Nov 16, 2015 | Uncategorized
As part of the ongoing effort to educate providers about the most effective treatment protocols for workers’ compensation, Pinnacol Assurance is amending their SelectNet network credentialing standards for nurse practitioners and physician assistants practicing in the following urban counties: Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas, El Paso, Elbert, Garfield, Jefferson, Larimer, Mesa, Pueblo, and Weld. Mid-level providers in these counties will be required to complete Division of Workers’ Compensation (DOWC) Level 1 training.nnEffective January 1, 2016, Pinnacol’s mid-level provider credentialing requirement for your SelectNet Agreement (Exhibit B, SelectNet Credentialing Policy) is amended/updated to include the following participation requirement: “Evidence that Mid-Level provider successfully audited a Division of Workers’ Compensation Level I course (or compliance within 12 months)”nnFor your convenience, a revised Exhibit B has been created and is available by clicking here. Please print this updated version and use it to replace the current Exhibit B of your SelectNet Agreement. In the next week, impacted mid-level providers will be notified of this new requirement. Registration information for an upcoming DOWC Level 1 training on December 3, 2015, the last training in 2015, is available here and here. You may register for additional Level I seminars in 2016 through the DoWC website. Pinnacol will reimburse a limited number of SelectNet mid-level providers for the cost of this course. Email LevelOne@pinnacol.com to request information about this reimbursement program.nnIf you have questions regarding this notification, please contact Pinnacol’s provider network management department at 303.361.4945 and speak with the provider relations specialist assigned to your contract.
Oct 12, 2015 | Uncategorized
Colorado Medicaid and CHP+ Provider Revalidation & Enrollment Begins September 15, 2015
nNew federal regulations established by the Centers for Medicare and Medicaid Services (CMS) require enhanced screening and revalidation for all Medicare, Medicaid, and CHP+ providers.nnBeginning September 15, 2015, all Colorado providers who want to continue, or begin, providing services to Medicaid and CHP+ members after March 31, 2016, will be required to be validated and enrolled under new federal enrollment screening criteria. To meet these new requirements, as well as to ensure enrollment in the new claims processing system, Colorado providers must revalidate using the new Online Provider Enrollment (OPE) tool. Although the new OPE tool will launch in September 2015, Colorado Medicaid asks that provides complete your revalidation during your assigned revalidation and enrollment wave.nnBased on the CMS provider type and risk designation, the revalidation process may include a criminal background check, fingerprinting, and unannounced site visits – including pre-enrollment site visits for some providers. Visit our provider resources page for information specific to your provider type and information specific to the Home and Community-Based Services (HCBS) provided (if applicable). Providers who fail to revalidate and enroll by March 31, 2016 may have their claims suspended or denied.n
Revalidation & Enrollment Training Announcement
nEnrollment Application Training AvailablenOnline self-paced training for the new Colorado Online Provider Enrollment (OPE) tool is now available.n
Who: All interested providers
n
When: Modules available online anytime beginning September 4, 2015
n
Where: Online via eLearning modules
nPlease visit the Provider Resources page to register!nn
CLICK TO ENLARGE
Medical Reval FAQ
nWhy am I required to go through the revalidation/screening process?nnNew federal regulations established by the Centers for Medicare and Medicaid Services (CMS) require enhanced screening and revalidation for all existing (and newly enrolling). These regulations are designed to increase compliance and quality of care. The final regulations are being implemented at a federal level and were published in the federal register in February 2011.nnWhat is the difference between revalidation and screening?nnRevalidating is an enrollment process required every 5 years. Screening is verifying the provider is qualified for the risk level assigned.nnAre non-medical service providers subject to revalidation/screening?nnYes, all providers who are enrolled with and bill Medicaid for services under the state plan or a waiver must be screened under this rule.nnWill we be notified when we need to revalidate?nnWe are sending a revalidation notice letter to all currently enrolled providers. This letter will mailed 1-2 weeks prior to your enrollment wave, as a reminder.nnI didn’t receive a Revalidation Notice letter, does this mean I don’t have to revalidate?nnNo, all providers need to revalidate regardless of whether you receive the Revalidation Notice letter. Please visit Colorado.gov/HCPF/Provider-Resources to see your assigned revalidation wave.nnWhat is an enrollment wave window?nnYour wave window is a suggested time frame in which we would like you to complete your revalidation. These waves are just recommendations; if you need to begin sooner or later you can. The most important date to remember is March 31, 2016. Providers not enrolled and revalidated by this date, may have their claims suspended or denied.nnWhat should we do if our agency is spread out across multiple revalidation waves?nnGo ahead and choose between the waves that you are assigned to, you do not need to notify us of this change.
Oct 6, 2015 | Uncategorized
S61.451A — Open bite of right hand, initial encounternW55.81XA — Bitten by mountain lionnY93.01 — Activity, hikingnnIn preparation for the upcoming deadline for ICD-10 implementation, Welter Healthcare Partners presents weekly ICD-10 Codes of the Week! Our goal is to familiarize you with the new and expanded code set and the additional clinical documentation needed from your providers to comply with ICD-10 coding, and more importantly, for accurate and clean claims submission to keep your revenue stream flowing! We are to help YOU prepare for the October 1, 2015 implementation date. Please don’t hesitate to contact us for all of your training and education needs!
Oct 6, 2015 | Uncategorized
The blood that keeps a practice alive:nPick a patient seen one month ago and follow that revenue cycle. Look at the claim, compare it to the notes, has it been paid? Did the patient pay a co-payment or deductible if so when? (Co-payments and deductibles should be paid at the time of service). Did the insurance pay, if a clean claim was sent electronically it should be paid within 30 days. Was it paid properly? How do you know? If it hasn’t been paid, find out why! Revenue Cycle is a Cycle! Follow it! You may be surprised at what you find.nn
nn
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.
Oct 5, 2015 | Uncategorized
Once officially completely implemented, the ICD-10 transition will provide infinitely more descriptive codes for use in the realm of medical documentation, to both more accurately document ailments, treatments, and the like, as well as more easily allow for interoperability.nnProductivity DropnFor years, critics have opposed ICD-10 in part out of fears of lost productivity—and few deny that this is a valid concern. Many point to Canada’s often-cited 67% drop in productivity when the country transitioned to ICD-10.nnThe lack of familiarity will come as a shock to many, says Selva. “If memorized codes were something someone was leaning on, this will cut their productivity… the biggest change will be when coders are reviewing physician notes.”nnThere is a concern shared by many that the level of specificity—and the sheer volume of codes—will prevent clinicians and coders from memorizing codes. “It will become much more complicated. There is a lot of fear right now regarding specificity. No one wants to be interrupted [to look something up] over and over again.”nnThere’s no easy solution for this one. The general consensus is that some loss of productivity is inevitable. “I think they’ll be slower,” says Draak.nnBut Buckholtz is more optimistic. “What we’ve seen from the coder standpoint is that after being trained for 40 to 80 hours, they do go back to old level of productivity,” she says. She points out that coders will no longer have to do dual coding, which should be a relief to many departments.nnTime and practice will help clinicians and coders memorize codes they use frequently, and EHR/EMR systems that auto-populate codes will also help. Now, however, might be a good time for hospital leadership to evaluate staffing levels.nnEmory’s Plummer suggests pairing struggling physicians with practices coders to help them adjust to the new system. “If coders are available to work with them, that’s the best thing—tell them, ‘don’t ask another physician, they probably don’t know any more than you do.'”nnPerhaps most importantly, very few experts believe patient care will be impacted by the move to ICD-10. “I can rest assured that at our facility, patient care is our chief concern. We’ll do everything around that as our focus. Our quality won’t go down,” says Draak.nnMost organizations have done their homework and have spent many resources training employees and preparing, and most of them can expect a fairly smooth transition, says Gordon. “I think people are ready.”nnThis article posted on HealthLeadersMedia.com
Sep 21, 2015 | Uncategorized
T22.112A — Burn of first degree of left forearm, initial encounternX08.8XXA — Exposure to fire, initial encounternY93.G2 — Activity, grilling
n
In preparation for the upcoming deadline for ICD-10 implementation, Welter Healthcare Partners presents weekly ICD-10 Codes of the Week! Our goal is to familiarize you with the new and expanded code set and the additional clinical documentation needed from your providers to comply with ICD-10 coding, and more importantly, for accurate and clean claims submission to keep your revenue stream flowing! We are to help YOU prepare for the October 1, 2015 implementation date. Please don’t hesitate to contact us for all of your training and education needs!
