February 2018
Anthem responds to CMS letter opposing pay cut for same-day services, prompts continued CMS opposition

The Colorado Medical Society, American Medical Association and other state medical societies have been actively advocating against a plan by Anthem Blue Cross Blue Shield to reduce payment for significant, separately identifiable evaluation and management (E/M) services that are provided on the same day a procedure is performed or a wellness exam is conducted.

The company announced in December that it would reduce the size of its planned pay cut from 50 percent to 25 percent and move the implementation date to March 1, 2018. CMS sent a letter on Dec. 15, 2017, from CMS President M. Robert Yakely, MD, to Elizabeth Kraft, MD, medical director of Anthem BCBS in Colorado.

In her Jan. 29 response, Kraft defended the pay cut citing duplication of the fixed/indirect practice expense when performing a minor surgery and E/M service on the same day by the same provider. "To redress the duplicative payment, Anthem's Policy reduces the office visit reimbursement by 25 percent and, thereby, reduces the double payment for fixed/indirect practice expenses."

Yakely responded on Feb. 12 that there is no overlap of indirect practice expense and that "by providing two separate and distinct services during the same visit the physician can be more efficient, streamline care for the patient and facilitate a prompt diagnosis, potentially avoiding additional out-of-pocked expense for the patient" - particularly for those in rural areas or seeking certain types of specialty care that have long wait times for non-emergency appointments. He continued, backing up his point that codes are already adjusted by the Relative Value Scale Update Committee (RUC) and that further reductions are inappropriate.

CMS stands by its original request that Anthem retract the new modifier 25 policy without delay. Watch for more information as this issue develops.
The Weinstein Effect:
What practices should do to protect their employees, their physicians and the practice - March 7 in Denver

Arapahoe-Douglas-Elbert Medical Society, Aurora-Adams County Medical Society and Denver Medical Society, in collaboration with COPIC, present their next event in their quarterly practice management series, "The Weinstein Effect: What is happening and what practices should do to protect their employees, their physicians and the practice." Speakers will discuss why allegations of sexual harassment in the workplace are becoming more prevalent and what practices should do in response.

This event will be held Wednesday, March 7, 7:30-8:30 a.m., at Comedy Works in Greenwood Village. Office managers, practice administrators and physicians are all encouraged to attend this free program. Each practice with a COPIC-insured physician can receive 1 COPIC point. To RSVP, email ADEMSstaff@gmail.com. Questions? Contact Andrea at 303-761-2887.
COQPP Fast Facts for February: Wrapping up 2017 QPP Year 1 Reporting, plus office hours

Deadlines are fast approaching if you plan to submit data for the 2017 Merit-based Incentive Payment System (MIPS) performance period. Don't wait until the last minute to submit your data. Submit early and often. 

The two key dates are: 
  • March 16 at 8 pm ET for group reporting via the federal CMS web interface 
  • March 31 for all other MIPS reporting, including via qpp.cms.gov 
Now is the time to act. Click here to view a timeline and the top 10 things you need to do and know if you are an eligible clinician. This list focuses on reporting via the qpp.cms.gov data submission feature, not on group reporting on via the CMS Web Interface and not on individual reporting on Quality measures via claims submission data. 

Wrapping up 2017 QPP Year 1 Reporting
With the March 31 deadline approaching, make plans to participate in the Feb. 27 Colorado QPP Coalition Office Hours webinar on how to report for individual MIPS performance categories. Hosted by TMF Health Quality Institute and Telligen, consultants will explain reporting processes and demonstrate the TMF MIPS Toolbox, a free online application to help you track MIPS measures and optimize your scores. Click here to register!

For more helpful resources, visit the coalition's website at www.cms.org/coqpp.
Now available: 2018 Medicare Participation Physicians/Suppliers Directory (MEDPARD) 

The 2018 Medicare Participation Physicians/Suppliers Directory (MEDPARD) was made available on the Novartis website on Jan. 30, 2018. Find the 2018 Medicare Participation Enrollment information on the tool bar on the left hand side of the website. As in the past, there will be no hardcopy distributions. Beneficiaries can use the internet or contact 1-800-MEDICARE for assistance in locating a participating physician/supplier near their home.
Feb. 21 AMA webinar: Prepare for April's new Medicare card

The American Medical Association has arranged for a briefing from the Centers for Medicare and Medicaid Services on the new Medicare card. The webinar will be held Feb. 21, 1-2 pm MT. The new Medicare card is a result of MACRA's requirement that the federal CMS issue Medicare cards that do not display Social Security Numbers to address the risk of beneficiary identity theft. New Medicare cards will be issued beginning in April 2018 and physician offices must be prepared to accept the new Medicare identification number at that time.

As the new Medicare cards will significantly impact physician practices' workflows, physicians and their office staff are strongly encouraged to attend this webinar. It will include time for Q&A and will be recorded for those who are unable to attend.

Register here. 
Prepare your practice and patients for the New Medicare Card coming in 2018

From April 2018 to April 2019, the Centers for Medicare and Medicaid Services will mail new Medicare cards to all active Medicare beneficiaries. The New Medicare Card removes Social Security numbers from Medicare cards due to concerns about identity theft. The new cards have a Medicare Beneficiary Identifier (MBI) instead of the Social Security Number-based identifier known as the Health Insurance Claim Number (HICN).

Practices must be prepared to use MBIs starting April 1, 2018, as patients new to the Medicare program beginning in April 2018 will only have cards with MBIs. From April 1, 2018 to Dec. 31, 2019, the federal CMS will accept both HICNs and MBIs on Medicare transactions (including eligibility requests and claims) for beneficiaries in the Medicare program prior to April 1, 2018 (i.e., those who received a HICN). Beginning in January 2020, physicians may only use MBIs. (Exceptions may include appeals and retrospective adjustments.)

Read more here from the AMA about how to prepare your practice and your patients. Read more here from the federal CMS.
Latest bulletins
Aetna - December 2017
 


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