Medicare Access and CHIP Reauthorization Act (MACRA) Final Ruling Released by CMS

Oct 14, 2016 | Uncategorized

A final rule released today (Oct. 14, 2016) by the Centers for Medicare and Medicaid Services (CMS) details the final regulations for implementation of the Medicare Access and CHIP Reauthorization Act (MACRA), the historic Medicare reform law that repealed the Sustainable Growth Rate (SGR) formula last year.

Vote NO on Amendment 69 – Get the Word Out!

Oct 13, 2016 | Uncategorized

Colorado’s mail voting system means that the first ballots of the 2016 election will reach voters’ mailboxes in just one week. That means we’re almost out of time to make sure every voter has the FACTS about Amendment 69 and the untested experimental health care debacle that it would enshrine in our state’s constitution. We need your strong support during this final sprint toward Election Day.nnYou already know that Amendment 69 would likely mean employers fleeing Colorado, a huge tax increase on workers and a completely untested health care system. ColoradoCare would mean a panel of unaccountable politicians deciding treatment options and raising taxes without TABOR limitations. The dangers of Amendment 69 are clear. There isn’t much time to defeat this dangerous amendment. Colorado voters deserve to know the truth about Amendment 69 before they vote.nnBigger is not always better and Amendment 69 is too BIG for Colorado! Opposition to Amendment 69 continues to grow!nnnnHere are the facts:n

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• It is costly. The $25 billion tax increase would essentially DOUBLE the size of the current state budget. Employers would have a new 6.67 percent payroll tax, and all workers would pay another 3.33 percent payroll tax.

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• It hits business owners and sole proprietors disproportionally. These Coloradans would pay both sides of the tax – that’s 10 percent in new employment taxes. On top of that, there would be an additional 10 percent tax on all non-payroll income.

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• It is unaccountable. While supported by your tax dollars, Amendment 69 is specifically designed to operate outside state government and TABOR limitations, run by a 21-member board elected by plan “members.” This board would bear the sole ability to decide coverage, negotiate prices and reimbursement rates and raise taxes when the initial $25 billion in annual revenue proves insufficient and would have no accountability to the governor or legislature.

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• It would limit health care choice, access and quality. A government run system like this makes Colorado less attractive to providers. We fear our best providers would leave the state and that it would be hard to attract new providers to practice here.

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• Workers and their families face uncertainty about coverage. Today, workers know what their plan covers – and what it doesn’t. There are no specifics about what the Amendment 69 plan would cover, and those decisions are left to the 21-member board.

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nWith Amendment 69, it actually feels good to say NO.nn

CAQH ProView Improvements – New Required Fields

Oct 5, 2016 | Uncategorized

Professional Liability InsurancennThe latest release for CAQH ProView includes improvements to the Professional Liability Insurance (PLI) screen. Based on feedback from practice managers and participating organizations, changes to this section will help providers enter PLI information accurately, reducing follow-up and making the credentialing process smoother and faster.nnChanges to this section will include:n

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• A new required question will be added to the PLI screen: “Are you covered under a professional liability insurance policy?”

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• Providers who indicate that they are not covered under a PLI policy will be required to upload supporting documentation.

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• When updating a PLI record already in CAQH ProView, a new “Renew” button will enable providers or practice managers to quickly copy information from a previous PLI record into a new record.  They will then be prompted to input an updated Effective Date and Expiration Date.

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• Providers will be prompted to upload a current Certificate of Insurance or PLI face sheet, documentation that is required by many health plans during the credentialing process.

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• This section will also include improved instructional text and expanded “Help” information.

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nStandardizing Practice Location AddressesnnCAQH ProView is making additional improvements to ensure that provider data entered is accurate. The United States Postal Service standardized format will be applied to ensure practice addresses are accurate and complete per USPS address standards. This feature will prompt providers to review, and correct if necessary, their practice location addresses prior to attestation. Per the USPS format, all addresses will appear IN ALL CAPITAL LETTERS.nnSystem Improvements Released August 1nnThe Employment Information screens within CAQH ProView have been updated, making them easier to use. Additionally, some fields that were previously optional are now required, enabling healthcare providers to submit more complete profiles that require less follow-up work and reducing requests for additional information from health plans and other organizations. Healthcare providers may wish to allow additional time during the next re-attestation to complete these fields. These changes to CAQH ProView do NOT affect a provider’s status in CAQH ProView or the ability for authorized participating organizations to view data.n

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• Employment Information Screen: Providers are able to enter their employment history, and clearly see if they have omitted any relevant information. The following changes have been implemented:n
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  • At least one employment record is required.

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  • A summary screen displays the provider’s employment history. Any gaps greater than six months which require an explanation are automatically highlighted.

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  • A drop-down menu with predefined options is available to select the appropriate reason for any gaps in employment.

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  • A confirmation pop-up window appears if more than one employment record is marked as a current employer.

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  • The “Help” information has been expanded throughout the Employment Information screens.

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• Required Fields: Select fields that were optional are now required. The following fields are required:n
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  • Professional IDs section:n
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    • DEA State (for each DEA number entered into CAQH ProView).

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  • Education section:n
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    • Did you complete your professional education at this school?

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    • If yes, Completion Date.

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  • Professional Training section:n
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    • End Date.

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    • Did you complete the training program at this institution?

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    • If yes, Completion Date.

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  • Specialties section:n
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    • Does your board certification have an expiration date?

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    • If yes, board certification expiration date.

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    • If yes, board certification re-certification date.

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  • Practice Location section:n
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    • Provider’s start date.

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    • Do you have an organization (Type 2) NPI?

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    • If yes, NPI Type 2.

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    • Gender Limitations.

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    • If yes, Gender Limitations Type.

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    • Are there any age limitations?

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    • If yes, Age Minimum and Age Maximum

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Transition to The Colorado InterChange and New Provider Web Portal

Oct 5, 2016 | Uncategorized

nnNew Plan InformationnOn October 31, 2016, Hewlett Packard Enterprises (HPE) will assume fiscal agent operations on behalf of Health First Colorado (Colorado’s Medicaid program) and Child Health Plan Plus (CHP+). These operations include the transition to the Colorado interChange (a new claims payment system) and a new provider Web Portal.nnClaims Payment DelaysnDuring the transition to the new Colorado interChange, there will be a delay in payments for ALL providers. The length of delay will depend on the type of claim you’re submitting. The Department recognizes that payment delays can create challenges for providers, which is why we’re providing this information now so you can plan accordingly. Unfortunately, these delays are unavoidable and no exceptions can be made.nnFind more detail about these dates on the Provider Resources web page.nnPaper pharmacy or medical claims (i.e. all paper claims)n

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• The last day Xerox will accept paper claims is 10/7/16

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• These claims will be processed (as usual) and paid the week of 10/11/16 or 10/18/16 (as usual)

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• Claims that don’t make this deadline will be held and processed on or after 10/31/16

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• If you only submit paper claims, you will not receive another payment until the week of 11/7/16

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nElectronic medical claims (and encounters)n

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• The last day Xerox will accept electronic medical claims is 10/21/16

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• These claims will be processed (as usual) and paid the week of 10/24/16 (as usual)

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• Claims that don’t make this deadline will be denied and will need to be resubmitted on or after 10/31/16

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• If you only submit electronic medical claims, you will not receive another payment until the week of 11/7/16

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nElectronic pharmacy claims (and encounters)n

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• The last day Xerox will accept electronic pharmacy claims is 10/30/16

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• Claims submitted before 10/21/16 will be processed and paid (as usual)

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• Claims submitted between 10/22/16 and 10/28/16 will be paid the week of 11/7/16 (one-week delay)

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• Claims submitted 10/29/16 or 10/30/16 will be paid the week of 11/7/16 (as usual)

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• Claims submitted on or after 10/31/26 will be processed and paid (as usual)

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nProvider IDs and Portal LoginsnYour Provider ID number will be changing. Starting on October 31, 2016, claims must be submitted using your new provider ID number. Your new provider ID number will be sent out via email on October 15, 2016.nnYour provider Web Portal login information will be changing. The new provider Web Portal will be launching on October 31, 2016. You will receive additional instructions for Web Portal registration when you receive your new Provider ID on October 15, 2016.nnNote: You will NOT need the password you used to submit your application for revalidation/enrollment or your 5-digit application tracking number.nnYour batch claims submitter MUST apply for a new Trading Partner ID (TPID). To avoid any delay in claims submission, ensure your submitter starts their Trading Partner enrollment soon. Your submitter can learn more information about applying for a new TPID on the EDI Support web page.nnImportant Dates and Training OpportunitiesnPlease visit the Provider Resources web page for a list of important dates, training availability for the new provider Web Portal, and additional information.

Demigods

Oct 5, 2016 | Uncategorized

Demigods…nWe want and seek the best in ourselves and in others. nnOur own demigodery often clouds our vision.nStay tuned for more Todd’s Tips!nn

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About R. Todd Welter • MS, CPCnFounder and President of Welter Healthcare Partners

nMr. Welter has over 25 years of healthcare industry experience assisting physicians and other providers, hospitals and other facilities with the business side of medicine. Through strategic planning and analysis, Mr. Welter’s main focus is to strategically increase revenues and profitability in this radically changing health care environment. 
Mr. Welter has a Masters Degree in Organizational Leadership from Regis University in Denver where he has had an appointment as affiliate faculty in the School for Professional Studies for over ten years. In addition, Mr. Welter holds a faculty appointment at the University of Denver’s University College. In the Health Care Leadership program he teaches Macro Economics in Health Care and Innovative Strategies and Change in Health Care to graduate students.