May 2018
CMS launches Know Your Legal Rights

The Colorado Medical Society and component medical societies are pleased to launch the Know Your Legal Rights database, an online, searchable compilation of all of the Colorado laws in place to protect physicians, their practices and patients from unfair, predatory and unscrupulous -- not to mention illegal -- 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. Now, you are just a keystroke from knowing the legal tools at your disposal and how to use them effectively. It's 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.

We have much more planned to make Know Your Legal Rights as effective as possible for Colorado physicians and staff. We invite you to explore this tremendous tool and share your comments by replying to

What practices need to know about the new Medicare cards

Medicare patients are currently getting their new Medicare cards with new numbers known as Medicare Beneficiary Identifiers (MBIs). MBIs will replace the existing Social Security Number (SSN) based Health Insurance Claim Number (HICN) on the new Medicare cards and in the systems Medicare uses now. Medicare will replace all current cards and SSN-based numbers by April 2019. Previous Medicare patients will receive their new cards based on a flow system; Colorado patients are scheduled to receive new cards after June 2018.

Medicare is telling your Medicare patients to show you and your office staff their new Medicare card when they come for care. It is important for you to protect the identity of your Medicare patients by getting and using their new MBIs as soon as you have them.
You and your office staff should:
  • Use the MBI to bill Medicare as soon as you get a Medicare patient's new number, and
  • Use the transition period to make sure your systems can accept and transmit MBIs.
Here are three ways you and your office staff can get MBIs:
  • Ask your Medicare patients: Medicare is mailing the new Medicare cards in phases by geographic location to Medicare patients. Ask these patients for their new Medicare card when they come for care. If they have received a new card but don't have it with them at the time of service, they can use to get their new Medicare number.
  • Use the Medicare Administrative Contractors' secure MBI look-up tool: Learn about and sign up for the portal to use the tool when it is available no later than June 2018. You can look up MBIs for your Medicare patients who don't have their new cards when they come for care.
  • Check the remittance advice: Starting in October 2018 through the end of the transition period, Medicare will return the MBI on every remittance advice when you submit claims with valid and active HICNs.
Medicare has resources to help you use the new cards:
QPP group eligibility status now available

The Centers for Medicare and Medicaid Services has announced that physician practices/groups may now log into the federal CMS QPP website to check their 2018 eligibility for Medicare's Merit-based Incentive Payment System (MIPS). After groups log in, they will be able to click into a details screen to see the eligibility status of every clinician in the group (based on their National Provider Identifier or NPI) to find out whether they need to participate during the 2018 performance year for MIPS. 

Unfortunately, the federal CMS will not be sending out letters to advise physicians of their eligibility status this year so checking on the QPP participation status look-up tool is the only way to determine or verify eligibility status. Eligibility rules in 2018 are different than in 2017 so status this year may be different than last. Also as is indicated in the look-up tool, exempt individual clinicians still will need to report if their group is eligible and chooses to report as a group. The look-up tool can be found here.
COQPP Fast Facts in 5 Minutes - May


1. HOT OFF THE PRESS: Now an easier way to check your group's 2018 eligibility status! Log into the federal CMS QPP Website using your EIDM credentials, browse to the TIN affiliated with your group, and click into a details screen to see the 2018 performance period eligibility status of every clinician based on their NPI.

2. Federal CMS changes name of the EHR incentive programs and advancing care information to "Promoting Interoperability"  to better reflect the focus of commitment to promoting and prioritizing interoperability of health care data. The federal  CMS is overhauling and streamlining the EHR Incentive Program for hospitals, CAH and Medicaid Eligible Professionals. This does not combine the two programs; for 2018, it will only change the name of the MIPS Advancing Care Information performance category to Promoting Interoperability (PI). Rebranding of ACI resources will be completed soon.


3. ATTENTION EHR submission mechanism users: If you plan to submit your Quality Performance Category measures through the QPP Portal for 2018 and will be using the reports exported from your EHR, please work with your vendor to ensure you can export the appropriate QPP File Format QRDA3 from your EHR to upload to the QPP Portal. The following links may be helpful in understanding the QRDA3 format and how to export it.

  • The federal CMS validator can be found here.   
  • Exporting a QRDA3 File can be found here.
  • For further assistance, please contact your EHR vendor or the QPP Support Service Center at
4. Medicare Learning Network Event: "QPP: Answering Your Frequently Asked Questions," Wednesday, May 16th at 12:30 - 2 p.m. CST.  During this call the federal CMS will answer FAQs about the QPP program from the 2018 HIMSS Annual Conference and inquiries received by the APP Service Center. Then they will open lines to take your questions. Here's the  registration link.
5. Check out the new resources added to the federal CMS QPP Resource Library:
  • Group Participation in MIPS 2018
  • MIPS Improvement Activities
  • 2018 Registration Guide for the CMS Web Interface & CAHPS for MIPS Survey
  • Updated EIDM User Guide
What's new with Novitasphere Part B

Novitas, the Medicare Administrative Contractor (MAC) for Colorado, has launched Novitasphere, a free, secure internet portal for providers, billing services and clearinghouses to help improve customers' Medicare experience. A number of new features were implemented in April 2018 and more new features are coming in June 2018. 

New features:
  • Immediate Recoupment Requests: The immediate recoupment process is for providers who have received an overpayment demand letter from Medicare. Providers may elect to have overpayment(s) repaid through the immediate recoupment process and avoid paying by check or waiting for the standard recoupment that begins 41 days from the date of the initial demand letter.
  • Appeals Requests for Redeterminations: The Appeal Requests feature is available to submit Redetermination and Clerical Error Reopening requests for finalized claims.
  • General Inquiry Requests: This feature is available to submit a general question to Medicare, such as questions related to coverage guidelines, policy issues or how to bill Medicare. This form should not be used to submit claim-specific questions, questions that require PHI to research, or Novitasphere-related questions.
  • Medical Review Claims: The Medical Review Claims feature is available to perform a search of medically reviewed claims to obtain additional documentation request (ADR) dates, ADR letter copies, review status and education information.
Novitas has also implemented some changes to make Novitasphere better for our users. For example: 
  • Changes to the Part B Claims Status and Claim Correction required search criteria allow for easier searches. Specifically, the Patient Medicare Number, First Name Initial, and Last Name fields are no longer required to search for claims. You may choose to narrow your search by using these fields, but they are no longer required fields.
  • Features that request the Patient's Medicare Health Insurance Claim (HIC) Number will now allow the new Medicare Beneficiary Identifier (MBI) to be entered. 
Additionally, more changes are coming to Novitasphere this summer. To assist providers with the Medicare Beneficiary Identifier (MBI) transition, the MBI Lookup tool will be available in Novitasphere beginning in June 2018. This will be a helpful resource to look up the beneficiary's MBI number if the beneficiary has not provided an updated card. If you are not already enrolled for Novitasphere, Novitas strongly encourages you to enroll now. To see what customers are saying about Novitasphere, check out these customer testimonials.

To learn more about Novitasphere, Novitas offers a monthly series of educational webinars to review the features within Novitasphere. They encourage providers to join them for upcoming presentations for the Novitasphere Part B Overview, Novitasphere Enrollment Overview, Novitasphere Claim Submission Overview, Novitasphere Claim Correction Overview, or Novitasphere Hot Topics and Frequently Asked Questions.

Please visit the Educational Events page of the Novitas website to register for an upcoming event.  You may also visit the JH Novitasphere Center on the Novitas website for more information about Novitasphere, including enrollment forms and instructions.

For questions regarding Novitasphere, please contact a Novitas EDI Analyst at 1-855-880-8424.
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