January 2018
Fight continues against Anthem pay cut for same-day services

The Colorado Medical Society has joined the American Medical Association and other states in opposing 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 payment cut for such services from 50 percent to 25 percent and move the implementation date back from Jan. 1, 2018, to March 1, 2018. However, the AMA feels strongly that no reduction is warranted and will continue their discussions with Anthem. Read more, here, from the AMA.  Read a Jan. 10 announcement from Anthem  here .

Another state opposing the pay cut is Kentucky. Patrick T. Padgett, executive vice president of the Kentucky Medical Association, wrote an opinion-editorial article about the insurer's market power. Read the article here.
Health First Colorado Recovery Audit Contract: RAC 101 webinars

The Department of Healthcare Policy and Financing, along with Health Management Systems, present Health First Colorado Recovery Audit Contract: RAC 101. This informational one-hour webinar will be provided two dates and times: Tuesday, Jan. 23, 2018 at 12 p.m. MT and Friday Jan. 26 at 11 a.m. MT. During the webinar, representatives will introduce the department's new RAC contractor, HMS, and will cover details of the Health First Colorado RAC project, its processes, and the resources available to Health First Colorado providers. All CFOs, Medicaid billing managers, and accounts receivable specialists are encouraged to attend. Find more information here. 
Last chance to apply for SIM cohort 3; deadline Jan. 19 

SIM practices have a "glide path" to participate in the new Medicaid alternative payment model (APM). Take advantage of consultation support and resources (valued at over $25,000 per practice) to help you be successful. There are only a few days left to apply for SIM's final cohort. Apply here by Jan. 19: http://bit.ly/sim3application.
Special Open Door Forum: New Medicare Card Project

The Centers for Medicare and Medicaid Services' Office of Information Technology (OIT) will host a Special Open Door Forum (ODF) on Tuesday, Jan. 23, 12-1 p.m. MT, to allow State Medicaid agencies, Medicaid providers, Managed Care Organizations (MCOs), Medicaid partners and other Medicaid stakeholders an opportunity to learn more about and ask questions regarding the federal CMS's approach towards changing the Social Security Number-based Health Insurance Claim Numbers (HICN) to the new Medicare Beneficiary Identifier (MBI). 

Participant Dial-In Number: 1-800-837-1935
Conference ID #: 8259057

During this ODF the agency will cover the background of the New Medicare Card Project, the implementation of new Medicare numbers, the format of the new number, timeline and milestones, the transition period, outreach and education, and what you need to know to get ready for the new number. For more information about the New Medicare Project, please visit: www.cms.gov/newcard.
Important Medicaid co-payment information

The Colorado Department of Health Care Policy and Financing has made updates to the Health First Colorado (Colorado's Medicaid Program) co-payment policies. These changes have been previously reflected in the department's December Provider Bulletin and December Special Provider Bulletin - Co-payment Policy Updates

Effective Jan. 1, the department plans to change the following co-payment policies for Health First Colorado members: outpatient hospital visit (increase from $3 to $4), outpatient hospital non-emergent emergency room visit (increase from $3 to $6), and generic drug (increase from $1 to $3). Brand-name drug remains unchanged at $3.

Additionally, a co-pay limit for Health First Colorado members now applies. All providers should be aware that members are liable for no more than 5 percent of their monthly household income towards co-payments per month. Members will be notified by letter when their household has reached the monthly limit. Once a member has paid 5 percent of their monthly household income on co-pays in a month, no one in the household pays co-pays for the rest of that month. For more information, visit HealthFirstColorado.com/copay.

The department continues to urge providers to verify a member's eligibility and co-payment amount at each visit. The Colorado interChange Provider Web Portal will reflect the member's current eligibility and the proper co-payment amount.

Reminder: Transparency in health care prices, what physicians need to know 

The Colorado General Assembly passed legislation in 2017 requiring greater transparency in provider prices enabling consumers to be better informed. Beginning Jan. 1, 2018 physicians must disclose to consumers their charges for the 15 most common services they provide when payment is made directly by the patients rather than by a third party.

This applies to physicians in a solo practice, medical group, independent practice association or professional corporation. Health care providers are required to make available to the public the prices for at least the 15 most common health care services provided. Such information should be available in a single document, either electronically or by posting conspicuously on the provider's website if one exists.

Read more about the new provision on CMS.org.
New: Medicare newsletter from Novitas 

Novitas, the Medicare contractor for Colorado, has released a new publication: Medicare Part B Quarterly Report. The January 2018 issue covers general news, coding guidelines, reimbursement, coverage issues, and more. Access this issue 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.
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