November 2019
Flu vaccination season has begun: Reminders from the CDC
The Centers for Disease Control and Prevention recommends annual influenza vaccination for everyone 6 months and older. Health care professionals are urged to make a "strong recommendation" to patients that influenza is a serious health threat, especially to vulnerable populations like people 65 and older, who are at high risk for hospitalization and developing serious complications. Tell your patients it is important to vaccinate as soon as possible to help protect themselves and their families. For more information, access the following resources.

UnitedHealthcare now requires "site of service medical necessity" reviews for certain surgeries
UnitedHealthcare has expanded prior authorization requirements and site of service medical necessity reviews for certain surgeries in an effort to shift outpatient surgeries to lower-cost settings outside of the hospital, a move that could put a dent in hospital revenue, according to Modern Healthcare (subscription required) and Becker's Hospital Review (no subscription required). The news sites report that as of Nov. 1 for fully insured groups in most states, UnitedHealthcare will not pay for certain planned surgeries delivered at outpatient hospital settings unless, after a review, it determines the site is medically necessary. The policy applies to more than 1,100 medical codes for a wide array of planned procedures, from colonoscopies and knee replacements to eye surgeries, biopsies, and inserting a pacemaker or heart catheter. The Modern Healthcare article quotes CEO Dirk McMahon in saying that the policy is meant to curb spending and that there is "considerable excess spending on care delivered in sub-optimal, high-cost settings." Read the UnitedHealthcare policy here.
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Online toolkit provides evidence-based resources related to perinatal substance use
The Substance Exposed Newborns (SEN) Provider Education Work Group has launched the Colorado Perinatal Substance Use Provider Toolkit and work group members urge all clinicians working with this patient population to utilize the searchable online compendium. The hundreds of evidence-based and inclusive resources provided include clinical guidelines and recommendations, data and epidemiology, and patient handouts and resources, bringing the latest from sources such as ACOG, AAP and CDC. Providers can also find tools and resources related to patient identification and communication, substance use disorder treatment, lactation, management of substance-specific impacts, community referrals, patient education, and more. Read more here.
Practice resource: Tobacco Cessation Change Package from the CDC
The Centers for Disease Control and Prevention’s new Million Hearts® Tobacco Cessation Change Package is a quality improvement resource that offers a set of the latest evidence-based changes to improve delivery of clinical interventions for the treatment of tobacco use and dependence. The tools and resources in the Change Package can be adapted and scaled to meet an organization’s needs, and are designed for use in outpatient, inpatient and behavioral health settings.  Access it here.
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COQPP Coalition: November Fast Facts
Get the latest Fast Facts education from the Colorado Quality Payment Program (COQPP) Coalition. Click here to read the November edition for information on the 2019 quality performance category, 2019 PI performance category, upcoming events and resources.
AMA releases 2020 PFS Final Rule Summary
On Nov. 1, 2019, the Centers for Medicare and Medicaid Services released the CY 2020 Revisions to Payment Policies under Physician Fee Schedule and Other Changes to Part B Payment Policies final rule. The American Medical Association has provided a summary of some of the policies the federal CMS finalized in the rule. The AMA will continue to review the rule and analyze the policies, with more information coming soon. Access the summary here.
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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.
Reminder from Novitas: Log in at least once every month to avoid losing Novitasphere access
To maintain access to the Novitasphere Portal, you must access the Novitasphere Portal at least once every 30 days. Any users that do not take this step will be considered inactive and the Novitasphere role will be removed. After a role is considered inactive and removed, you will be required to re-request the Novitasphere role in EIDM to re-gain access to Novitasphere. Access Novitasphere at https://www.novitasphere.com. If you are having trouble successfully logging in, review the Novitasphere Log In Help document or contact the Novitasphere Help Desk. The Help Desk can assist with password issues, locked Multi-Factor Authentication (MFA) devices, and adding additional MFA devices.
New Medicare card: Claim reject codes after Jan. 1
The Centers for Medicare and Medicaid Services reminds all practices that starting Jan. 1, 2020, you must use Medicare Beneficiary Identifiers (MBIs) when billing Medicare regardless of the date of service:
  • The federal CMS will reject claims submitted with Health Insurance Claim Numbers (HICNs) with a few exceptions
  • They will reject all eligibility transactions submitted with HICNs

If your practice does not use MBIs on claims after Jan. 1, you will get:
  • Electronic claims reject codes: Claims Status Category Code of A7 (acknowledgment rejected for invalid information), a Claims Status Code of 164 (entity’s contract/member number), and an Entity Code of IL (subscriber)
  • Paper claims notices: Claim Adjustment Reason Code (CARC) 16 “Claim/service lacks information or has submission/billing error(s)” and Remittance Advice Remark Code (RARC) N382 “Missing/incomplete/invalid patient identifier”

Note that if you get an eligibility transaction error code (AAA 72) of "invalid member ID," your patient's MBI may have changed. You should do a historic eligibility search to get the termination date of the old MBI and get the new MBI from the Novitas secure MBI look-up tool.
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Payer issues: We want to hear from you!
CMS, with Colorado MGMA, is gathering intelligence for advocacy efforts
As we approach the upcoming legislative session, we need to hear from you concerning issues impacting your practice. In partnership with the Colorado Medical Group Management Association, the Colorado Medical Society seeks intelligence from practices on the "front lines." Please contact us at payerissues@cms.org with your payer issues.

And remember to use the members-only Know Your Legal Rights online catalog of provider protection statutes. It contains decades of public policy victories that may assist you in your dealings with payers. Make sure all of the physicians in your practice are members of the Colorado Medical Society so you have access to this great resource today!

*Accessing Know Your Legal Rights requires a CMS member login. Member physicians’ staff can obtain their own login by contacting Tim Yanetta at tim_yanetta@cms.org .
The Colorado Medical Society is pleased to announce a new member benefit: Group dental insurance plans through Delta Dental
Poor oral health can lead to and escalate serious overall health issues. That’s why dental insurance is important and why the Colorado Medical Society (CMS) has collaborated with COPIC Financial Service Group and Delta Dental, the state’s leading dental benefits provider, to offer CMS members an affordable dental benefits program for their employees and their families. Designed for small- to medium-sized organizations, this plan offers a combination of flexibility and cost savings to fit your group’s needs. CMS worked closely with COPIC Financial Service Group to develop this association plan for its members. It's a product we believe in.  Read more here.
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