MACRA and Payment Reform - CCHAP Practice Manager Meeting

Connecting the Dots: MACRA and Payment Reform -
The Impact on Pediatric Practices

Tuesday, November 15th; Noon - 1:00PM  (Lunch will be available starting at 11:30AM)

Children's Hospital Colorado
South Campus Highlands Ranch
1811 Plaza Drive, Highlands Ranch, CO 80129
Tennessee Conference Room - 1st Floor
ReadyTalk Web Conference for remote attendees

Instructions to join the meeting remotely:
1. Open a web browser and enter URL: www.readytalk.com
Enter participant access code: 2093166
2. Dial in by phone for the audio portion of the conference:
1-866-740-1260
Enter the participant access code: 2093166
Please click here to RSVP

[Source: CCHAP]

CCHAP Practice Manager Meeting: Behavioral Health Integration in Primary Care Practices

Thursday September 29th
Noon - 1:15PM
(Lunch will be available starting at 11:30AM)

Fitzsimons Village

13100 East Colfax Avenue, Aurora, CO 80045
(click here for parking map)
Silverton Conference Room - 6th Floor
ReadyTalk Web Conference for remote attendees
Please click here to RSVP

Presented by:
Bridget Burnett, PsyD
Director of Behavioral Health Integration, CCHAP
Senior Instructor
University of Colorado Denver, SOM
Department of Psychiatry
Children's Hospital Colorado

Please open this short survey to help our presenter better understand the issues you would most like to hear about

Instructions to join the meeting remotely:
1. Open a web browser and enter URL: www.readytalk.com
Enter participant access code: 2093166
2. Dial in by phone for the audio portion of the conference:
1-866-740-1260
Enter the participant access code: 2093166

Colorado Children's Healthcare Access Program: Practice Manager Newsletter

New Medicaid Fee Schedule Effective July 1, 2016

"The new and complete Medicaid provider rate fee schedule has just been released for dates of service effective July 1, 2016.

Medicaid reimbursed these codes at a Medicare equivalent rate to comply with Section 1202 of the Affordable Care Act (ACA) for Calendar Year 2013 and Calendar Year 2014 and temporarily extended the Medicare equivalent rate through June 2016.

Effective July 1, 2016, evaluation & management (E&M) and vaccine administration services will be reimbursed at the December 2012 level, except as noted below. From July 1, 2016 through June 30, 2017, through the efforts of HCPF and provider associations, one year of additional funding is authorized to reimburse important E&M code categories and vaccine administration codes at somewhat higher rates. 

Click here for common Medicaid July 2016 codes for Pediatrics.  

Click here for the entire Medicaid July 2016 fee schedule.

The E&M categories with temporary funding are standard office visits, preventive care office visits, newborn visits, neonatal and pediatric critical care visits, and counseling visits. These rates are scheduled to return to the December 2012 level on July 1, 2017."

Check out the CCHAP newsletter for more information on:

• Next CCHAP Practice Manager Meeting
• New Vaccine Resources Available
• SIM Cohort 2 Information

[Source:  CCHAP]

New Vaccine Resources for Providers Now Available

"A brand new set of resources offer health care providers tools to help vaccinate their patients including help with inventory management, storage and handling, billing and coding, and much more. Also, there is peer-to-peer provider mentoring help available as well as an "Ask the Expert" link for you to submit questions to the immunization clinical staff."

Click here for resources: https://www.colorado.gov/cdphe/healthcare/vaccine-resources

[Source:  CCHAP]

Medicaid Updates: Governor’s budget proposal, ACC Phase II updates, reattribution of ACC patients

“Medicaid Proposed Budget for 2016-2017 and Provider Rate Impact: Last Monday, November 2nd, Governor John Hickenlooper released his 2016-17 state budget proposal. Because of TABOR amendment limits on state spending growth, the legislature will be forced to cut more than $370 million from the state’s budget for the next state fiscal year. While the Governor’s proposal calls for cuts across all budget categories, there are particularly deep cuts called for in the Medicaid program, including cuts to the primary care reimbursement rates.

Accountable Care Collaborative Phase II Concept Paper: The Accountable Care Collaborative (ACC) is the core delivery system for Colorado Medicaid, with more than 940,000 members enrolled as of August 2015. Since its inception, the ACC has been intended to be an iterative program, driving a steady and sustainable shift in the delivery system from one that incentivizes volume to one that incentivizes value. The Regional Care Collaborative Organization (RCCO) contracts expire in July 2017, creating an opportunity to evolve the program during Phase II of the ACC. In mid-October, HCPF released the ACC Phase II Concept Paper, inviting dialogue with the community. HCPF has organized numerous opportunities to solicit public feedback. Click here to read the Concept Paper, stakeholder forum schedule and more information about the development of ACC Phase II.

Reattribution of Medicaid ACC Patients is Happening Now: Beginning in October 2015, Medicaid has begun to run the attribution algorithm on all systematically-attributed ACC clients on a quarterly basis and allow the system to assign those clients to PCMPs based on claims history over the most recent 12-month period. Clients will be notified of the change to their PCMP assignment via normal notification processes (a letter to the client informing them of the assignment which is sent before the effective date).

This process will initially result in the reassignment of about 78,000 clients. Recognizing the potential financial impact of these reassignments on some providers, Medicaid will be providing the RCCOs with lists of the approximate total number of reassignments by each provider ID. It is anticipated that in subsequent quarters the number of clients reassigned will be significantly lower. Read the entire Policy Statement here for more details.

Read the full Colorado Children’s Heathcare Access Program’s Practice Manager Newsletter for more information on:

• Medicaid Provider Revalidation & Enrollment Update
• Psychiatric Consultation for Children
• Cavity Free at Three Training Opportunity
• ECHO Colorado Learning Series Opportunities” [Source: CCHAP]

ICD-10 Updates from Medicaid – CCHAP Practice Manager Newsletter

“ICD-10 Updates from Medicaid: External end-to-end testing has confirmed that Medicaid's systems are integrated, operable, and ready to accept the new ICD-10 codes and formats on October 1, 2015. Effective October 1, 2015, ICD-10 is now active and replacing ICD-9 diagnosis codes. Providers should note the ICD-10 implementation is Date of Service (DOS) specific:

• ICD-9 diagnosis and surgical procedure codes will be required on claims that contain DOS or dates of discharge (DOD) on or before September 30, 2015.
• ICD-10 diagnosis and surgical procedure codes are required on claims that contain DOS or DOD on or after October 1, 2015.

Claims submitted with both ICD-9 and ICD-10 codes will be rejected.
Medicaid billing manuals have been updated ICD-10 codes. Click here to access the manuals.
Appendix R – Provider Claim Report Denial/Error Codes Update for ICD-10. Click here to find this document under "Appendices"

Please contact the Department’s fiscal agent, Xerox State Healthcare at 800-237-0757 with billing questions. Please contact Sean Gagnon at Sean.Gagnon@state.co.us or 303-866-3467, or Shawna Tye at Shawna.Tye@state.co.us or 303-866-2347 with questions regarding the ICD-10 implementation project.

Check out the Colorado Children’s Healthcare Access Program’s full Practice Manager Newsletter for more information on:

• Preventative Screening Table – Update for ICD-10
• Young Minds Matter: Supporting Children's Mental Health Through Policy Change
• Tobacco Cessation Resource Group
• Reminder - Colorado PAR Program - New Vendor
• Medicaid Provider Relations Team
• Medicaid Provider Billing Workshops” [Source: CCHAP]

More rate increases coming for Medicaid providers – CCHAP Practice Administrator Newsletter

“Medicaid Provider Rate Increases: Medicaid provider rate increases were approved during the 2015-2016 legislative session and are effective for dates of service beginning July 1, 2015. HCPF has worked to obtain approval from CMS to implement the rates with an effective date of July 1, 2015. Some providers will be paid retroactively if there has been a delay in implementation, and other rate increases will be implemented when approved and loaded into the Medicaid Management Information System (MMIS).

Please see the FY 15-16 Frequently Asked Questions on the HCPF Provider Implementations webpage. The fee schedule is located on the Provider Rates & Fee Schedule webpage and is being updated to reflect the approved 0.5% rate increase. Approved increases include eligible physician and clinic services, Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services, and more. Read all the details here…

Medicaid Revalidation Requirement: Beginning 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 enroll and revalidate their licensure and business information under new federal enrollment screening criteria. Providers who fail to revalidate and enroll by March 31, 2016 may have their claims suspended or denied.

Self-paced Online Enrollment Application Training for the new Colorado Online Provider Enrollment (OPE) tool is available for all providers. These are online, self-paced, eLearning modules. Please visit the Provider Resources page to register!

Check out the Colorado Children’s Healthcare Access Program’s full Practice Manager Newsletter for more information on:

• Enhanced Primary Care Medical Provider Initiative
• Back To School Immunizations
• Reattribution of Medicaid ACC Patients is Coming
• Colorado PAR Program - New Vendor
• ICD-10 Update from Medicaid
• Record Retention for Medicaid and CHP+ Patients
• Medicaid Provider Billing Workshops
• Medicaid Provider Relations Team” [Source: CCHAP]

CCHAP Practice Manager Newsletter - Medicaid Provider Revalidation Requirement

“New federal regulations established by CMS require enhanced screening and revalidation of all Medicare, Medicaid, and CHP+ providers. Beginning 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 enroll and revalidate their licensure and business information under new federal enrollment screening criteria.

HCPF will be hosting Revalidation & Enrollment webinars every business day from 1 p.m. - 2 p.m. (Mountain Time) in August 2015 for all providers. Visit the Provider Resources page to register!

Self-paced Online Enrollment Application Training for the new Colorado Online Provider Enrollment (OPE) tool will be available for all providers starting August 24, 2015. These are online, self-paced, eLearning modules. Visit the Provider Resources page to register!

Check out the Colorado Children’s Healthcare Access Program’s (CCHAP) latest Practice Manager Newsletter for more information on:

• Enhanced Primary Care Medical Provider Initiative
• Medicaid Provider Relations Team
• Brochure for Teens: Depression
• Health Reform and the AAP: What the New Law means for Children and Pediatricians
• Colorado PAR Program - New Vendor” [Source: CCHAP]

CCHAP Practice Manager Newsletter: Vaccine Administration Rate Increase

“Vaccine Administration Rate Increase:  Effective January 1, 2015, the General Assembly approved an increase to the rate for vaccine administration. The new rate is 100% of the maximum rate for Colorado, set by DHHS.

The rate for vaccine administration codes 90460, 90471, and 90473 is now $21.68, an increase of more than 300% from the previous rate of $6.59. The federal law creating the Vaccines for Children Program also mandated that DHHS cap fees for vaccine administration. Each state has a different cap. Colorado’s fee cap is $21.68.

Providers will receive the new rate through a mass adjustment, unless their submitted charge is less than the new rate, $21.68. Any claim with a submitted charge lower than the revised rate must be adjusted by the provider. It is recommended that providers submit charges based on Usual and Customary rates, when applicable.

Read the Colorado Children’s Healthcare Access Program’s (CCHAP) full newsletter for more information on:

• Vaccine Access Task Force Update (SB 222)
• Next CCHAP Practice Manager Meeting
• Medicaid Provider Revalidation Requirement
• Diabetes Self-Management Education Coverage
• ICD-10 Update from Medicaid
• Cavity Free at Three Training Opportunity

Also available is their July 9th Clinical Newsletter.” [Source: CCHAP]

CCHAP Practice Manager Newsletter: Quick and Easy Well Visit Screening Chart

“Preventive Screening Summary Table – Updated: Medicaid policies and coding requirements have changed for some of the recommended well visit screenings. We have created a simple easy to read one-page summary table for you to use as a reference guide. Click here for the table in PDF format.

Check out the Colorado Children’s Healthcare Access Program’s (CCHAP) full practice manager newsletter for more on:

• Next CCHAP Practice Manager Meeting – August 18
• Vaccine Access Task Force Update (SB 222)
• Open Access Scheduling Case Study
• Medicaid Provider Rate Increases Approved
• Denver Health Medicaid Passive Enrollment Modifications” [Source: CCHAP]

CCHAP Practice Manger Newsletter: Denver Health Passive Enrollment Changes

“The Department of Health Care Policy and Financing (HCPF) in conjunction with Denver Health Medicaid Choice (DHMC) is modifying the DHMC passive enrollment process. The current DHMC passive enrollment process enrolls ALL Medicaid eligible Denver County residents into DHMC regardless of current plan or previous history with a non-Denver Health provider. This process has negatively affected some Medicaid population’s ability to receive services. DHMC and HCPF have collaborated and created a new process intended to decrease the roadblocks for those negatively affected.

During the month of May, the current MMIS DHMC passive enrollment logic was removed and a new process will be implemented that prevents DHMC passive enrollment of the following:

• Medicaid clients with existing attribution to a non-DHMC provider.
• Refugee populations that utilize Volunteer Agencies addresses as residential addresses
• Foster children

Removing these populations from the DHMC passive enrollment process does not restrict the client from selecting DHMC as a health plan; it merely provides the client with ability to choose their plan and not be defaulted into DHMC. The modified process will be implemented beginning June 1, 2015 and will be seamless to the client and health plans.

This new process will only be applicable to newly eligible Medicaid clients and will not affect currently enrolled clients. All other existing process and procedures related to enrollment are unchanged (e.g. open enrollment, etc.).

If you have any questions or concerns please contact the Denver Health Contract Manager, Jeremy Sax at jeremy.sax@state.co.us or 303-866-3227.

View the Colorado Children's Healthcare Access Program’s full newsletter for more information on:

• Life After SGR: Medical Home Concept Looms Larger
• Drug & Alcohol Abuse Questionnaire - Important Updates
• Important Medicaid Help Resources” [Source: CCHAP]

Colorado Children’s Healthcare Access Program Practice Manager Newsletter – ICD-10 Presentation Recording

“ICD-10 Presentation Recording and Slides: On Thursday April 23rd, Denny Flint from The Talon Group gave a fun and informative presentation with practical guidance on how practices can prepare for the rollout of the new ICD-10 diagnosis code set. The presentation recording and PowerPoint slides can be accessed here.

Check out CCHAP’s latest Practice Manager Newsletter for information on:

• Medicaid 2015 Fee Schedule is Live
• Medicaid Enhanced Primary Care Program
• Screening, Brief Intervention, and Referral to Treatment - Important Policy & Coding Updates
• Add-A-Baby Project
• Child Abuse and Neglect Campaign
• Repeal of the Sustainable Growth Rate (SGR)” [Source: CCHAP]

CCHAP Practice Manager Newsletter - Higher Medicaid Payments Approved for 2015

“Medicaid 2015 fee schedule: CMS has approved the rate increase to E&M and vaccination codes, bringing them on par with Medicare rates published in December 2014. These rates took effect on January 1, 2015, but Medicaid was unable to pay the rates until CMS approval was received.  The rates are currently being loaded into the MMIS claims system. Once loaded, any qualified E&M or vaccination claim will be paid at the new rate. Providers are not required to attest to providing primary care. All qualified claims from January 1st, 2015 will be mass adjusted and repaid at the higher rate. Click here for the fee schedules.

ICD-10 implementation presentation: This presentation is for providers, managers, and staff on April 23rd noon-1pm. The presenter is a national expert on ICD-10 and we are excited to be able to bring his expertise to medical home practices in Colorado. You may attend in person or via webinar remotely. RSVP by emailing joanie.muzzulin@childrenscolorado.org. The meeting will be held at Fitzsimons Village, 13100 East Colfax Avenue, Aurora, CO 80045, Silverton Conference Room - 6th Floor.

Instructions to join the meeting remotely:
1. Open a web browser and enter URL: www.readytalk.com
Enter participant access code: 2093166
2. Dial in by phone for the audio portion of the conference: 1-866-740-1260
Enter the participant access code: 2093166

National Correct Coding Initiative Challenges: The National Correct Coding Initiative (NCCI) was introduced to Medicaid claims processing for claims filed on and after October 1, 2010. The NCCI consists of code edit files and a manual that provides instruction on reporting multiple procedures and services or multiple units of a procedure, service, or supply. The Medicaid NCCI manual for 2015 was published in November 2014 and can be downloaded here: Medicaid NCCI Reference Documents. Click here for more information about how to use the NCCI procedure-to-procedure code edit files and examples of commonly used modifiers.

Developmental Screening in Practice: Are you interested in using standardized developmental screening tools to improve screening for developmental delays?  Birth to 5: Watch Me Thrive! is a guide for primary care providers, which includes information about healthy development, developmental concerns, how to select an appropriate screening tool, where to go for help, how to talk to families and tips on how to best support children.” [Source: Colorado Children’s Healthcare Access Program’s Practice Manager Newsletter]

CCHAP Practice Manager Meeting April 23rd: Get Ready for ICD-10

“The Colorado Children’s Healthcare Access Program (CCHAP) will be hosting a presentation on ICD-10 implementation for providers, managers, and staff on April 23rd noon-1pm. The presenter is a national expert on ICD-10 and we are excited to be able to bring his expertise to medical home practices in Colorado. You may attend in person or via webinar remotely. RSVP by emailing joanie.muzzulin@childrenscolorado.org. The meeting will be held at Fitzsimons Village, 13100 East Colfax Avenue, Aurora, CO 80045, Silverton Conference Room - 6th Floor.

Instructions to join the meeting remotely:
1. Open a web browser and enter URL: www.readytalk.com
Enter participant access code: 2093166
2. Dial in by phone for the audio portion of the conference: 1-866-740-1260
Enter the participant access code: 2093166” [Source: CCHAP]

Are you ready for ICD-10? – CCHAP Clinical Newsletter

“ICD-10 Presentation April 23rd:  The Colorado Children’s Healthcare Access Program (CCHAP) will be hosting a presentation on ICD-10 implementation for providers, managers, and staff on April 23rd noon-1pm. This was one of the most requested topics from our annual practice survey. Our presenter is a national expert on ICD-10 and we are excited to be able to bring his expertise to medical home practices in Colorado. You may attend in person or via webinar remotely. The recording will also be available on our CCHAP website following the presentation. All meeting recordings, presentation slides, and related handouts and resource links are available here. Invitations and further details are forthcoming...

ECHO for Children and Youth with Epilepsy: Project ECHO® (Extension for Community Healthcare Outcomes) is an innovative healthcare program developed by the University of New Mexico to treat chronic and complex diseases in rural and underserved areas by supporting and expanding the primary care provider scope of practice.

ECHO Colorado will be launching spring of 2015 to support providers across Colorado and surrounding states. The University of Colorado and Children’s Hospital Colorado have partnered with the American Association of Pediatrics to offer ECHO for Children and Youth with Epilepsy (CYE) as the first ECHO Colorado topic. CYE ECHO, beginning March 3, 2015, is currently recruiting community healthcare providers who are interested in expanding their scope of practice specific to pediatric epilepsy.

During ECHO clinics, healthcare clinicians present de-identified cases using a case-based format by video conferencing equipment. Project ECHO specialists and other participants discuss patient cases and recommendations are made regarding diagnostic and treatment plans. CME credit is provided at no cost for participating (1hour = 1CME credit) conducted via teleconference. Please contact the CYE ECHO program coordinator, Kory Thomas at 303-724-8061 or korrine.thomas@ucdenver.edu to register and for more information.” [Source: Colorado Children’s Healthcare Access Program]

Colorado Children’s Healthcare Access Program: Practice Manager Newsletter

“Medicaid 2015 fee schedule update - Increase in Payment for Office Visits and Vaccine Administration: Beginning January 1, 2015, Colorado Medicaid is reimbursing covered office visit (E&M) and vaccine administration procedure codes at a rate equal to 100% of the December 2014 Medicare reimbursement rate. The new rate is available to all enrolled providers that submit fee schedule claims for office visits or vaccine administrations. The new reimbursement rate will remain in place through June 30, 2016. Click here for the fee schedules.

Due to a delay in CMS approval of the new rates, the higher rates have not yet been loaded in the Medicaid claims processing system.  Medicaid does not have an anticipated approval date at this time. Medicaid will retroactively adjust claims with dates of service on or after January 1, 2015, to reflect the rate increase. Providers should continue to submit charges based on Usual and Customary rates, when applicable.  Automatic adjustments can be made by the Medicaid claims system only if the original submitted charge on a claim is greater than the newly revised rate; otherwise, the provider must resubmit a claim with the higher rate. Once CMS approval is received, the new rates will be loaded and will be paid upon claim submittal.

Check out the CCHAP Practice Manager Newsletter for more information on:

• Next CCHAP Practice Manager Meeting
• New CCHAP website
• Quick Reference Preventive Screening Coding Table
• ECHO for Children and Youth with Epilepsy
• New CCHAP Attribution Scrubbing Tool” [Source: CCHAP]

Update on Coding and Billing for Developmental and Behavioral Screening - CCHAP Clinical Newsletter

“Update on Coding and Billing for Developmental and Behavioral Screening: The good news (and this is a reminder) is that Colorado Medicaid reimburses medical homes for a number of developmental and behavioral health screenings. The new news is that they have recently changed the required coding methods in ways that help them, and you, keep track of positive and negative screens. The bad news is that many practices are not billing and coding according to the new requirements; or are doing the screenings but not bothering to bill them at all.  And as a result, some practices are not getting reimbursed appropriately for the screenings.

Colorado Medicaid often leads the way on screening and then later, the commercial plans follow suit. So, most commercial plans now also pay for these screenings. Each of these screening tests address something that is a health disparity for children on Medicaid: they have poorer outcomes, so they really need to be screened. But, it also addresses something that is very important for all children. Click here to see what Medicaid will reimburse you.

Click here to view the full Colorado Children’s Healthcare Access Program’s Clinical Newsletter.” [Source: CCHAP]

CCHAP Practice Manager Meeting Feb. 20

"The Colorado Children’s Healthcare Access Program is holding their Practice Manger Meeting on Friday, February 20th, noon-1pm at 13100 East Colfax Avenue, Aurora, CO 80045, Silverton Conference Room - 6th Floor. The meeting topic is Healthcare Reform and Payment Reform: how to prepare for the future with presenter David Keller, M.D. ReadyTalk Web Conference is available for remote attendees: go to readytalk.com and enter access code 2093166; dial in by phone for audio by dialing 1-866-740-1260 and entering the access code 2093166. Email joanie.muzzulin@childrenscolorado.org to RSVP.

Check out the CCHAP Practice Manager Newsletter for more information on:

• Medicaid fee schedule effective July 1, 2014
• Teen Depression Screening Reminder
• Colorado Medicaid Dental Program” [Source: CCHAP]

Colorado Children’s Healthcare Access Program (CCHAP) Practice Manager Newsletter

“Effective January 1, 2015, fee-for-service primary care providers are required to bill the following procedure codes to receive payment for Colorado Medicaid member depression screenings for dates of service on or after January 1, 2015: G8431 (positive screening) or G8510 (negative screening). Additional ICD-9 diagnosis codes are required. CPT code 99420 will not be accepted for dates of service on or after January 1, 2015.

Check out CCHAP’s latest Practice Manager Newsletter for more information on:

• CCHAP Practice Manager Meeting Feb. 20th
• Vaccine Administration Code Additions
• Influenza Vaccine Coding and Rate Table
• Depression Screening Coding Changes
• Colorado Awards State Innovation Model (SIM) Funding
• Colorado Launches New Child Abuse and Neglect Hotline
• Payment Collection from Medicaid Patients
• Cavity Free at Three
• Locum Tenens” [Source: CCHAP]

Colorado Children’s Healthcare Access Program Updates

“Beginning January 1, 2015, the Colorado Medical Assistance Program (Medicaid) will reimburse covered office visit procedure codes (E&M codes) and the vaccine administration procedure codes for all providers at a rate equal to 100% of Medicare’s December 2014 reimbursement rate. The new rate will be available to all enrolled providers that submit fee schedule claims for office visits or vaccine administrations. The new reimbursement rate will be in place until June 2016.

Check out CCHAP’s latest Practice Manager Newsletter for more information on:

• Flu Vaccine Administration Code Additions
• Influenza Vaccine Coding and Rate Table
• Depression Screening and Important Coding Changes
• Community Provider Rate Increase
• Cavity Free at Three
• New State Medicaid Director
• Locum Tenens

Also available is CCHAP's latest Clinical Newsletter.” [Source: CCHAP]