September 2019
Payer issues: We want to hear from you!
CMS, with Colorado MGMA, is gathering intelligence for advocacy efforts
It has been getting harder to keep track of all the payer policy changes. There seems to have been a flurry of them this year (e.g., Anthem, UnitedHealthcare, etc.) that will likely impact your practice. The Colorado Medical Society advocates on behalf of physician practices with payers, regulators and legislators to reduce your hassle factors, ensure fair reimbursements, and ensure proper processing of claims. We need to hear from you about the payer issues you are facing! 

Did you know you have access to a searchable catalog of provider protection statutes that you can use in disputes with health plans? Know Your Legal Rights* 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!

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." We need to hear from you! Please contact us at payerissues@cms.org with your payer issues.

*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
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FDA presents new webpage on respiratory illnesses associated with use of vaping products
CDPHE reports current Colorado outbreak at 6 cases
The U.S. Food and Drug Administration (FDA) and the U.S. Centers for Disease Control and Prevention (CDC) are working closely with state and local health officials to investigate incidents of severe respiratory illnesses associated with the use of vaping products. While the investigation is ongoing, FDA has created a Consumer Update to provide information for consumers to help protect themselves, as well as a new Lung Illnesses Associated with Use of Vaping Products webpage to provide an overview of these incidents and FDA’s actions to date, as well as recommendations for consumers, health care providers, and state health departments. Though data has not yet been conclusive, the FDA recommends consumers avoid products that contain Vitamin E acetate and tetrahydrocannabinoil (THC)-containing vaping products.

The Colorado Department of Public Health and Environment and the American Medical Association go one step further, encouraging people to avoid all e-cigarette products. CDPHE asks clinicians and local health departments who become aware of cases of this outbreak to report them to the Disease Reporting Line: 303-692-2700 or 303-370-9395 (after hours). If the patient has the product in hand, providers should safely collect and hold it, and contact CDPHEs Disease Reporting Line so that the product can be collected by CDPHE for potential testing.
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Colorado Division of Workers' Compensation: Rules 16&18 updates seminars to be held in October and November
The Division of Workers' Compensation offers training sessions to update physicians and practice staff on the important changes to Rules 16 & 18 (the medical fee schedule). This year's sessions will be held both in person in Colorado Springs, Littleton, Denver and Fort Collins and by webinar during October and November. For more information and to register, please visit the DOWC website. The Division of Workers’ Compensation is statutorily required to review the medical fee schedule on an annual basis. The Division hosts a series of annual stakeholder meetings to assist in this process, and the DOWC says these meetings have helped make Colorado a national role model for stakeholder collaboration in payment policy development. Check their website for upcoming events.
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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.
CMS attends stakeholder meetings on draft out-of-network regulations
The Division of Insurance is holding two stakeholder meetings to discuss the recently released draft regulations on out-of-network services that have been developed in accordance with the passage of House Bill 19-1174. The first meeting was held Wednesday, Sept. 17 to discuss the establishment of a carrier payment arbitration program for non-participating providers and carrier disclosures for potential emergency and non-emergency out-of-network services. The second meeting was held Thursday, Sept. 19 to discuss the proposed payment methodology for non-contracted service agencies that provide ambulance services and additional requirements for carrier out-of-network reimbursements.

Colorado Medical Society staff and leaders are gathering information, sharing initial thoughts and concerns, and receiving answers to questions at these initial stakeholder meetings. CMS plans to submit comments on Friday, Sept. 20. Stay tuned. As a reminder, CIVHC has compiled a "frequently asked questions" document to provide some guidance to providers. Access the FAQ here.
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New Medicare card: Transition ends in less than four months
The Centers for Medicare and Medicaid Services finished mailing Medicare Beneficiary Identifier (MBI) cards to all Medicare beneficiaries from the Social Security Number (SSN)-based Medicare number. As a reminder – the MBI transition period allows you to submit claims with either the MBI or the Medicare number through Dec. 31, 2019. You have multiple ways to obtain your patient’s MBI.

  • Ask your patients for their new card when they present for an appointment, at registration and/or admission.
  • Use your remittance advice (RA). For RAs generated on 10/1/2019 through the end of the transition period, the federal CMS will return the MBI when the claim was submitted with a valid and active SSN-based Medicare number.
  • Use the Novitasphere MBI Look-Up tool on Novitas Solutions website. You must be an active Novitasphere Portal user in order to access this tool. Please refer to the MBI Lookup Tool article for instructions on how to use the look-up tool.
Apply for the Colorado Consumer Insurance Council by Sept. 30
The Colorado Division of Insurance is currently soliciting applications for membership on the Consumer Insurance Council. The Consumer Insurance Council (CIC) provides a consumer's perspective on regulations and initiatives developed by the Division of Insurance. It acts in an advisory capacity to the commissioner and Division of Insurance, and is a forum to discuss and share information, concerns, questions and criticisms on insurance issues facing Colorado consumers. Click here to access the online application for membership and more details about the CIC. The deadline to submit an application is Sept. 30, 2019.
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