October 2017
CO QPP Coalition October Quality & Resource Use Report Fast Facts

On Sept. 18, 2017, the federal CMS made the 2016 Annual Quality and Resource Use Reports (QRURs) available to all group practices and solo practitioners nationwide. Plan to join the Colorado QPP Coalition on Oct. 24 for a webinar on Understanding your QRUR Report. To register for this webinar, click here .
To better prepare you for this event, here are 5 Fast Facts in 5 minutes about the Quality & Resource Use Report.

1. How do I obtain my 2016 QRUR?

Visit How to Obtain a QRUR to access your report prior to the event.

2. Does every group and/or solo practitioner receive an annual QRUR?
No, the QRUR reports are based on quality reporting metrics from the previous year. Therefore if you have not participated in previous quality reporting programs, such as PQRS, you will not receive a 2016 QRUR report for your physician practice.

If I do not have an EIDM account, and I am a solo practitioner, what should I do?

A solo practitioner is defined as a TIN with only 1 EP, as identified by a NPI, that bills under the TIN. To access a solo practitioner's QRUR, one person must first sign up for an EIDM account with the Individual Practitioner role. If you do not have an EIDM account, then follow the instructions provided here to sign up for an EIDM account with the correct role.

4. If I do not have an EIDM account, and I am participating in a group, what should I do?
 A group is defined as a TIN with two or more eligible professionals (EPs), as identified by their National Provider Identifier (NPI), that bill under the TIN. To access a group's QRUR, one person from the group must first sign up for an EIDM account with the Security Official role. If you do not have an EIDM account, then follow the instructions provided here  to sign up for an EIDM account with the correct role.

5. Where can I go for more information or upcoming webinars?
For assistance with interpreting QRURs and requesting an informal review of your data, contact the QRUR Help Desk at 888-734-6433 (select option 3) or pvhelpdesk@cms.hhs.gov .

There is also an upcoming Webinar hosted by the federal CMS. Please click here  to sign up for this event! 
Medicaid payment updates

The Department of Health Care Policy and Financing (HCPF) recently announced that they are extending the temporary timely filing extension for an additional six months "in an effort to ensure providers are appropriately paid for services." Effective May 12, 2017, the timely filing limit was extended to 240 calendar days. Effective May 1, 2018, the limit will be changed back to 120 calendar days.

Visit the new  Regional Provider Support webpage to learn more about the DXC regional field representatives. The regional field representatives were recently hired and are currently training to be available to assist providers with training and technical support for the new Colorado interChange system. For your immediate individual claims questions, the Provider Services Call Center (1-844-235-2387) is the best resource.

HCPF maintains a Known Issues and Updates webpage of many known issues and encourages practices to check it regularly for updates.

The Colorado Medical Society's effort to seek payment and interest on clean claims improperly denied or delayed is ongoing.
Physicians protected from health plan credit card fees

The Centers for Medicare and Medicaid Services has weighed in with definitive guidance saying that health plans cannot require physician practices or other health care organizations to accept payments made using so-called virtual credit cards that are often accompanied by exorbitant service fees.

In this and other respects, persistence has paid off on AMA advocacy to clarify the Health Insurance Portability and Accountability Act (HIPAA) standard payer-to-provider payment method for electronic funds transfer (EFT).

Ever since the Automated Clearing House (ACH) EFT standard went in effect in 2014, the AMA has advocated that the federal CMS issue guidance spelling out physician rights regarding insurance company electronic payments. The effort proved to be successful as the agency recently posted the requested clarification of its EFT operating rules and standards on its HIPAA Administrative Simplification  frequently asked questions webpage .
Medicaid Alternative Payment Model announcement

Payment for primary care is changing. The Department of Health Care Policy and Financing is implementing an Alternative Payment Model for Primary Care (APM). New resources are available on the department's website.

APM Resources - The APM Survival Guide is now available on the Department's website here. The guide provides a good overview of the information providers need to know to begin getting ready for the APM. Here is a link to detailed resources (measures, code set, timeline, and model) on the department's website.

Implementation Workgroup - As the department moves forward with the APM, a workgroup is forming to assist with the implementation of the APM. Similar to the process used to design the APM, the department is looking for representation from primary care physicians, primary care practice coordinators, office managers, and Regional Care Collaborative Organization representatives. The group would provide feedback and input on how best to implement the APM and help the Department understand the impact of operational decisions.

The time commitment would be one 60-90 minute meeting every other month. A kick-off meeting will be held on Nov. 20, 12-1 p.m., and meetings will be scheduled every other month thereafter. There will be a call-in option for those unable to attend in person.

If you are interested in participating in the Implementation Workgroup please send an email to HCPF_PrimaryCarePaymentReform@state.co.us.
Register for the FREE DoWC 2017 fall discussions/training sessions

Registration is open for the 2017 discussions/training sessions presented by the Division of Workers Compensation. There are three main topics to participate in:
  • 2017 Medical Fee Schedule rule changes;
  • Getting Set Up for Telemedicine; and
  • Introduction to the Medical Treatment Guidelines.
DoWC is continuing the "Universe" registration process to create and track event tickets. Please print these out and bring to your session. Eight sessions remain, with the main topics highlighted in the event title -- all are free to attend.

If you opt for a session that is webinar-based, AND you plan to attend via the webinar, there is a link within the event to complete the "GoToWebinar" registration as well (view able after clicking the "+More" link). Please complete both.

Register by visiting: https://www.universe.com/users/cdle-division-of-workers-compensation-5Y8KF1. Questions? Contact Jim Becker at james.becker@state.co.us.
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Take Credit Cards? Is Your Practice Ready for the Oct. 15 EMV Deadline?

Important! What your practice needs to know about switching to EMV: Click here.

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