August 2018
Influenza virus vaccine code update effective January 2019

The Centers for Medicare and Medicaid Services (federal CMS) has announced an update to the code for the influenza virus vaccine effective January 2019. The new code is  90689.

Effective for claims processed with dates of service on or after Jan. 1, 2019, influenza virus vaccine code 90689 (Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25mL dosage, for intramuscular use) will be payable by Medicare. The short descriptor is VACC IIV4 NO PRSRV 0.25ML IM. This new code will be included on the 2019 Medicare Physician Fee Schedule Database file update and the annual Healthcare Common Procedure Coding System (HCPCS) update. 

MACs will use the CMS Seasonal Influenza Vaccines Pricing webpage to obtain the payment rate for 90689.The new influenza virus vaccine code 90689 is not retroactive to Aug. 1, 2018.

Please make certain your billing staffs are aware of this update. Read more here.
Colorado QPP Coalition - August Fast Facts

Do you have questions on your 2017 MIPS Performance Feedback Reports? Check out the Performance Feedback Report User Guide here.

The video "How to Request a Targeted Review" demonstrates how MIPS eligible clinicians or groups can request a targeted review of their 2019 MIPS payment adjustment.

"How to Access Performance Feedback for APM Entities"  provides an overview of how to access 2017 MIPS performance feedback for Alternative Payment Model (APM) Entities.
"How to Access Performance Feedback for Individuals" demonstrates how to access 2017 MIPS performance feedback for a clinician whose performance was scored separately from his or her group.
"How to Access Performance Feedback for Voluntary Submitters" provides an overview of how to access 2017 performance feedback data for a clinician who voluntarily submitted data for 2017.

These fast facts are brought to you by the Colorado QPP Coalition. The coalition, of which the Colorado Medical Society is a leading member, provides no-cost resources, training and technical assistance to clinicians and their team. Visit the website,, for resources, including monthly live webinars and the webinar archive. COQPP is here to help clinicians and their teams successfully transition to the QPP. 
AMA launches website with resources and stories on prior auth

Stay in the know on prior authorization;  learn more about the effects of prior authorization on both patients and physicians through a new website launched by the American Medical Association --

The website has a "patient" track and a "physician" track for users to learn how prior authorization affects you. Both tracks take users through a slideshow of the barriers to care placed by prior auth, with the last slide soliciting stories about users' experiences.

The "resources" page of the site contains news and resources to help patients and practices navigate prior authorization hurdles. Visit the site often as new resources are posted.
Upcoming provider training session: CMS 1500 Professional Billing

The Department of Health Care Policy & Financing invites you to join DXC Technology (DXC) for a training session on CMS 1500 professional billing. This training session is intended to help new providers and will provide a high-level overview of claim submissions, prior authorizations, using the website and more. Those seeking more in-depth training materials on navigating the Provider Web Portal can refer to the Provider Web Portal Quick Guides available on the Quick Guides and Webinars webpage.

This training will be held via live webinar and in person at the DXC office on Thursday, Aug. 23, 2018, 9 - 10:30 a.m. MT.

Register for the live webinar here.

To attend the training session in person, RSVP to by noon on Wednesday, Aug. 22, 2018, with the subject line "8/23 Training" and include your name, organization and contact information (email address and phone number). You will receive a response to confirm your reservation. The in-person training session will be held at the DXC Office in Civic Center Plaza in Denver.

Questions or issues with registration? Contact with the subject line "8/23 Training Registration" with a description of the issue you are experiencing, your name and contact information (email address and phone number).
Important changes coming to Novitasphere log in requirements

Novitas, the Medicare Administrative Contractor (MAC) for Jurisdictions H and Jurisdiction L, has announced important changes to Novitasphere, their free internet portal. Please share this message with all Novitasphere users within your organization.

The Centers for Medicare and Medicaid Services (federal CMS) will be implementing a system security change that affects the Novitasphere log in requirements for maintaining access.

Effective Sept. 1, 2018, registered users must log in to Novitasphere at at least once every 30 days to be considered active. This is a change from the current 60-day login requirement.

Any users that do not take this step will be considered inactive and the Novitasphere role will be removed. After a role is removed, users will be required to re-request the Novitasphere role in EIDM to regain access to Novitasphere.

To prepare for this change, all users should ensure that they are meeting the 30-day login requirement prior to Sept. 1, 2018. Then, keep your access active by logging in at least once every 30 days.

Novitas has provided a list of helpful resources and tips for users, available here:

If you need any additional assistance with your log in, please contact the dedicated Novitasphere Help Desk at 1-855-880-8424.

Have you explored the Know Your Legal Rights database yet?

The Colorado Medical Society and component medical societies are launched the Know Your Legal Rights database in May. This online tool compiles in one place all of the Colorado laws in place to protect physicians, their practices and patients from unfair, predatory and unscrupulous practices.

These protections have been secured through more than a decade of hard-hitting advocacy by CMS and our allies in the General Assembly and the rule-setting process, but many physicians and their staff are unaware that these laws exist or how to find and use them. With Know Your Legal Rights, practices are now just a keystroke from knowing the legal tools at your disposal and how to use them effectively -- your instant guide to Colorado physicians' legal rights.

To access the Know Your Legal Rights database, go to You'll need to sign in with your CMS username and password. (Users must be logged in with their credentials to access Know Your Legal Rights. Staff of CMS members can request a login from Once logged in, scroll through the topic list or enter keywords in the search bar at the top of the page to find laws relevant to your issue, a summary of the law and details about how the law affects physicians. The exact references are available in the sidebar of each entry. View a "how-to" video here for more information on using the tool.

Have you explored this tremendous tool yet? Share your comments by emailing
Explore the practice management section of the AMA website

The American Medical Association provides numerous practice management resources on their website,, to help practices  enhance practice efficiency, professional satisfaction and the delivery of patient care.
  • Find guides and preferred providers to help practices run more smoothly and save money.
  • Use the Current Procedural Terminology (CPT®) code set to bill outpatient and office procedures.
  • Stay informed on the AMA's work to improve the Medicare and Medicaid experience for patients, physicians and practices.
  • Find new payment and delivery models developed to enhance patient and practice needs.
  • Learn about improvements to make the claims process and medical billing more simple and efficient.
  • Access information about how to comply with HIPAA to ensure the privacy of each patient's medical information.
  • See how the AMA is working to reshape the current medical liability system to better serve both physicians and patients.
  • View resources that help physicians succeed as payment and delivery changes evolve.
Go to to access these resources and more. 
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