May 2019
CMS and allies achieve prior authorization reform
A hard-fought legislative session ended May 3 and one of the greatest victories for physicians and practices this year came from a negotiation between CMS (along with several specialty societies) and health plans that led to the passage of HB19-1211, Prior Authorization Requirements Health Care Service. This bill will streamline the overall process of prior authorization by reducing the time for response to a non-urgent request from 15 days to five days; ensuring that services that have been approved cannot be retrospectively denied; and that an approved prior authorization request remains valid for at least 180 days and continues for the duration of the prescribed course of treatment, among other provisions. Read more about outcomes from the 2019 Colorado legislature here.
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Support employees! MINES' Practice Assistance Program offers CMS members 24/7 access to free confidential counseling, resilience resources, legal services, wellness coaching, and unlimited work/life referrals. Phone: 800.873.7138, email or visit
COQPP May Fast Facts: Spend five minutes reading the latest on the program
The Colorado Quality Payment Program Coalition (COQPP) has released their May 2019 Fast Facts, giving you all of the information you need to know for just five minutes of your time. This month’s Fast Facts include the following.

The Medicare Promoting Interoperability Program Hardship Exception Application for Eligible Hospitals and Critical Access Hospitals is now available

The federal CMS requires that all eligible hospitals and critical access hospitals (CAHs) use 2015 Edition certified electronic health record technology (CEHRT) to meet the requirements of the Promoting Interoperability Programs. The agency mandates downward payment adjustments be applied to eligible hospitals and CAHs that are not meaningful users of CEHRT.

Eligible hospitals and CAHs may be exempt from Medicare penalties if they can show that compliance with the requirement for being a meaningful EHR user would result in a significant hardship. To be considered for an exemption, eligible hospitals and CAHs must complete a hardship exception application and provide proof of hardship.

The application for eligible hospitals and CAHs is now available online as a web-based application and can be found here.

Developments in the QPP Look-up Tool for APM entities

The federal CMS has added secure access to the Quality Payment Program Eligibility & Reporting page for Alternative Payment Models (APMs). Alternative Payment Models (APM) entities have requested the ability to download a participant list of their clinicians. APM entities are the organizations that participate in the Alternative Payment Model and are not always the billing organization.

The new capabilities will allow APM entities to download a list of their clinicians. The APMs supported are the Shared Savings Program, Next Generation ACO, and Comprehensive Primary Care Plus models.

Updated eCQM Specifications and eCQM Materials for 2020 reporting now available

The federal CMS has posted the electronic clinical quality measure (eCQM) specifications for the 2020 reporting period for Eligible Hospitals and Critical Access Hospitals, and the 2020 performance period for Eligible Professionals and Eligible Clinicians. The agency has updated eCQMs for potential inclusion in the following programs:

  • The Hospital Inpatient Quality Reporting (IQR) Program
  • The Medicare and Medicaid Promoting Interoperability Programs
  • Quality Payment Program: The Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs)
  • Comprehensive Primary Care Plus (CPC+)

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Telligen QPP resources
Explore Telligen’s 2019 QPP Toolkit for a suite of QPP references to help you be strategic with your QPP activities. The latest: Improvement Activities: What's New for MIPS 2019.

Plus, listen to the new QPP Podcast: A Closer Look at the Cost Performance Category. Episode 4 with MGMA consultant Pamela Ballou-Nelson, RN, MSPH, CMPE, PhD, explores the cost category as a part of the Merit-based Incentive Payment System (MIPS), including what to report and how measures are scored. Access it 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.
Cofinity/Health First claim migration notification
Cofinity Health Care Solutions and Health First are merging and their claims processes will be changing. Though you’ll need to change how you submit claims with them, they assured providers in an email notice that they will use a process most rental networks already use. Click here for more information on how the system will change.

Providers should prepare to send your claims directly to the payer, instead of Cofinity. You can even start sending claims to certain migrated payers now. To find which payers will accept your claims now, log in to, access 'Tools' and locate the migrated payer list. The list will be updated monthly. After Nov. 30, 2019 Cofinity will no longer be able to accept claims directly from you. All claims will need to go through the payer first. To identify the right payer, review the member’s ID card. The ID card will tell you exactly where to send your claim.
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New Medicare Card: Need an MBI for a patient?
You can find the Medicare Beneficiary Identifier (MBI) on the remittance advice of a prior claim or from your Medicare Administrative Contractor’s portal. Update your system and use it on the claim. Still having problems? Review the one-page Understanding the MBI Medicare Learning Network Educational Tool to learn about alpha and numeric characters that are used, and which letters are never used.

Starting Jan. 1, 2020, Medicare will only accept claims submitted with the Medicare Beneficiary Identifier (MBI). Medicare will reject any claims submitted with the Health Insurance Claim Number (HICN) with a few exceptions. Review the MLN Matters Article to learn about getting and using the MBI.
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