Registration for the Colorado Prescription Drug Monitoring Program

shutterstock_162776243Legislation passed this year (House Bill 14-1283, now CRS 12-42.5-403) requires all Colorado prescribers who possess a DEA registration and all Colorado licensed pharmacists to register an account with Colorado’s Prescription Drug Monitoring Program (PDMP). Prescribers with a DEA registration and pharmacists must register an account by the corresponding deadlines below:n

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  • Pharmacists and DEA-registered Advanced Practice Nurses: September 30, 2014
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  • DEA-registered Dentists, Veterinarians, Optometrists and Podiatrists: October 31, 2014
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  • DEA-registered Physicians and Physician Assistants: November 30, 2014
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nPrescribers and pharmacists are encouraged to register an account early but must do so prior to the respective deadlines above.n

Click here to register a PDMP account and for more information about the PDMP in general.

nAccount creation normally takes less than 5 minutes. Questions regarding how to register a PDMP account may be directed to the PDMP Help Desk at 1-855-263-6403.nnThe Colorado Prescription Drug Monitoring Program is a public health tool providing prescribers and pharmacists a secure database with immediate access to their patients history of controlled substance prescriptions (Schedules II – V) that they otherwise may not have.nnThe information in the PDMP can help prescribers and pharmacists make more informed decisions when considering prescribing or dispensing controlled substances.The secure database provides a more comprehensive health record and connects practitioners to their patients other prescribers and dispensers.nnSource: www.cdn.colorado.gov; 2014.

Rates and Volume, Volume or Rates

shutterstock_50485129The fee-for-service world of professional reimbursement (compensation for services) is, essentially, the following economic transaction between payer and provider:n

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  • Provider point of view: In exchange for patient volume being directed (Steered) into my practice I will allow for a discount off my billed charges.
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  • Payer point of view: we will direct patients into your practice via patient cost share amounts, in and out of network benefit differentials, etc. in exchange for an agreed to reimbursement schedule.
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nReimbursement amounts are sensitive to, among other things, the law of supply and demand. In larger urban areas the supply of a given specialty needed for the payers network dictates the reimbursement level. Where providers are in perceived short supply the price goes up. Where they are perceived to be in overabundance the prices go down or stay stagnant.nnIn some markets and specific to some specialties there is an overabundance of providers in a given specialty that has been tolerated for a variety of reasons: it keeps patients happy (patients like choice), it spreads out risk, it allows for stagnation of reimbursement, etc.nnshutterstock_177677333There is a tipping point however! Payers, who have fully insured customers, partially funded and self-funded customers (Employers and increasingly Affordable Care Act/Exchange membership) simply pass along the cost of care, one way or another, to their customers. Those customers (i.e. employers) have for far too long simply absorbed the increasing costs (or they have passed it along to their employees in the form of higher premiums, higher and higher cost share, deductibles, co-payments, etc.) and now we are seeing a rebellion. Why?…because they now can!nnThe payers and the traditional way their “product” (health insurance coverage) and “services” (paying claims, developing a network, medical management, etc.) are sold is going through just as much change as is being felt on the provider side.  The brokers and direct sales people are having their commissions cut, employers are revolting – threatening to just allow their employees to go at it alone through the ACA and all of this is combining with the latest generation of work force who no longer stay with an single employer for very long and thus do not value the very expensive benefits lavished upon them. The young and healthy (those we need in the insurance system so desperately) tend to be very transient and don’t feel the handcuffs of great benefits.nnThe market is changing! The tipping point has arrived (depending on your specific location and your specialty). Health plans no longer want or need a large network of providers. They never did need a large network they just tolerated it for patient convenience and for rate pressure. The trouble with allowing large networks for so long (especially in a market that is more PPO than HMO) is that it is hard to dismantle it. Employers and more so patients have enjoyed having a lot of choice. Today (the tipping point) employers and patients pay more attention to the intolerable cost of premiums! Rates are out of control!nnIf and when a payer can shrink its network they will, especially if the payer can take credit for it. (“look at us, we dropped the most expensive providers from our network” or “We have identified for you the most expensive providers with our rating system”) Once upon a time providers could (and some did so successfully) get together in larger groups and use market dominants to demand higher fee-for-service reimbursements. Today (with some latitude to the specific market) that strategy only allows a health plan an excuse, the chance and the positive public relations to shrink its network size and push more volume into fewer providers.nnshutterstock_82001416Change always brings opportunity: The fee-for-service “beat our chests” and demand more days are over for most specialties, especially those which are in abundance. Such chest beating will simply play into the hands of the payers who are looking for an excuse to shrink their big networks.nnThe real opportunity exists in looking not at the rates providers receive but rather at the much larger overall Spend. Physicians receive roughly 16% of the Spend on any case, diagnosis, course of treatment (rough number). Physicians (and other provider colleagues) have, however, control of the other 84% of the Spend! Control it, take credit for its control and demand a piece of the larger number! The play is not in trying to make the smaller number bigger…The real play is getting a piece of the larger number.nnMore to come…

Are you ready for some football…

shutterstock_110257877Y93.61 — Activity, American tackle footballnnY93.62 — Activity, American flag or touch footballnnW21.01XA — Struck by football, initial encounternnW21.81XA — Striking against or struck by football helmet, initial encounternnIn 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!

School Is In Session…

shutterstock_110170004Z02.0 — Encounter for examination for admission to educational institutionnnZ55.3 — Underachievement in schoolnnY92.157 — Garden or yard of reform school as the place of occurrence of the external causennY99.8 — Student activity as the external cause statusnnIn 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!

Cash Flow Is Not Just Important, It's Everything

Cash Flow Is Not Just Important, It's EverythingCash flow is often the difference between keeping a private practice private and looking for an alternative situation that may not be quite as palatable to the doctors.

nTo us, Cash Flow is not just important… it is EVERYTHING. The staff and management of AMRS work very hard to generate regular, predictable cash flow including working with the practice staff to get the right information at the right time to the payers so they will be able to pay the claim quickly. Clean claims are the goal and we will do what is necessary to get a clean claim to the payer quick! Working with your staff to explain, coach and even prod to get the right information out the door fast. Billing is easy! Getting the right information to the right place is hard for some practices (maybe they have training issues or a lot of staff turnover or a thin labor pool), it is something we pride ourselves in.n

Q: You make it sound so easy, why do so may have problems with cash flow?  

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A: It is often attention to detail and a training issue. Staff turnover causes disruption and “brain drain.” The Revenue Cycle requires constant attention, like riding a bike. It is easy but it has to be done right and constantly for the results to be good. Think of all the muscles, tendons, bones, joints and nerves working together to ride a bike, balance, eye sight, awareness and anticipation. Seems so easy when it is going well. When you have a broken leg or have lost your balance it then becomes incredibly difficult. Just one component not working well with all the others will make you crash your bike or crash your cash flow!

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Q: Everyone wants to be paid, why is Cash Flow itself so important?

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A: Cash Flow is everything in a service business. Cash Flow is the life blood of every service business. There are salaries and rent to pay whether one patient is seen or one hundred. The constant and predictable flow of reimbursement is critical.

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Q: Doctors (and other medical professionals) work as hard now as they always have (in some cases more so) but taking home less money. How can AMRS make a difference?

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A: Fee-for-service revenue, for procedures (what used to be the big ticket items), is under constant downward pressure. Some services are paid more and a lot are constantly being paid less. A good billing service understands this and works to help their customers to also understand it. At AMRS we not only bill and collect, we analyze billings and collections to help the providers maximize their revenue where ever possible. We are ready and able to work with and help our clients with other reimbursement methods. We are not only knowledgeable, we are excited to work with Capitation, Bundled payments, Risk adjusting and others. n

When it’s 90 degrees, everyone’s sweaty…

When it’s 90 degrees, everyone’s sweaty…L75.0 – Bromhidrosis (Body Odor)nnL75.1 – Chromhidrosis (Colored Sweat)nnR61 – Excessive SweatingnnIn 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!