November 2016
Colorado QPP Coalition: Resources and education for your MACRA success

The Colorado Medical Society has joined a new coalition that will provide information to Colorado physicians and practices about the Quality Payment Program (QPP). The Colorado QPP Coalition was formed to help educate and inform practices about the QPP, which was introduced in the final rule for the Medicare Access and CHIP Reauthorization Act, and promises to reward the delivery of high-quality patient care.

Our goal is to equip physicians and their staffs with the information and infrastructure they need to successfully test value-based reimbursement models, and we will achieve this by sharing resources and educational opportunities. Along with the Colorado Medical Society, the Colorado QPP Coalition comprises the Colorado Academy of Family Physicians, the Colorado Community Health Network, the Colorado Health Extension System, CORHIO, Colorado SIM and Telligen.

Regardless of political changes in Washington, D.C., the industry-wide effort to shift from volume- to value-based health care is moving forward. MACRA passed with bipartisan support, which reinforces the longevity of programs that are designed to help providers focus on patient care.

"The QPP is not just a change in payment," said Mark Levine, MD, FACP, chief medical officer, Centers for Medicare and Medicaid Services Denver, who participated in the first meeting of the Colorado QPP Coalition. "It is intended to align everyone in a common vision for the future of health care in America."

Watch for more from the Colorado QPP Coalition in January and beyond.
HCPF launches call center to answer Medicaid enrollment or validation questions

As we reported last month, the Colorado Department of Health Care Policy and Finance postponed the conversion date for moving to the new Medicaid Management Information System (MMIS), the Colorado interChange, until March 1, 2017, to allow more time for providers to complete the revalidation process and train on the web portal.

HCPF has compiled a " cheat sheet" outlining the changes resulting from the postponement of the launch date and their new Provider Enrollment Call Center. They encourage providers to share this information with claims, billing and office staff so that calls are directed to the appropriate resource. Go to for more information.
2017 PQRS results: Submit an informal review by Nov. 30

In 2017, the Centers for Medicare and Medicaid Services will apply a downward payment adjustment to those who did not satisfactorily report for the Physician Quality Reporting System (PQRS) in 2015 including:
  • Individual eligible professionals
  • Comprehensive Primary Care practice sites
  • PQRS group practices
  • Accountable Care Organizations
If you believe you have been incorrectly assessed the 2017 PQRS payment adjustment, submit an informal review through Nov. 30: 2015 PQRS feedback reports are available: For more information, visit the Analysis and Payment webpage. For questions about the informal review process, contact the QualityNet Help Desk at 866-288-8912 (TTY 877-715-6222) or
Value modifier: Informal review request period open through Nov. 30

The 2015 Annual Quality and Resource Use Reports (QRURs) were released on Sept. 26. These reports show how physician groups and physician solo practitioners performed in 2015 on the quality and cost measures used to calculate the 2017 Value Modifier. Access and review your 2015 Annual QRUR now to determine whether you are subject to the 2017 Value Modifier payment adjustment. See the How to Obtain a QRUR webpage and Quick Access Guide for the 2015 Annual QRURs and Tables for more information.

You may request an informal review of perceived errors in your 2017 Value Modifier calculation during the informal review period open through Nov. 30. See the 2015 QRUR and 2017 Value Modifier webpage for additional information.

Helpdesk Information:

For the Enterprise Identity Management System (EIDM), contact the QualityNet Help Desk at or 866-288-8912 (TTY 877-715- 6222) For QRURs or the Value Modifier, contact the Physician Value Help Desk at or 888-734-6433 (select option 3).
Register for the 2017 CPT Coding and Compliance Updates workshop in Denver - Dec. 6

Join the American Medical Association for the 2017 CPT® Coding and Compliance Updates workshops, annual, comprehensive one-day seminars that provide the necessary instruction for participants to keep pace with changes in procedural terminology, and helps them achieve more accurate reimbursement submissions. The Denver workshop will be held Dec. 6. Other locations include Baltimore, Las Vegas, Atlanta and Dallas.

The workshops provide a comprehensive review of CPT changes to provide professionals with key knowledge to keep up to date with changes and new procedural codes. This year, they will include HCPCS level II, OIG Work Plan and compliance highlights for 2017, and resources to take away.

See more information and register by downloading this event flyer.
DOWC: Stakeholder meetings for review of Rules 16 and 18

The Colorado Division of Workers' Compensation has announced their fourth annual series of stakeholder meetings for the review of Rules 16 and 18. Discussion will be open to all aspects of these rules and will also include the following topics:
  • ICD-10
  • National Provider Identifier (NPI) numbers
  • Who completes the WC-164
  • By Report and unlisted items
  • Accredited Physician Assistant (PA) reimbursement
  • Z Code reimbursement
  • Compound reimbursement
  • Average Wholesale Price (AWP) alternatives
  • X modifiers
  • Claim Claims
  • Facility fees associated with platelet-rich plasma (PRP)
  • Evaluation & Management (E&M) prolonged services
  • Non-physician provider deposition and testimony reimbursement
  • 8 percent interest on disputed claims
  • Peer-to-peer for prior authorization requests/telephone call reimbursement
  • Comprehensive vs. Composite ambulatory-payment-classifications (APCs)
The schedule for this year's meetings is provided below and will include a teleconference option.

Thursday, Jan. 26, 2017, 4 - 6 p.m.
Tuesday, Feb. 28, 2017, 4 - 6 p.m.
Thursday, March 23, 2017, 4 - 6 p.m.
Thursday, April 27, 2017, 4 - 6 p.m.
Thursday, May 25, 2017, 4 - 6 p.m.

Please contact Debra Northrup if you or a representative of your organization would like attend so we can ensure adequate accommodations are available or provide you with the teleconference number.
Four myths about the Healthcare EFT Standard, debunked

While it's been in effect since January 2014, the Healthcare EFT Standard via ACH is still a source of confusion for many medical providers. The standard allows providers to request that claims payments be made using EFTs instead of paper checks-that is, electronically transferred from the insurer to the provider's bank account via ACH, similar to direct deposit. Health plans are required, by law, to comply.

Converting to EFTs via ACH can result in substantial cost and time savings for healthcare practices. Yet, because the standard is still relatively new, many providers have received misinformation about EFTs via ACH that could be deterring them from making the switch. Read this article on on four common myths about the Healthcare EFT Standard and the reasons they're false.
Federal CMS announces initiative to increase clinician engagement

The Centers for Medicare and Medicaid Services has announced an initiative to increase clinician engagement, starting with the launch 18-month pilot program whereby providers practicing within certain Advanced Alternative Payment Models (APMs) will be relieved of medical record reviews under certain medical review (MR) programs.

"The new initiative will launch a nationwide effort to work with the clinician community to improve Medicare regulations, policies, and interaction points to address issues," said Andy Slavitt, CMS Acting Administrator, in a press release. To see a fact sheet describing the pilot, click here. To read an overview, click here.
Workers' compensation: Provider teleconference on Nov. 30

Only one event remains in the Division of Workers' Compensation series of annual fall Listening and Rule Update seminars, the Nov. 30 provider teleconference. It will be held from 1-5 p.m. Click here to sign up for the teleconference. Each person attending must register online individually. As always, these seminars are free.

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