application process and the value to participation. We will report these dates when they are available.
CMS online payment/member renewal process - information for administrators

Anyone can access and renew memberships via credit card payment by going to CMS.org and clicking on the green icon on the right side of the screen titled "Renew Online."

Once there, enter the physician's last name and either their CMS ID number or their Colorado Medical License number. This will bring you to a payment screen whereby you can select the invoice items to pay. Then click "continue" and it gives them a screen with a subtotal to verify. Click "pay now" if correct. The payment screen will come up to fill in additional information for billing on the credit card, most important the billing zip code.

This process applies to individual memberships. Group processing is still in the development stage. Questions? Contact tom_wilson@cms.org.
Workers' Comp Claims Newsletter - January 2017

The Colorado Department of Labor and Employment Division of Workers' Compensation has released their January 2017 Claims Newsletter. Click here to read more about rules updates, events and the 2016 year in review. 
Quality Payment Program resources

The Centers for Medicare & Medicaid Services recently posted new resources to the Quality Payment Program website to help eligible clinicians and data submission vendors successfully prepare to participate in the program. According to the agency email announcement, CMS encourages these eligible clinicians, registries, qualified clinical data registries (QCDRs), and electronic health record (EHR) vendors to visit the website to review the new materials and information, including the following.
Judge blocks Aetna-Humana merger

In a landmark win for organized medicine and the nation's patients, federal judge John D. Bates blocked the proposed Aetna-Humana merger. The judge found that the merger would have substantially lessened competition in Medicare Advantage and commercial health insurance markets. This is an extraordinarily well documented, comprehensive, fact-based ruling by U.S. District Judge John D. Bates, which acknowledges that meaningful action was needed to preserve competition and protect high-quality medical care from unprecedented market power that Aetna would acquire from the merger deal. The decision is a historic, stunning affirmation of the position urged by the American Medical Association (AMA) and the 17-state medical association antitrust coalition members, which includes the Colorado Medical Society. The court's ruling sets a notable legal precedent by recognizing Medicare Advantage as a separate and distinct market that does not compete with traditional Medicare. This was a view advocated by the AMA, as well as leading economists.

The AMA and its coalition partners worked tirelessly to oppose this merger: sending comprehensive, evidence-based advocacy letters to the U.S. Department of Justice (DOJ) and state regulators after the merger was announced in July 2015; engaging like-minded stakeholders like the American Hospital Association and various patient coalitions, as well as the National Association of Attorneys General; conducting extensive physician surveys to gauge physician concern about the merger and presenting the DOJ and state regulators with compelling survey results; testifying in or submitting memoranda in various state insurance department hearings and/or attorney general investigations, and making that, and other evidence and testimony, available to the DOJ and state regulators; securing outside experts to support arguments and strip down those of the insurers -- all demonstrating how the merger would harm patients and physicians.

The ruling on the Anthem-Cigna merger is expected very soon.
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