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for implementation of the Medicare Access and CHIP Reauthorization Act (MACRA), the historic Medicare reform law that repealed the Sustainable Growth Rate (SGR) formula last year.
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!nn
nnHere are the facts:n
n
n
n
n
n
nWith Amendment 69, it actually feels good to say NO.nn
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
n
n
n
n
n
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
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
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
n
n
n
n
nElectronic medical claims (and encounters)n
n
n
n
n
nElectronic pharmacy claims (and encounters)n
n
n
n
n
n
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…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
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.
Amendment 69 will create a first-of-its-kind, untested, government run health care system that will not work as intended.nnNo other state in the country has a health care system in place like the one proposed in Amendment 69 so there is no model to look to for how this will play out in Colorado. Vermont explored a similar plan but its governor, a single payer champion, ultimately pulled the plug on his own proposal stating, “In my judgment, the potential economic disruption and risks would be too great to small businesses, working families and the state’s economy.”n
nOf course not!nnIt’s clear to anyone who has studied the bill that Amendment 69 is not only not free — it would cost Colorado’s economy way too much!nnThe measure would give Colorado the highest income tax rate in the country, would sacrifice our health care coverage to a panel of politicians and would DOUBLE the size of state government!nnColorado cannot afford the risks associated with Amendment 69!nnThis article originally posted on ColoradansforColoradans.com.
It is, after all, a service industry and a very very big one. To be so we need and have customers. Customers provide value to us in return for the services we provide to them. In turn, we are also a customer seeking services, providing value in return for it. It is the latter that is often lost and therefore not used to proper advantage in the noise of the moving parts of this two-trillion dollar industry.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.
Accounting, Bookkeeping, and Financial Controls are now available at Welter Healthcare Partners!nnOur clients’ financial success is our number one priority! We understand that having up-to-date and accurate financial information is critical to running a successful business. More so, understanding the financials allows for good and thoughtful execution of ideas.nnWe offer personalized accounting services designed to help you identify opportunities for increased profitability and growth. Our experienced team of accountants and bookkeepers, superior customer service and overall financial management knowledge, allow our clients and business owners to focus on what they do best—being successful in their chosen field!n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
n
More than three dozen just-released audits reveal how some private Medicare plans overcharged the government for the majority of elderly patients they treated, often by overstating the severity of certain medical conditions, such as diabetes and depression.nnThe Center for Public Integrity recently obtained, through a Freedom of Information Act lawsuit, the federal audits of 37 Medicare Advantage programs. These audits have never before been made public, and though they reveal overpayments from 2007 — money that has since been paid back — many plans are still appealing the findings.nnMedicare Advantage is a privately run alternative to standard Medicare; it has been growing in popularity and now enrolls more than 17 million seniors. In 2014, Medicare paid the health plans more than $160 billion.nnBut there’s growing controversy over the accuracy of billings, which are based on a formula called a risk score; it is designed to pay Medicare Advantage plans higher rates for sicker patients and less for people in good health. In a series of articles published in 2014, the Center for Public Integrity reported that overspending tied to inflated risk scores has cost taxpayers tens of billions of dollars in recent years.nnIn May, a Government Accountability Office report called for “fundamental improvements” to curb excess charges linked to faulty risk scores. In addition, at least half a dozen health-industry insiders have filed whistleblower lawsuits that accuse Medicare Advantage insurers of manipulating risk scores to boost profits.n
Credentialing processes are generally outdated, burdensome and plagued with delays, according to a new survey on the state of today’s medical credentialing processes. It was found that 1 in 3 healthcare organizations are not satisfied with the credentialing experience.nnThe SkillSurvey survey of nearly 500 healthcare industry leaders was intended to discover the impact credentialing delays and inefficiencies have on a healthcare organization’s bottom line. Notably, more than half of all U.S. states now recognize negligent credentialing as a reason for litigation against healthcare organizations, according to information from SkillSurvey.nn”As our study shows, the traditional credentialing process is outdated and slow. While waiting to be fully credentialed, top medical talent sits on the bench, negatively affecting the hospital revenue cycle,” Ray Bixler, president and CEO of SkillSurvey, said in a statement. “Our survey shows that one in three job applicants are not satisfied with their credentialing experience. Credentialing is long overdue for an upgrade.”nnHere are four additional survey findings.nn1. Two in three credentialing processes (67 percent) are taking longer than five to six weeks to credential a clinician.nn2. Sixty-two percent of respondents said it takes from one to three weeks for peer references to respond to traditional credentialing requests.nn3. Half of respondents report it takes one to two weeks to verify a hospital affiliation.nn4. Nine in 10 organizations believe it is critical to continue improving the applicant onboarding experience within the credentialing process.nnThis article was originally posted on BeckersHospitalReview.com.nn
Or is it? We can’t help patients, cure disease or fix trauma without a healthy practice.nnMany providers have sought the perceived safe harbor of hospital employment. That is OK for some, a good idea for others but, in my experience, a huge mistake for most. It is also my experience that the reason used to make the mistake is, at the end of the day, bookkeeping or the lack of it being done properly. Private practice is a business and, when run successfully with good operations, good and honest information and analysis, and well thought–through strategic decision–making, the last and worst option is hospital system employment.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.
Z56.6 — Other physical and mental strain related to worknnZ56.5 — Uncongenial work environmentnnZ56.3 — Stressful work schedulennZ56.4 — Discord with boss and workmates
Are there advantages of a single payer system? Some say there are.nnI happen to not be one of them. Rather we really desperately need more payers, more choice, more competition, more access and a lot more imagination.nn 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.
A07.1 – Giardiasis [lambliasis]nnY93.01 – Activity, hikingnnY92.828 – Stream as the place of occurrence of the external cause
Welter Healthcare Partners strongly believes that transparent competition among payers and providers regarding value and cost is the only way to make the delivery of health care more effective and efficient. nColorado’s Amendment 69 does nothing to address either issue. Amendment 69 is an incredibly expensive attempt to fix what is not working, but in the process will eliminate all of the things that do work, and do work well. Why would we go backward only to regain ground we have already traveled? Amendment 69 is a baby and the bathwater approach to very complex, multifactorial societal issues affecting costs, infrastructure, taxes, the attraction, education and distribution of providers, how, why and by whom health care is consumed, etc. The backers of Amendment 69 have yet to publish a comprehensive plan to do this.nnWe need more competition, not less! We urge a vote no on 69. In doing so we should also prevent the mega–mergers which we are facing with Anthem and CIGNA, Aetna and Humana. Competition is a good thing, transparency is a good thing; we should move in the direction of both and we should do so expeditiously.n
Click here for more information on Amendment 69 and to endorse NO!
Problems…everyone has them. Every practice has them. A good manager knows problems and setbacks are out there and does h/her best to get in front of issues before they become major and even worse, destructive. It starts with honest assessments. An honest look at ones own shortcomings first and then the issues which do or could affect the practice and those within it. issues within a practice or department no matter how small and seemingly in consequential become destructive and even career ending when they are allowed to!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.
W16.111A – Fall into natural body of water striking water surface causing drowning and submersion, initial encounternnV92.06XA – Drowning and submersion due to fall off (nonpowered) inflatable craft, initial encounternnY93.16 – Activity, rowing, canoeing, kayaking, rafting and tubing
Medicare pays for clinical diagnostic laboratory tests (CDLTs) under the CLFS. The CLFS provides payment for approximately 1,300 CDLTs, and Medicare pays approximately $7 billion per year for these tests. As of July 6th, 2016, some of the medicare & medicaid rules and policies are changing. Read Below for some facts and information about the upcoming changes:n
n
n
n
n
n
n
nProposed Hospital Outpatient Payment Changes for 2017nnOn July 6, 2016, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2017 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System policy changes, quality provisions, and payment rates proposed rule (CMS-1656-P). CMS is proposing a number of outpatient prospective payment policies that will improve the quality of care Medicare patients receive.nnA key proposal in this year’s rule is to implement Section 603 of the Bipartisan Budget Act of 2015, which will affect how Medicare pays for certain items and services furnished by certain off-campus outpatient departments of a provider (hereinafter referenced as off-campus “provider-based departments” (PBDs)). In addition, CMS has listened to concerns raised by health care providers on the patient experience survey questions about pain management and is proposing to remove the Pain Management dimension of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey for purposes of the Hospital Value Based Purchasing Program. In addition to the payment provisions and quality reporting program changes for the OPPS/ASC proposed rule, CMS has created other propositions.n
The Justice Department is suing to block two proposed mergers between major health insurance companies, saying the deals violate antitrust laws and would lead to higher health care costs for Americans.nnU.S. Attorney General Loretta Lynch explained the decision at a press conference:n
“If allowed to proceed, these mergers would fundamentally reshape the health insurance industry. They would leave much of the multitrillion-dollar health insurance industry in the hands of three mammoth insurance companies, drastically constricting competition in a number of key markets that tens of millions of Americans rely on to receive health care.nn”Among other consequences, the number of health insurance options available to nationwide employers would shrink from four to three. Two of the largest and fastest-growing providers of Medicare Advantage plans, which millions of seniors rely on for crucial medical coverage, would combine into just one. And competition would be substantially reduced for hundreds of thousands of families and individuals who buy insurance on the public exchanges established under the Affordable Care Act.”
nThe lawsuits filed Thursday morning challenged a $37 billion merger between Humana and Aetna, which the Justice Department alleges “would lead to higher health-insurance prices, reduced benefits, less innovation, and worse service for over a million Americans,” and a $54 billion acquisition of Cigna by Anthem, which the court filing states would be the largest merger in the history of the health insurance industry.n
T67.0XXD — Heatstroke and sunstroke, subsequent encounternnY93.02 — Activity, runningnnY92.414 — local residential or Business Street as the place of occurrence of the external cause