December 2018
Happy holidays from the Colorado Medical Society, and a staff change

This holiday season and all year long the Colorado Medical Society is grateful for the opportunity to serve Colorado physicians and practice staff by bringing you the latest information and resources to make your job a little easier. Thank you for all that you do to improve the health of Coloradans. 

At year's end, Marilyn Rissmiller, CMS senior director of the Division of Health Care Financing and longtime curator of this newsletter, will retire. We welcome Amy Berenbaum Goodman, JD, MBE, as the CMS senior director of policy.

All of the staff at CMS wish you a wonderful holiday season and a prosperous 2019, and we look forward to working with you in the coming year. Don't hesitate to reply to this email with your questions, comments or concerns.
Division of Insurance: Judge's ruling won't change protections for pre-existing conditions in Colorado

On Friday, Dec. 14, a federal district judge in Texas issued a ruling stating that the Affordable Care Act (ACA) is unconstitutional. This was a ruling in the case Texas v. the United States, where 20 state attorneys general filed a lawsuit against the ACA, saying that since Congress ended the law's mandate to have health insurance, the entire ACA is unconstitutional.

"Even with this ruling, the ACA isn't going away," the Colorado Division of Insurance stated in a news release. "This decision will now be part of a long, drawn-out legal process, as it will be appealed and likely work its way to the U.S. Supreme Court. And the Trump administration is assuring the country that the ACA will remain in force during the appeals process."

This case has caused the most concern around the ACA's protections for people with pre-existing conditions, especially as the Trump administration said it would not defend that part of the law.

"I said it in June when this case first bubbled up, and I'll say it again: Guaranteed health insurance coverage for people with pre-existing conditions is enshrined in Colorado law," Interim Insurance Commissioner Michael Conway said in the release. "The Division of Insurance will continue to enforce Colorado law and maintain this important protection for our citizens."
Federal CMS opioid overutilization policies take effect Jan. 1

Beginning Jan. 1, 2019, the federal CMS is rolling out two new opioid overutilization polices in its Medicare Part D program. See this Medicare Learning Network (MLN) article that explains the new policies in an easy-to-understand format.
Important QPP dates and information

Check your Final 2018 MIPS Participation Status on the QPP Portal!

Reporting and submission dates

December 31, 2018 - Performance Year 2018 ends 
  • Quality Payment Program Exception Applications Window Closes 
  • Fourth Snapshot date for full TIN APMs (Medicare Shared Savings Program) for determining which eligible clinicians are participating in a MIPS APM for purposes for the APM scoring standard
January 2, 2019, 10 a.m. EST - April 2, 2019, 8 p.m. EST - Submission Window Opens for Performance Year 2018 *check with registries for submission dates as all may vary*

January 22, 2019 - March 22, 2019 - Federal CMS Web Interface Submission Period Performance Year 2018

March 2, 2019 - MIPS claims data submission deadline

Questions? Contact Courtnay Ryan, senior quality improvement facilitator, Telligen, at [email protected] or 720-612-3111.
New Medicare Card: MAC look-up tool updated

Your Medicare Administrative Contractor's (MAC's) secure portal Medicare Beneficiary Identifier (MBI) look-up tool now returns the MBI even if the new Medicare card has not been mailed. If you do not already have access, sign up for your MAC's portal to use the tool. For more information on the transition to the MBI: You can also ask your patients to call 1-800-MEDICARE to get a new card if they need one. To ensure your Medicare patients continue to get care, you can use either the Health Insurance Claim Number or the MBI for all Medicare transactions through Dec. 31, 2019.
2019 Medicare Part D opioid policies: Training materials

The federal CMS will implement new opioid policies for Medicare drug plans on Jan. 1. The new policies include: 
  • Improved safety alerts when patients fill opioid prescriptions at the pharmacy 
  • Drug management programs for patients at-risk for misuse or abuse of opioids or other drugs 

The agency posted new training materials, including slide decks and tip sheets for Prescribers and Patients


The federal CMS also recently released an MLN MattersĀ® Article: A Prescriber's Guide to the New Medicare Part D Opioid Overutilization Policies for 2019. Visit the Reducing Opioid Misuse webpage for more information on their overall strategy.

HCPF: Guidance for resubmitting denied claims

Denied claims do not need to be adjusted or sent as a request for reconsideration. A denied claim should be resubmitted electronically as a new claim once corrections have been made. Resubmissions should not be sent on paper, even if the claim has surpassed the 365-day timely filing period.

If the claim is past the 365-day timely filing period, providers can contact the Provider Services Call Center (1-844-235-2387) to see if any timely filing waivers may apply, such as using the previous internal claim number (ICN), a backdated enrollment, or a load letter for member eligibility. If the claim is outside of the 365-day timely filing period, either a previous ICN within 60 days or valid attachment must accompany the claim.

If a claim was previously paid and then recouped, the provider can rebill the claim within 60 days of the recoupment to keep the claim within the timely filing guidelines. The claim must reference the previous ICN.

For more information about how to correct and resubmit a denied claim, or for questions about timely filing, please contact the Provider Services Call Center at 1-844-235-2387.
New Episode - Pain Assessments: A Patient's Experience and What The Doctor Recommends

Pain assessments offer a collaborative and structured approach to pain evaluation and treatment. Learn why, when and how to conduct pain assessments with Jan Gillespie, MD, of Northern Colorado Pain Management in this latest episode of Telligen's Speaking Out on Pain Management podcast.
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Latest bulletins
Aetna - December 2018

Colorado Medicaid - December 2018 

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