Influenza codes received a makeover with this year’s CPT update. The codes are no longer classified based on age. The descriptions of these codes now reflect dosage amounts. Codes now state “becomes 0.25 mL dosage” in place of “when administered to children 6-35 months of age” and “becomes 0.5 mL dosage” in place of “when administered to individuals three years and older”. These changes affect codes 90655 – 90661 and 90685 – 90688.nn
Physical and occupational therapy codes received a major overhaul with this year’s CPT update. Codes have been expanded to take into account the overall evaluation complexity. The new codes incorporate a tiered level of complexity for physical and occupational therapy as well as athletic training evaluations. These new codes also require a substantial increase in the volume and quality of clinical documentation needed to capture these services compliantly.n
n
n
n
n
n
n
n
n
n
n
n
n
n
There are 8 new CPT codes to reflect epidural spinal injections. These new codes are classified by both anatomy and whether imaging guidance was used and replace codes 62310 – 62319.n
n
n
n
n
n
n
n
n
n
Bunionectomy codes underwent expansion and revision in this year’s CPT update. Two new codes were added to reflect more accurate procedural options as well as many revisions to the technical descriptions of existing bunion correction codes.n
n
n
n
The most significant changes this year for diagnostic and interventional radiology involve mammography bundling, ultrasound screenings for AAA, and fluoroscopy services. Fluoroscopy codes 77002-77003 are now subject to the global period concept and are designated add-on codes.nnMammography services now include computer – aided detection (CAD), which eliminated the add-on codes reported in previous years. CMS is still requiring the use of HCPCS G-codes and will not eliminate these codes until 2018.n
n
n
n
n
n
n
nA new code has been created to specifically screen for an abdominal aortic aneurysm. This CPT code will replace G0389, which has been used in previous years.n
n
n
At the end of the day, contracting in this day of pay–for–performance and adding value to the relationship is about the bottom line. What is the bottom line? The Spend!nnIn most states, including Colorado, the commercial health plans have to tell the state what their premiums are. Their premiums come from their estimate as to what their network and covered population will cost. I find it fascinating to look and see what the various payers are declaring! You can tell a lot about a network and its management by looking at these numbers.nnCan a provider help a payer lower its spend? Can you control costs? Not necessarily your own costs but the costs of those you refer to? You may be surprised!n
n
Stay tuned for more Todd’s Tips!
nnn
nn
About R. Todd Welter • MS, CPCnFounder and President of Welter Healthcare PartnersnMr. 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.
Transition InformationnOn March 1, 2017, 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.nnYou must be enrolled in the new Colorado interChange. All providers must be enrolled (and approved) in the Colorado interChange system by March 1, 2017. Those who are not enrolled and approved will not be able to submit claims or receive payments. Visit Colorado.gov/HCPF/Provider-Enrollment for more information.nnAll ordering, prescribing, or referring (OPR) providers must be enrolled in the new Colorado interChange. The Affordable Care Act (ACA) now requires physicians and other eligible practitioners to enroll in the Medicaid program to order, prescribe, and refer items or services for Medicaid members, even when they do not submit claims to Medicaid. Claims listing an OPR provider that is not enrolled cannot be paid. Visit Colorado.gov/HCPF/OPR for more information.nnClearinghouse Enrollment & TestingnIf you utilize a Clearinghouse to submit batch claims or eligibility transactions, your Clearinghouse MUST apply for an interChange Trading Partner ID (TPID) and pass test transactions for HIPAA compliance. Clearinghouses without an interChange TPID will not be able to submit batch claims or receive reports beginning March 1, 2017.nnPlease check this list to see if your Clearinghouse has enrolled and passed testing. If your Clearinghouse has not started or has not completed their testing, we recommend that you reach out and remind them to do so immediately. Your Clearinghouse can learn more information about applying for a new TPID at: Colorado.gov/HCPF/EDI-support.nnContact UsnIf you need assistance with your revalidation or enrollment application, please call the Health First Colorado Enrollment and Revalidation Information Center at: 1-844-235-2387. Standard operating hours are 8am – 5pm MT, Monday – Friday.nnPlease Note: For billing, claims and Provider ID questions regarding the current Xerox system, please continue to call Xerox State Healthcare at: 1-800-237-0757.nnThis article originally posted on Colorado.gov.
Photo Courtesy of Healthleadersmedia.com.
nThis article was originally posted on Healthleadersmedia.com.
With just over a week before it was scheduled to take effect, a federal judge blocked the implementation of an Obama administration overtime pay rule that would have extended overtime eligibility to some 4 million Americans.nnThe Labor Department’s sweeping overhaul to the overtime rule required employers to pay time-and-a-half to their employees who worked more than 40 hours in a given week and earned less than $47,476 a year. That salary threshold is about twice what currently allows workers to be exempted from overtime. As NPR’s White House Correspondent Scott Horsley told our Newscast Unit, supporters of the rule called it “long overdue” as inflation took its toll on overtime protection.nn”The rule was one of the administration’s most far-reaching efforts to boost pay for workers at the lower end of the income ladder. It’s one of many administrative actions that was already facing the threat of reversal from the incoming Trump administration.” The measure, which had been set to take effect Dec. 1, was intended to send a jolt to slow-growing U.S. incomes.nnOn Tuesday, U.S. District Judge Amos Mazzant III issued a preliminary injunction in the case, siding with plaintiffs who said the new overtime rules would have caused an uptick in government costs in their states and made it mandatory for businesses to pay millions in additional salaries. Business groups said the new rule changes would have eventually led to layoffs.nnThe timing of the block brings an early answer for workers who were wondering about the rule’s fate after the election. As NPR’s Business Correspondent Yuki Noguchi reported earlier this month: “In any presidential transition, previous policies are subject to review. Trump has pledged to undo President Obama’s executive orders, dismantle the Affordable Care Act, reverse policies on clean air, immigration and on Dodd-Frank financial reform. This [month], the Congressional Budget Office said canceling the overtime rule would reduce employers’ compliance costs and boost profits, a point advocates refute. This leaves businesses wondering how they should proceed on rules that might be unwound.”nnWith Republicans controlling both houses in Congress and the Trump administration set to take office in less than two months, the new overtime rule’s long-term future remains in limbo. The Department of Labor issued the following statement regarding the federal court’s preliminary injunction.n
Happy Thanksgiving! We are very happy whenever the season of Thanksgiving is fast approaching because we consider this as a wonderful holiday that permit us the best opportunity to thank all our valued friends, supporters and clients. These previous years have really been good to our company, and so we thank all of you for continuing to patronage us and for experiencing our remarkable service.nnWishing you and your family a wonderful Thanksgiving!n— Welter Healthcare Partners
The new Overtime Rule law implemented by the Department of Labor REQUIRES you to modify how you pay some of your full-time salaried employees, or fall victim to expensive lawsuit nightmares.nnEffective Dec. 1st, the new Fair Labor Standards Act (FLSA) rule changes the threshold for salaried employees. In a nutshell, this means you could be among the thousands of practices REQUIRED to pay overtime to full-time employees making less than $47,476 a year. And, noncompliance really isn’t an option.nnSo what can you do about it…nnHuman Resources Expert, Lori Kleiman, SPHR, SHRM-SCP, is offering a healthcare-specific FLSA Overtime Compliance online training session just for you. In only 60-minutes, you’ll receive a step-by-step breakdown of the new FLSA requirements as they relate to healthcare. You’ll learn how to ensure compliance with this new rule – which includes avoiding overpaying your staff too – and have time to get your specific questions as well.nnHere are just a few of the proven tactics you’ll receive by attending this step-by-step, plain-English online training:n
n
n
n
n
n
n
n
n
nWARNING: Every medical practice, clinic, and hospital that has full-time employees, no matter how big or small, is responsible for complying with the new Overtime Rule law — FLSA rule modifications. No one is immune, you must comply by the Dec. 1st deadline. You must take steps NOW to ensure your compliance. Don’t wait, register today.
Sneaky Sneak!nI am seeing some pretty sneaky fee schedules lately! If you cannot explain a fee schedule on the way up the elevator between two floors of your building, it is either too complicated to know if your being paid properly or so vague that you won’t be.nnSome new carriers are popping up to take on older programs or member groups, very often these out of state payers first start off on fishing expeditions trying to catch those who don’t know, don’t pay attention or don’t care. Don’t be one of them!nStay tuned for more Todd’s Tips!nn
nn
About R. Todd Welter • MS, CPCnFounder and President of Welter Healthcare PartnersnMr. 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.
The Colorado Department of Health Care Policy and Financing made the decision to postpone the Go Live date of:n
n
n
n
nThe new Go Live date is March 1, 2017.nnProviders should continue to use their current processes for submitting claims, prior authorization requests and provider enrollment updates to the Department. Claims will continue to be processed and paid as they are currently.nnThe additional four months will allow providers and partners more time to complete the enrollment and revalidation process, receive comprehensive training and prepare for associated changes in their business processes. The Department will conduct additional systems testing during this time.nnThe Department will post updates and resources including revised deadlines on The Department’s Provider Resources web page.nnWe appreciate your continued commitment to serving our more than 1.3 million Health First Colorado (Colorado’s Medicaid Program) and Child Health Plan Plus (CHP+) members.
The 2017 Medicare Part B Physician’s Fee Schedules have been posted to the Novitas Solutions website. Downloads are available in Adobe PDF, Microsoft Excel, and Plain Text formats. The Code Search feature will not have 2017 fees loaded until the first week of January, 2017.nnClick Here to Download Copies.
It doesn’t matter who does the math, Thomas: Amendment 69 would be a disaster for Colorado taxpayers. This week the Tax Foundation, an independent research organization, released a report on the impacts of passing ColoradoCare into law — and it’s as bad as we thought.nnHere are some of the Tax Foundation’s findings:n
n
n
n
n
nExperts from all across the political spectrum — as well as independent research entities like the Tax Foundation — all agree: Amendment 69 is wrong for Colorado.
Bill Summaryn Colorado Stat. 10-16-123 (new rev. eff. 1/1/17)nnHOUSE SPONSORSHIPn Buck and Ginal,n SENATE SPONSORSHIPn Kefalas and Martinez Humenik,nnUnder current law, health benefit plans issued, amended, or renewed in this state cannot require in-person health care delivery for a person covered under the plan who resides in a county with 150,000 or fewer residents if the care can be appropriately delivered through telemedicine and the county has the technology necessary for care delivery via telemedicine.nnStarting January 1, 2016, the bill removes the population restrictions and precludes a health benefit plan from requiring in-person care delivery when telemedicine is appropriate, regardless of the geographic location of the health care provider and the recipient of care. A provider need not demonstrate that a barrier to in-person care exists for coverage of telemedicine under a health benefit plan to apply.nnIn addition, carriers:nn! Must reimburse providers who deliver care through telemedicine on the same basis that the carrier is responsible for coverage of services delivered in person;n! Cannot charge deductible, copayment, or coinsurance amounts that are not equally imposed on all terms and services covered under the health benefit plan; andn! Cannot impose an annual or lifetime dollar maximum that applies separately to telemedicine services.
Reminder, ACA Section 1557 Compliance Began Sunday, October 16th!nnAll practices – regardless of practice size – are required to post the non-discrimination notice and taglines. Follow theses easy steps to ensure your practice is compliant.nnPost Notice of Nondiscriminationn- Download PDF.n- Enter practice name.n- Print/post in office.n- Post PDF to your website.nnArrange for a Language Assistance Providern- Download list of language assistance providers.n- Select a provider.n- Establish a relationship.nnMake a Tag Lines Postern- Identify the top 15 languages in your state.n- Download the example PDF.n- Enter practice name & language assistance provider phone. Download language verbiage and copy into template.n- Print/post in clinic.nnEstablish Civil Rights Grievance Proceduren- Only required for covered entities with 15 or more employees.n- Designate a Civil Rights Grievance Officer.n- Put Civil Rights Grievance Procedure in place and document.nnComplete Online Attestationn- Go to OCR attestation portal.n- Submit Assurance of Compliance.nnThis is required for all practices receiving government funding (ie. Medicare Parts A, C & D [NOT B], Medicaid, Meaningful Use, etc.)
CMS Provider Education Message:nnOn October 14, HHS finalized its policy implementing the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (APM) incentive payment provisions in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), collectively referred to as the Quality Payment Program. The new Quality Payment Program will gradually transform Medicare payments for more than 600,000 clinicians across the country, and is a major step in improving care across the entire health care system.nnThe final rule with comment period offers a fresh start for Medicare by centering payments around the care that is best for the patients, providing more options to clinicians for innovative care and payment approaches, and reducing administrative burden to give clinicians more time to spend with their patients, instead of on paperwork.nnAccompanying the announcement is a new Quality Payment Program website, which will explain the new program and help clinicians easily identify the measures most meaningful to their practice or specialty.nnFor More Information:nFinal Rule and Executive SummarynPress ReleasenFact SheetnQuality Payment Program website
ColoradoCare’s proponents claim that Amendment 69 will be good for our active duty and retired military. But that’s not what Colorado’s veterans think! The Pueblo Chieftan published a letter from two decorated retired Colorado veterans, who are opposing the dangerous tax burdens and uncertain health coverage contained in Amendment 69. Read their letter here.nnWith the health care system set up by ColoradoCare, veterans and active duty military members will still receive their care through TRICARE and VA benefits, not through ColoradoCare. But despite no benefits from the new system, Colorado’s military families would still be forced to pay their share of a huge new income tax hike! That could mean a retired colonel eligible for Medicare benefits would pay a $6,000 annual premium for ColoradoCare, with no health care benefits!nnAmendment 69 is dangerous for all Coloradans, but especially for our military families. We only have a few weeks to defeat Amendment 69.nn
nn
The Denver Post‘s recent editorial on Amendment 69 starts off with a bang:nn”Should Amendment 69 find itself embedded in the Colorado Constitution, and fail even half as dramatically as it could — and we cannot imagine how it could succeed — it would take navigating circles of hell in a wooden dingy to correct the damage.”nnFrom the giant tax hikes that would affect not only workers’ bottom lines but also the ability of Colorado’s small businesses to grow, to the 21-member board of politicians that would control your health coverage, the Post urges a “resounding ‘no’ on Amendment 69.”This is a huge boost of momentum to our effort to stop ColoradoCare from becoming law, Thomas.nnBut ballots were mailed to voters today — there’s just not much time left to make sure we have the votes to defeat this dangerous measure. Can you chip in $15 today?
The Centers for Medicare & Medicaid Services (CMS) invites you to join a webinar on October 26 at 2:00 PM ET, on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) final rule with comment period. The webinar will provide an overview of the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Model (APM) incentive payment provisions under MACRA, collectively referred to as the Quality Payment Program.nnWebinar DetailsnnQuality Payment Program OverviewnnDate: Wednesday, October 26, 2016nTime: 2:00 to 3:00 PM ETnRegister: https://engage.vevent.com/rt/cms/index.jsp?seid=530nSpace for this webinar is limited. Register now to secure your spot. After you register, you will receive an email message with a dial-in number and webinar link. Please note, you will not be able to share your participant information because it will be unique to you.nnQuality Payment Program Final Rule MLN Connects® Call — November 15nnDate: Tuesday, November 15, 2016nTime: 1:30 to 3:00 PM ETnRegister: MLN Connects Event RegistrationnTarget Audience: Medicare Part B Fee-For-Service clinicians, office managers and administrators; state and national associations that represent healthcare providers; and other stakeholders.nSpace may be limited, register early. During this call, learn about the provisions in the recently released final rule; participants should review the rule prior to the call. A question and answer session will follow the presentation.nnFor More InformationnnTo learn more about the final rule and the Quality Payment Program, view the following resources:n
n
n
n
n
nSubmit a Formal CommentnnCMS encourages the public to submit comments on the MACRA final rule. Comments are due 60 days after the date of filing for public inspection, and can be submitted in several ways, including:n
n
n
n
n