April 2017
QPP fast facts in 5 minutes

Get the help you need to prepare for the Centers for Medicare and Medicaid Services' Quality Payment Program (QPP) through the Colorado QPP Coalition. The coalition released the first in its series of "QPP Fast Facts in 5 minutes" (below). This series will be published regularly on the coalition webpage,  www.cms.org/coqpp , and in CMS's newsletters. 

Here is an excerpt of the first installment:
  1. Who's in the Quality Payment Program?
    You're a part of the Quality Payment Program in 2017 if you are in an advanced alternative payment model (APM) or if you bill Medicare more than $30,000 in Part-B allowed charges a year and provide care for more than 100 Medicare patients a year. You must meet the minimum billing and patient requirement to participate in the QPP in 2017. If you are below either requirement, you are not in the program.
  2. What are the options to report under the MIPS track for 2017?
    Your options on how you report your performance data for MIPS is dependent on whether you report as an individual or as a group. You will only be able to report quality data using your Medicare claims data as an individual. You will need to submit as a group to use the CMS web interface. Individual and group reporting can be done through an electronic health record, registry, or a qualified clinical data registry.
  3. What is the difference between reporting as an individual and reporting as a group?
    Individual reporting: If you submit MIPS data as an individual, your payment adjustment will be based on your performance. CMS defines "individuals" as EPs who have a single national provider identifier (NPI) tied to a single tax identification number.

    Group Reporting: If you submit MIPS data with a group, the group will receive one payment adjustment based on its performance. A group is defined as a set of clinicians (identified by their NPIs) sharing a common tax identification number no matter the specialty or practice site.
  4. If our practice does not have an EHR, what are our options for reporting in 2017?
    If you do not have an EHR, your only option is to report as an individual using claims data. For more information on how to submit claims data, click here.
  5. Where do I go for help?
    There is support available to you through the Colorado QPP Coalition, www.cms.org/coqpp.
Click here to read the full first installment, which includes basic questions-and-answers to QPP participation, eligibility and reporting options.
Register to attend Colorado Payer Day - May 18, 2017 - and learn what's new from insurance carriers

Pikes Peak Professional Association of Health Care Office Management (PAHCOM) and Colorado Medical Group Management Association (MGMA) will host Colorado Payer Day 2017 on May 18, 2017 in Castle Rock. This is an important statewide event for all medical managers!

Hear what's new from our insurance carriers and have your questions answered. Get the inside track to the latest information vital to your practice including health care reform plans, claims submissions and payments. This is an excellent opportunity to connect with your peers and meet Insurance representatives face to face, and an important statewide event for all medical managers.

Rebecca Weiss, Senior Director of Government Relations for Anthem, and Jon Watson, Market Executive at Bright Health, will present an interactive session: Future Health Care Policy Decisions - How, What, When do we Start Preparing? Jean Haynes, Chief Population Officer at UCHealth will discuss Population Health over lunch. Chet Seward, Senior Director, Division of Healthcare Policy at Colorado Medical Society will follow with The Domino Effect of the Projected Policy Decisions as seen by CMS.

The cost to attend for PP-PAHCOM member or staff or CMGMA member or staff is $50. Non-members can attend for a $100 fee.

Register here. View the event flyer here.
Join the AMA for a MACRA/QPP Webinar on April 20, 5 p.m. MT

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), represents the most significant change in Medicare physician payment policy in over 25 years. Last fall, the Centers for Medicare and Medicaid Services released final policies on implementation of MACRA's Merit-Based Incentive Payment System (MIPS) and alternative payment models (APMs). Collectively, these programs are part of what CMS now calls the Quality Payment Program (QPP). 

Physicians have the opportunity to pick their pace of participation during the 2017 QPP transition year. During the 2017 transition year, physicians only need to report one quality measure for one patient, one Improvement Activity or all of the required Advancing Care Information (ACI) measures to avoid a negative payment adjustment in 2019. While the performance year is 2017, physicians will not receive their payment adjustment until two years later. 

Taking steps now to prepare for 2017 and beyond can ease the transition for your practice and position you to earn financial rewards for the high-value care you provide. This webinar will help physicians and medical society staff understand both MIPS and APMs. Join the AMA on Thursday, April 20 at 5 p.m. MT to learn what needs to be done to prepare and succeed.  Click here to register for the webinar.  
Resources and top questions about Colorado's interChange

The Department of Health Care Policy and Financing, which administers Health First Colorado (Colorado's Medicaid program) and its new fiscal agent have been posting information to help providers learn to navigate the new provider claims system, Colorado interChange. Over the past 18 months, more than 43,700 providers have enrolled in the new system that went live on March 1, 2017. Since going live, the new claims system has paid more than half a billion dollars in claims to providers. This is on pace with the volume of payments made in the old system. 
With any new system launch, there is a learning curve and frequent questions about using the new system. The top reasons for calls to the provider call center are to check on claims and to ask provider enrollment questions. Some examples of the top denial of claims reasons include: revalidation was not started or completed; the wrong combination of provider type, specialty and taxonomy was used on the claim; and the wrong NPI number was used on the claim.
The department and its fiscal agent have developed resources that can help providers with these frequent questions about using the new system.
The Provider Portal and Provider Resources pages are updated as soon as new materials are available, providers can sign up for our e-newsletter to receive updates, along with accessing billing manuals and provider bulletins . Visit these pages on colorado.gov/hcpf/our-providers often for updates. Providers should also be sure that they are signed up to receive Department publications and that their contact email in the Provider Portal is correct.


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