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SlitLamp provides illuminating e-news for Colorado ophthalmologists. It keeps you in the know on the evolving Colorado health care scene by detailing the latest legislative and regulatory happenings. It also spotlights the information and resources you need for your practice.

 

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Executive director's update: Time to turn it down or up?

Posted By Chet Seward, Friday, April 13, 2018
Is it just me or is it getting louder? While that question clearly fits recent interactions at home with my teenagers who seem to have developed a pre-existing condition known as “loud talker syndrome” given the earbuds that are glued to their ears, professionally it is definitely one to ponder. Perhaps a better way of phrasing it would be, is civic engagement becoming shrill? 

I don’t know if the answer to that question is yes or no. Maybe social media, or the 24-hour news cycle, or current political discourse is driving people apart. 

What I do know is that in a seemingly divided world, CSEPS is a unifying force. We bring Colorado ophthalmologists together to solve problems and improve care. Whether it is through upcoming events like the meeting with AAO President Keith Carter, MD, FACS, Codequest, our first legislative reception or our new practice management online community, CSEPS offers members like you the chance to connect and engage in a broader dialogue on issues and interests that are important to ophthalmologists and the patients you serve.

So here is to turning up you participation with CSEPS. Get plugged in and stay plugged into your organization, the only one in the state solely focused on your priorities. I will be right there with you – that is of course after I attempt to take the earbuds away from my kids. Wish me luck.

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Negotiating physician employment contracts seminar

Posted By Chet Seward, Friday, April 13, 2018
Kevin Perez, Esq.
Thanks to all of the CSEPS members that attended the March event focused on the dos and don’ts of employment contracts. The program featured Denver attorney Kevin Perez who routinely works with physicians across the state on these sometimes-thorny negotiations. His real-world examples, expert insights and practical recommendations were a hit for all those that attended. The fact that the program occurred just days before St. Patrick’s Day and it offered attendees a chance to hoist a pint in honor of the green (pun intended) probably didn’t hurt either. Let’s face it – you have worked incredibly hard to get where you are and ensuring that you are reimbursed for the value that you bring is critical. If you missed the program but are still interested in connecting with Kevin and obtaining some e xpert tips for your next employment contract negotiation, then send an email to Chet in the CSEPS offices.

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New CSEPS president-elect

Posted By Chet Seward, Friday, April 13, 2018
After a statewide nomination process and subsequent election, Christopher Thiagarajah, MD, FACS, has been chosen as president-elect of CSEPS. An actively practicing oculo-plastic surgeon in Denver, Dr. Thiagarajah will work closely with CSEPS President Leonard Seibold and the rest of the board of directors to guide the organization forward. He will assume the presidency in January 2019. Congratulations Dr. Thiagarajah!

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MIPS 2018: Are you in or out?

Posted By Chet Seward, Friday, April 13, 2018

If you’re still trying to figure out whether you have to report MIPS data for 2018, based upon recent changes by the federal government, then a new online tool can help your decision-making process. The Centers for Medicare & Medicaid Services (CMS) has released an online tool that enables clinicians to determine whether they must participate in the Merit-Based Incentive Payment Program (MIPS) this year. 

Fierce Healthcare reports that “the second year of MIPS quality reporting requirements started January 1, yet physicians were not sure if they were in or out of the program. In fact, given new threshold requirements for the MIPS program in 2018, CMS estimates more than 500,000 clinicians will be excluded from MIPS this year.

In its notice about the 2018 MIPS eligibility tool, CMS makes note of the changes to its low-volume threshold requirements. To reduce the burden on small practices, CMS changed the threshold to exclude clinicians and groups if they:

  • Billed $90,000 or less in Medicare Part B allowed charges for covered professional services under the Physician Fee Schedule; OR
  • Furnished covered professional services to 200 or fewer Medicare Part B-enrolled beneficiaries

In other words, to be included in MIPS in 2018, clinicians or groups need to have billed more than $90,000 in Medicare Part B allowed charged AND furnished services to more than 200 beneficiaries. (The threshold exempts even more physicians, since in 2017, clinicians had to participate in MIPS if they billed Medicare Part B more than $30,000 a year and saw more than 100 Medicare patients a year.)”

Determine your 2018 MIPS eligibility status today by using the MIPS Participation Lookup Tool.

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Medicare billing issue

Posted By Chet Seward, Friday, April 13, 2018

CSEPS encourages all our members to proactive in reviewing their own documentation to make sure it consistently meets the payer requirements. Members should be aware of a recent notice from the American Academy of Ophthalmology (AAO) regarding issues affecting physicians in four states.

AAO writes, “Ophthalmologists in North Carolina, South Carolina, Virginia and West Virginia, whose comparative billing report puts them in the 80th percentile, with greater than $10,000 of allowed charges and more than 30 beneficiaries undergoing an exam plus cataract or complex cataract surgery from January - December 2016, are asked by the Medicare administrative contractor Palmetto to provide the answers to specific questions. Depending upon the answer, the physician's documentation may be directed to target, probe and educate (TPE) review. They are given 1 week to respond to the following questions:

  1. Is there documentation present for all dates of service billed and or operative eye billed?
  2. Is patients own assessment of functional status causing him / her to seek medical attention?
  3. Is there evidence of a comprehensive eye examination and ocular examination and a single diagnostic a scan to determine the appropriate lens?
  4. Is there documentation indicating that the cataract is significantly contributing to the patient’s visual impairment in the presence of one or more concomitant ocular diseases?
  5. What are your self-auditing methods?”

While these TPE reviews are not  happening in Colorado, take this opportunity to be aware of trends in other states and then review the latest local coverage determinations by Novitas here. For more information, contact Sue Vicchrilli, COT, OCS, AAO Director, Coding & Reimbursement.

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Executive director's update: Try something

Posted By Chet Seward, Wednesday, February 7, 2018

As I think about a new initiative that CSEPS is launching I am reminded of a recent “talk” that I had with one of my teenagers. Perhaps you have had comparable conversations. After going around and around with my son, things ended with the predictable, yet still boneheaded, paternal declaration, “Just do it.” If you’ve let slip similar statements, then odds are you too have experienced the unflinching, unfailing, trademark-teenage no that I did that day. 

What I should have said is give it a try and if you don’t like it then try something else.

That is exactly what CSEPS is doing today with the launch of the CSEPS Clinical Trials Community. We are trying something new. As a CSEPS member we know that you turn to us for advocacy at the state capitol, insightful information and fun, creative ways to connect and engage with your colleagues. A few days ago a CSEPS member called and wanted to share information about one of his practice’s clinical trials. As we talked further, it became clear that many ophthalmologists are right in the middle of cutting edge research and that sharing this information across the state in an easy, user-friendly way would benefit patients and the profession. Consider this your invitation to learn what trials are occurring in practices around the state and share information on some of the latest clinical innovation work at your practice. The CSEPS Clinical Trials Community is an online feature of CSEPS.org and is available exclusively to CSEPS members. Click here to learn more and to sign up to share about your work.

At CSEPS we are not afraid to try something new. Sometimes it works and sometimes it leads to other things. I’m excited about this new initiative and I hope that you will find it useful. I’m also grateful for my teenage son for reminding me to be curious. As a learning organization, just trying something is one of the best ways to stay connected to you, our member, and learn more about how we serve your professional needs better. Let me know what you think about the CSEPS Clinical Trials Community.

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Save the date - AAO President Keith Carter, MD, to present to CSEPS

Posted By Chet Seward, Wednesday, February 7, 2018

AAO President Keith Carter, MD

CSEPS is proud to announce that American Academy of Ophthalmology (AAO) President Keith Carter, MD, will present to Colorado ophthalmologists during a special CSEPS evening meeting on Monday, May 21, 2018. Don't miss this opportunity to learn about some of the latest news affecting ophthalmology, in addition to getting timely updates about AAO priorities and initiatives. When is the last time you got to share some good food and conversation with the president of AAO? Here's your chance. Location and registration information will be available soon. In the meantime, please mark your calendars and plan on attending.

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Register for Codequest in Colorado

Posted By Chet Seward, Wednesday, February 7, 2018

Get expert instruction from the recognized leader of ophthalmic coding at the American Academy of Ophthalmology Codequest™ 2018 course, presented with CSEPS on Saturday, April 28 in Denver. Stay up to date on changing regulations, get strategies for maintaining compliance with federal and commercial payers' rules and learn the latest tactics to maximize your reimbursements appropriately. 

This all-new four-hour program covers state-specific information relevant to practices of all sizes: 

  • Avoid costly mistakes that trigger audits in evolving health care markets
  • Audit-proof your documentation with our new payer-specific checklists for top surgical procedures 
  • Ensure your practice gets paid for newly covered procedures and devices
  • Telemedicine: Learn what to consider before you participate, including risk management coverage issues
  • Blepharoplasty: Get expert guidance on how to correctly bill cosmetic vs. functional procedures under new requirements
  • Review requirements for mastering modifiers

Registration prices have been reduced and you can get the best rate if you act now with the early bird discount. Register today.

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Medicaid fee schedule posted and payment issue resources

Posted By Chet Seward, Wednesday, February 7, 2018

Health First Colorado (Medicaid) recently posted an updated version of the program’s fee schedule. If you treat Medicaid patients, then make sure that your practice knows about the latest fees. TheJuly 2017 Fee Schedule Data File (1/18)and theJuly 2017 Fee Schedule Instructions (1/18)have been posted to the Provider Rates & Fee Schedule web page.

Some ophthalmology practices continue to face problems getting paid by Medicaid given the system’s conversion to a new payment processing system last year. CSEPS continues to share problems that members have raised with this conversion process. Click here to view the latest know issues and associated work around solutions regarding the Medicaid conversion process.

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OMIC presentation focuses on EHR liability

Posted By Chet Seward, Wednesday, February 7, 2018


Love them or hate them, electronic medical records (EHR) are here to stay and they pose specific risks for ophthalmology practices that must be understood and managed. Thanks to the ongoing, strong partnership between OMIC and CSEPS, on January 31 over 20 ophthalmologists from around the state heard from EHR expert and OMIC risk manager Michelle Pineda, MBA. The program was held in-person and virtually via video conference so that members from around the state could participate. Click here to view the presentation slides.

Michelle Pineda explains some of the risks and benefits of electronic health records.

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