June 2018
News from the Colorado Department of Health Care Policy and Financing
Effective June 1: Timely filing period extended to 365 days

Do you still have questions on the new timely filing rules? 
Effective June 1, 2018, the timely filing period has been extended to 365 days. For questions, please reference the Timely Filing Frequently Asked Questions (FAQs), located on the Provider FAQ Central webpage

Claims with primary Medicare or other insurance/third party liability (TPL)
Providers who receive payment from Medicare or other insurance/TPL no longer need to attach the Explanation of Benefits (EOB) to the electronic claim. Providers have an additional 120 days from a Medicare payment or denial and must include the Medicare or TPL EOB date on the claim. Providers must keep the EOB and supporting documentation on file. Claims with commercial insurance/TPL must be received within 365 days with no additional extension.

Note: This timely filing extension does not apply to behavioral health claims submitted through the Behavioral Health Organization (BHO), dental claims submitted through DentaQuest or pharmacy (point of sale) claims submitted through Magellan; however, Durable Medical Equipment (DME) claims are subject to the updated 365-day timely filing policy.

New member benefit: Know Your Legal Rights database helps you defend against unscrupulous practices

Physician practices have rights under Colorado law that can be exercised to reduce health plan barriers to care, thanks to more than a decade of advocacy by the Colorado Medical Society, the statewide network of component societies and our allies. To help physicians and practice staff understand what those rights are, the Colorado Medical Society has compiled countless physician protection statutes into helpful summaries and incorporated this information into a searchable members-only online database -- Know Your Legal Rights. Go to www.cms.org/kylr to explore this invaluable resource. (Users must log into the CMS website to use Know Your Legal Rights; practice staff of a CMS member can request a login from membership@cms.org.)

Legal rights for physicians advocated for by CMS include but are not limited to: physician profiling, prior authorization and referrals, telehealth, anti-retaliation, narrow networks, timely payment, contracting, and appeals. 

View a two-minute instructional "how-to" video on the Know Your Legal Rights database here.

News from Novitas - New Medicare Beneficiary Identifier (MBI): Get it, use it

The Centers for Medicare and Medicaid Services (federal CMS) is mailing the new Medicare cards with the new MBI in phases by geographic location. Here are three ways you and your office staff can get MBIs: 
  1. Ask your Medicare patients: Ask your Medicare patients for their new Medicare card when they come for care. If they haven't received a new card at the completion of their geographic wave, refer them to 1-800-Medicare (1-800-633-4227). 
  2. Use the MAC's secure MBI look-up tool: Once the new Medicare card with the MBI has been mailed to your patient, you can look up MBIs for your Medicare patients when they don't or can't give them. Sign up for the portal to use the tool. You can use this tool even after the end of the transition period -- it doesn't end on Dec. 31, 2019.
  3. Check the remittance advice: Starting in October 2018 through the end of the transition period, Medicare will return the MBI on every remittance advice when you submit claims with valid and active Health Insurance Claim Numbers (HICNs). 

You can start using the MBIs even if the other health care providers and hospitals who also treat your patients haven't. When the transition period ends Dec. 31, 2019, providers must use the MBI for most transactions.

News from federal CMS - MBI Look-up tool clarification 

The Medicare Administrative Contractor (MAC) portal Medicare Beneficiary Identifier (MBI) look-up tool will only return an MBI if the new Medicare card has been mailed; this avoids potential confusion if the MBI is used before the beneficiary receives their new Medicare card/MBI:
  • Medicare is mailing new cards in phases by geographic location.
  • Ask your patients for their new cards when they come for care.
  • Use your MAC's secure portal MBI look-up tool: Learn about and sign up for the portal to use the tool when it is available no later than June 2018. If the new Medicare card has been mailed to your patient, you can look up their MBI if they do not have the new card when they come for care * 
  • Check your Remittance Advice (RA): Starting in October 2018 through the end of the transition period we will return MBIs on RAs when you submit claims with valid and active Health Insurance Claim Numbers.
DORA: Guaranteed coverage for pre-existing conditions part of Colorado law

"Guaranteed health insurance coverage for people with pre-existing conditions is enshrined in Colorado law," said Interim Insurance Commissioner Michael Conway, in a DORA news release. "Regardless of how the Justice Department or the Trump administration attempt to change the Affordable Care Act, the Division of Insurance will continue to enforce Colorado law and maintain this important protection for our citizens."

Commissioner Conway offered this reassurance to Colorado health insurance consumers in response to actions by the U.S. Justice Department and the Trump administration. The Justice Department said it would not defend parts of the ACA from a lawsuit brought by 20 Republican state attorneys general. In particular, the administration argued that the ACA's provisions that guarantee health insurance coverage for people with pre-existing conditions be eliminated.

The administration also suggested that the part of the ACA that requires health insurance companies to set rates based on communities - as opposed to individuals themselves - be overturned.

Read the full DORA news release here.
Colorado QPP Coalition - June Fast Facts

Reminder! MIPS preliminary performance feedback data is available through June 30, 2018!

The Centers for Medicare and Medicaid Services (federal CMS) would like to remind you that if you submitted 2017 Merit-based Incentive Payment System (MIPS) data through the Quality Payment Program website, you can review your preliminary performance feedback. Please note: this is not your MIPS final score or feedback. Your final score and feedback will be available in July 2018. You will be able to access preliminary and final feedback with the same Enterprise Identity Management (EIDM) credentials that allowed you to submit and view your data during the submission period. Don't have an EIDM account? Start the process now! Refer to the EIDM User Guide for instructions.

Opportunity: Make your voice and vision heard!

The federal CMS is seeking thought leaders in practices across the country who enjoy thinking outside of the box to find innovative ways to educate clinicians and generate an awareness about the Quality Payment Program. The Clinician Champions Program offers the opportunity to collaborate with CMS in a voluntary capacity, sharing insights and feedback from a community of peers. Current participants spend approximately 4-6 hours per month volunteering in this role. If you're eager to support clinician practice transformation while helping CMS more effectively communicate about the Quality Payment Program, then joining this program may be right for you. Click here for more information!

Several new fact sheets have recently been released!

Check out the CMS Resource Library for updated information on the Quality Payment Program Performance Categories. (scroll down through list of resources and review by date)
  • Year 2 QPP Overview Fact Sheet
  • Promoting Interoperability Fact Sheet
  • Improvement Activities Fact Sheet
  • All Payer Combination Option and other Advanced APM FAQs
Do you have an Enterprise Identity Data Management (EIDM) account?

If you do, have you double-checked to make sure your practice information is updated and you have access to the reports you need? Check out the EIDM User Guide for step-by-step instructions to help you!

Want to learn more about the Promoting Interoperability (formerly Advancing Care Information) Performance Category? Join us for our June 26 CO QPP Coalition Office Hours Webinar over the lunch hour and hear from Lauren O'Kipney with CORHIO. She will provide an overview of the 2018 participation requirements for this category and share tips/tools for success. To register for this event,  click here.
QPP group eligibility status now available

The Centers for Medicare and Medicaid Services has announced that physician practices/groups may now log into the federal CMS QPP website to check their 2018 eligibility for Medicare's Merit-based Incentive Payment System (MIPS). After groups log in, they will be able to click into a details screen to see the eligibility status of every clinician in the group (based on their National Provider Identifier or NPI) to find out whether they need to participate during the 2018 performance year for MIPS.

Unfortunately, the federal CMS will not be sending out letters to advise physicians of their eligibility status this year so checking on the QPP participation status look-up tool is the only way to determine or verify eligibility status. Eligibility rules in 2018 are different than in 2017 so status this year may be different than last. Also as is indicated in the look-up tool, exempt individual clinicians still will need to report if their group is eligible and chooses to report as a group. The look-up tool can be found here.
Make plans to attend the 2018 AHCAE National Conference, Aug. 2-4, 2018

The Association of Health Care Auditors and Educators will hold their national conference in Denver Aug. 2-4, 2018. A nationally renowned panel of speakers will address auditing and investigations; HCC, MACRA and other risk programs; health care law and compliance; reporting and monitoring; reimbursement and auditing impacts; and more.

Network with high level professionals. The event is recommended for auditors and educators, EHR users and vendors, compliance officers, coders and billers, physicians and clinicians, practice administrators, educators and lawyers, health plan professionals and HIM professionals.

This program will have prior approval from various organizations for up to 27 continuing hours (AHCAE, CCB, AHIMA and AAPC). View more information and register here.
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