Hard work never fades…nIt lives in your achievements, it lives in your success stories and always inspires the generations to come. We salute you for the amazing work you do! Sending you warm wishes on Labor Day!nnIn honor of this special holiday, Welter Healthcare Partners will be closed on Monday, September 3rd and resume normal business hours on Tuesday.
New login requirements for Medicare — Action RequirednnThe Centers for Medicare & Medicaid Services (CMS) will be implementing a system security change that affects the Novitasphere log in requirements for maintaining access.nnEffective September 1, 2018, registered Novitasphere users must log into Novitasphere at least once every 30 days to be considered active. This is a change from the current 60 day login requirement.nnAny user IDs that do not take this step will be considered inactive and the Novitasphere role will be removed. After a role is removed, you will be required to re-request the Novitasphere role in EIDM to re-gain access to Novitasphere.nnTo prepare for this change, all users should ensure that they are meeting the requirement prior to September 1, 2018.nnDon’t miss this important deadline! For original article in it’s entirety and a list of helpful resources, CLICK HERE. Novitasphere Help Desk is also available for additional assistance.nnThis article was originally posted on novitas-solutions.com.
Providers affiliated with UCHealth University of Colorado Hospital and University of Colorado School of Medicine are no longer seeing patients with UnitedHealthcare Medicare Advantage plans, a UCHealth spokesperson said.nnSpokesperson Dan Weaver said in a statement that the providers made the decision because of UnitedHealthcare’s handling of medical claims.nn“Unfortunately, United Healthcare does not follow the normal reimbursement and appeals process for Medicare Advantage claims for University of Colorado Hospital or CU Medicine,” he said.nnAbout 600 patients received letters in June informing them that they will no longer be seen by providers at University of Colorado Hospital or with the School of Medicine.nnWhile some patients received letters, it’s unclear exactly how many will ultimately be affected by the decision.nnThe providers are already out-of-network for those covered by UnitedHealthcare Medicare Advantage plans, meaning most individuals did not see providers with University of Colorado Hospital or the School of Medicine regularly.nnHowever, the providers have offered specialty services, such as cancer care, to UnitedHealthcare members when it has been requested.nnWeaver said that in some cases, UnitedHealthcare told its members that they could receive advanced care from specialists, but “then refused to pay for their care.”n
nThis article was originally posted on denverpost.com
Kaiser Permanente Colorado said Monday it has notified about 2,500 patients that it will no longer serve as a Medicaid provider in some areas of the state.nnKaiser Permanente stopped providing health services as a Medicaid provider in its northern, southern and mountain service areas on June 30. It will continue providing care to Medicaid patients in the Denver-Boulder area.nnKaiser Permanente said it made the changes in Medicaid services because it is committed to seeing Medicaid and the second phase of the state’s Medicaid Accountable Care Collaborative succeed.nn“This was a difficult decision, but we feel it is the best way we can support the new program at this time,” Kaiser Permanente said in a statement. “We will closely monitor the progress of Phase 2 and re-evaluate our participation in Medicaid on an annual basis.”nnMedicaid is a government health care program for low-income adults and children.nnThe Accountable Care Collaborative is a health care program that is part of Health First Colorado, the state’s Medicaid program. The second phase of the collaborative involves initiatives, such as the state Department of Health Care Policy and Financing contracting a regional entity to coordinate physical and behavioral health for enrolled members.nn n
nThis article was originally posted on denverpost.com
Yesterday CMS released their CY 2019 physician fee schedule proposed rule, which includes major proposed changes to E&M coding. Below is my review of this component of their propose rule, including page references to the source in the federal register.nnWe all know E&M coding has it flaws, and 1995/1997 guidelines could not have accounted for changes in technology today, especially the EHR. Furthermore, many consider E&M guidelines as being too complex, ambiguous and incapable of meaningfully distinguishing between different code levels. For some time, physicians and other stakeholders have asked CMS to undergo extensive research to overhaul both the E&M documentation guidelines and the underlying coding structure. You would essentially blunt any potential benefit by updating one and not the other. Based on all of the feedback provided thus far, CMS begins their proposal by defining a number of trends which emerged from the feedback:nn• Substantially different recommendations came in by specialty; any changes would have both clinical and financial specialty-specific impactsn• History and exam portions of the guidelines are most significantly outdated; they should be simplified or reduced, but not eliminatedn• Medical decision making should be given more weight in determining visit level, but those specific guidelines should be updated as welln• Reduce E&M levels generally into three, such as low / medium / high, and also correlate these to timenn n
nThis article was originally posted on implementhit.com
As the CMS charts a path to level pay for outpatient services, it’s also leading toward a head-to-head battle with powerful hospital lobbying groups as some providers win and lose with site-neutral payments. Check out the article, below, for more information!
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If the agency’s 2019 proposal to pay the same rate for services delivered at off-campus hospital outpatient departments and independent doctors’ offices is finalized, the CMS said it would save Medicare $610 million and patients about $150 million via lower co-payments. That represents about 1% of the around $75 billion hospitals receive a year from the CMS for outpatient services.
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But hospitals argue that their higher reimbursement rates are needed to pay for expensive overhead costs. Without that payment flow, they contend, many hospitals would likely close as their margins thin. Providers also changed their business strategies with the current rate system in mind.nnThis is a continuation of the CMS’ aim to reduce payment disparities for virtually identical procedures, said Fred Bentley, a vice president at Avalere Health.nnHospital executives have seen this coming, but that doesn’t mean they won’t put up a big fight, he said.nn”There has been a recognition that this disparity was not justified and that it was a matter of time until this gap would be addressed,” Bentley said. “The CMS is starting to come to terms with the task at hand in terms of keeping Medicare solvent. Admittedly, they are going against a powerful lobby.”nn
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This article was originally posted on modernhealthcare.com