July 2019
Survey: Please give your feedback on the CAQH Index by July 22
CAQH is currently collecting physician responses to its annual CAQH Index, a benchmarking survey designed to measure progress on the industry’s movement to electronic transactions.  Follow this link to complete the survey. Providers who complete the Index will receive a $100 gift card. The survey is open until July 22. Questions? Contact Kristine Burnaska, PhD, at kburnaska@caqh.org.
COQPP Coalition: July Fast Facts
Your Colorado Quality Payment Program Coalition (COQPP) has released their five fast facts for July, helping you stay on top of your QPP compliance with helpful links, resources and tips. In this month's edition, find a link to feedback reports for the 2018 performance year, the connect as a clinician document and how to request a targeted review of your feedback report, plus two upcoming events that take maximizing your quality score "beyond the basics," and other new QPP resources. Read more here.
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Provider enrollment alert: Issues resulting from recent Provider Enrollment, Chain and Ownership System (PECOS) release 
On June 30, 2019, PECOS Release 7.37 was implemented. This release was prescheduled and designed to bring efficiencies to Medicare Administrative Contractors (MACs) and providers who use PECOS. While many aspects of the release were successful, a small component associated to changes made to existing and new group reassignments was found to be problematic post-implementation. As a result, data flows from PECOS to the Multi-Carrier System (MCS) for these changes have been delayed for all MACs to proactively correct the identified issue.  
The Centers for Medicare and Medicaid Services has assembled a team with accountability for resolving this issue. The team is working to resolve the issue. Potential questions and answers:
Q: Can I continue to submit enrollment applications?
A: Yes, please continue to submit applications. Internet-based PECOS applications are the quickest method of submission and processing, although you may submit either via Internet-based PECOS web or paper applications. Application processing will continue at each of the MACs as normal. Please also continue to respond to requests for additional information.
Q: My PECOS enrollment record has been approved, but when I attempt to enroll with Electronic Data Interchange (EDI), they indicate my provider/supplier is not present in the claims system. Is additional action needed on my part?
A: No, we will update you when a fix has been deployed and at that time you can enroll with EDI.
Q: My PECOS enrollment record has been approved, but when I submit claims, they cannot be processed because the NPI/PTAN is not present in the claims system. Is additional action needed on my part?
A: No, we will you when a fix has been deployed and at that time you can resubmit claims for processing.

Watch for more information from Novitas or CMS coming soon.
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Payment Error Rate Measurement (PERM) audit
Starting this summer, the Centers for Medicare and Medicaid Services will begin its Review Year 2020
Payment Error Rate Measurement (PERM) audit on Health First Colorado (Colorado's Medicaid Program) and Child Health Plan Plus (CHP+) claims. The federal CMS will randomly select a set number of paid or denied claims from July 1, 2018, to June 30, 2019, for its review.

The agency has contracted with AdvanceMed, an NCI Company, who will contact providers by phone and letter to request medical records that support claims providers submitted for payment. AdvanceMed will review the medical records to determine if the payment for the corresponding claim was justified. Providers have 75 calendar days to provide medical record documentation to AdvanceMed.

If the initially submitted medical record documentation is not sufficient, AdvanceMed will contact providers to request additional documentation. Providers have 15 calendar days to provide the additional
documentation. If documentation is not provided or is insufficient, the provider’s claim(s) will be considered in error, and the Department of Health Care Policy and Financing will initiate recovery for the monies associated with the claim from the provider. The reasons why the provider did not submit proper documentation will be investigated.

For more information, visit the PERM webpage of the federal CMS website and the PERM webpage of HCPF’s website. Questions? Email PERMProviders@cms.hhs.gov or contact Matt Ivy at Matt.Ivy@state.co.us or 303-866-2706.
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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.
New Medicare card: Transition period ends in less than six months
Starting Jan. 1, 2020, all providers must use the Medicare Beneficiary Identifier (MBI). The Centers for Medicare and Medicaid Services will reject claims submitted with the Health Insurance Claim Number (HICN), with a few exceptions and reject all eligibility transactions.

Many providers are using the MBI for Medicare transactions. For the week ending July 5, providers submitted 76 percent of fee-for-service claims with the MBI. Protect patients’ identities by using MBIs now for all Medicare transactions.

Don’t have an MBI?

  • Ask your patients for their card. If they did not get a new card, give them the Get Your New Medicare Card flyer in English or Spanish.
  • Use your Medicare Administrative Contractor’s look up tool. Sign up for the Portal to use the tool.
  • Check the remittance advice. We return the MBI on the remittance advice for every claim with a valid and active HICN.

For more information, see the MLN Matters Article.
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Federal CMS seeks ideas for reducing “red tape” that takes away from patient care
The Centers for Medicare and Medicaid Services issued a Request for Information (RFI) seeking new ideas from the public on how to continue the progress of the Patients over Paperwork initiative. Feedback must be submitted by Aug. 12. Since launching in fall 2017, Patients over Paperwork has streamlined regulations to significantly cut the “red tape” that weighs down the health care system and takes clinicians away from their primary mission of caring for patients. As of January 2019, CMS estimates that through regulatory reform alone, the health care system will save an estimated 40 million hours and $5.7 billion through 2021. Read more here.
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