January 2014
Now available: Online Medicare fee schedule for viewing
Novitas has posted the 2014 downloadable Medicare physician fee schedule on their website. Go to http://tinyurl.com/2014-Novitas to download a text-delimited file of the latest fees.
This text file is formatted for viewing only. It is not formatted for importing into billing systems or other types of computer systems. Novitas will notify physicians and practices on their website and by e-mail when the 2014 physician fee schedules are available in PDF and Microsoft Excel formats appropriate for importing.
Lost on ICD-10? Get help now
The Colorado Medical Society is a key partner in the Colorado ICD-10 Training Coalition, which aims to help physician practices navigate the ICD-10 maze. The coalition held a monthly webinar series in 2013, all of which are available on-demand on the coalition's website.
With just 258 days remaining until the Oct. 1, 2014 ICD-10 implementation deadline, we urge practices to visit www.cms.org/icd-10 to catch up on these webinars, access spreadsheets and timeline templates, and more.
Updated CMS 1500 Claim Form version 02/12 now accepted
In June 2013, the National Uniform Claim Committee (NUCC) announced the approval of an updated 1500 Claim Form, version 02/12, that accommodates ICD-10-CM diagnosis codes and meets requirements in the Accredited Standards Committee X12 (ASC X12) Health Care Claim: Professional (837P) Version 5010 Technical Report Type 3.
Many payers began accepting the updated 1500 Claim Form version 02/12 starting on Jan. 6, 2014. Practices are urged to follow the guidelines set forth by the NUCC for completing the new claim form or else claims may be rejected. For more information about the revised 1500 Claim Form, please visit the National Uniform Claim Committee website, www.nucc.org, which provides helpful resources.
Please note that the NUCC's transition timeline for use of the 1500 Claim Form version 08/05 includes a dual submission period from Jan. 6, 2014 - March 31, 2014. Effective April 1, 2014, paper claims should be submitted using only the revised 1500 Claim Form version 02/12.
Check practice status in exchange provider directory
Connect for Health Colorado now has a provider directory available to the public. Anyone shopping for health insurance on the exchange website can search the directory for plans that include certain physicians and preferred hospitals.
Connect for Health Colorado asks providers to help communicate the availability of the directory to their patients as they shop for a health plan.
Physician practices and health care facilities are also encouraged to go online to confirm in which plans they are listed as members. Insurance carriers update the information in the provider directory every month and send it to the exchange to post on the site, completely replacing the prior month's data. Carriers are the only means of changing or correcting information in the directory. The exchange encourages physicians to work closely with them to correct any errors.
To check your practice's information, follow these steps.
1. From the www.ConnectforHealthCo.com home page, click on the "shop now" button under individual and families
2. At top of page, click on "Find a Plan"
3. Click on the second option on the page - "Browse health plans"
4. Fill in the ZIP code and birth month/year of a typical patient
5. Enter a provider name OR practice/facility name and click "Search"
6. Confirm it's the correct office/practice by clicking on the check mark where names are listed at top
7. Select "go back to plans" at the top of the page and view the plans for which you or your facility are listed
Open enrollment on the marketplace extends through March 31, 2014.
For Medicare claims to be paid, ordering/referring physicians
must be enrolled
Previously, physicians and health care providers who billed Medicare were required to list the name and National Provider Identifier (NPI) of the ordering/referring physician or health care provider on their claims in order to be paid.
Starting Jan. 6, 2014, if the ordering/referring physician or health care provider listed on the claim is not enrolled in Medicare OR does not have a valid opt-out affidavit on file, then the billing physician's claims will be denied. This requirement was originally scheduled to go into effect in 2010, but the American Medical Association and Medical Group Management Association (MGMA) successfully convinced the Centers for Medicare and Medicaid Services (CMS) to delay this several times so that more time could be given for physicians to enroll or opt-out.
Click here to read more in this bulletin from the AMA and MGMA.
Also note that the deadline to designate a provider's Medicare participation is Jan. 31, 2014. Click here to read more from the American Medical Association.
Medicaid preventive and wellness services effective Jan. 1, 2014
Beginning Jan. 1, 2014, Colorado Medicaid covers all recommended preventive and wellness services defined by the U.S. Preventive Services Task Force (USPSTF) with a rating of A or B and the Advisory Committee on Immunization Practices (ACIP) without patient cost sharing (co-payments).
Most USPSTF and ACIP recommended preventive and wellness services were previously covered by Medicaid, but beginning Jan. 1, 2014, new preventive and wellness procedure codes were made available.
Proper coding is critical to receiving accurate payment for the USPSTF and ACIP recommended preventive and wellness services. For more information about the preventive and wellness services procedure codes and their utilization go to Colorado.gov/HCPF/ProviderACAInfo.
In This Issue
Novitas Medicare physician fee schedule
ICD-10 help
CMS 1500 Claim Form version 02/12
Check Connect for Health Colorado listing
Medicare claims change
Medicaid preventive and wellness services
Events
Colorado Medical Group Management Association
Feb 12 - Outsourcing Your Revenue Cycle Management - Profit or Loss?, Bette Warn
March, April, May - Three-part series on LEAN for Private Physician Practices, Kearin Schulte
CMGMA webinars are free for active CMGMA members, $50 for non-members. Click here for more information on the CMGMA website.
Submit your event by e-mailing marilyn_rissmiller@cms.org.
Health insurance exchange information
American Medical Association
Anthem
Latest bulletins
Aetna
Anthem
Colorado Medicaid
Novitas
Rocky Mountain Health Plans
United
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