Print Page   |   Sign In   |   Join
SlitLamp E-News
Blog Home All Blogs
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.

 

Search all posts for:   

 

Top tags: advocacy  health plans  practice management  2014 legislative session  Avastin  MACRA  AAO  Coffman  compounding  CSEPS Connect  FDA  health advisory alert  HIPAA  IPAB  legislator  Medicaid  Medicare  member meeting  mergers  MIPs  pay issues  payer issues  payment reform  PDMP  QPP  reimbursement  repackaged drugs  US Congress 

Executive director's update: A day in the life

Posted By Chet Seward, Friday, June 7, 2019
Clenched. That is how I felt at the very moment that the incision was made during the first eye surgery I ever witnessed. I remember the moment vividly as I breathlessly tried to disappear into the wall in spite of the white bunny-suit of sterile gown, bonnet and mask I was wearing so as to not be a distraction to George Ulrich, MD, as he worked his magic to improve a patient’s vision. I don’t remember what the procedure was, but I do remember the seemingly 0-150 miles per hour intensity of the act that carried potential blindness for a millimeter misstep. I was gripped. And here’s the kicker – so was Rep. Lois Landgraf who was standing right next to me. Throughout it all Dr. Ulrich was cool, calm and collected. It was just another day in the office for him.

This peek into everyday life of an eye surgeon may seem mundane to you, but take it from me it can have a profound and lasting impact. Rep. Landgraf is a strong friend of ophthalmology and a leader on the Colorado House of Representatives Public Health Care & Human Services Committee. At CSEPS we take patient safety seriously and fervently believe that surgery should only be done by surgeons. To busy legislators that have the power to profoundly change the way that you practice ophthalmology in Colorado, seeing is believing. Sometimes all it takes is actually witnessing a surgery to bring wonky policy discussion about safety and scope of practice into a new light. Perhaps most importantly, by sharing what you do every day you have the chance to connect, to understand what a typical day-in-their-legislative life is, and to build a relationship. In that way when a legislator has a question about eye care or anything that pertains to medicine in the future, they will call you first. It truly is day-in-the-life simple and at CSEPS we can make it easy for you to set up a similar surgery site visit by your legislator. We will coordinate the details. Contact me today to get a visit set up this summer with your legislator.

This post has not been tagged.

Share |
PermalinkComments (0)
 

CSEPS Summer Social: 2019

Posted By Chet Seward, Friday, June 7, 2019
Quick, before the dog days of hit, register now for the CSEPS summer social at Recess Beer Garden in Denver on Wednesday, July 24 from 5:30-8:00 pm. At CSEPS we understand the daily grind of practice, keeping up with busy surgery schedules, battling with payer administrative burdens and balancing all of it with your personal life. At a time when physician burnout continues to be a problem, maybe it is time to give yourself a little break. So kick back with a cold brew and some fun food with your ophthalmology colleagues. Whether you are grateful for the summer heat or just the chance to hang out with friends you may not see very often, this is your chance to celebrate the practice of ophthalmology in Colorado. Plus, registration is free for CSEPS members so consider it a bonus summer happy-hour. Get more information and register here.

This post has not been tagged.

Share |
PermalinkComments (0)
 

Medicare audit targets for Colorado

Posted By Chet Seward, Friday, June 7, 2019

Finding out that your practice is going to be audited is not something any Colorado ophthalmologist wants to hear. Being informed and prepared is the best defense for this news. CSEPS has learned from the American Academy of Ophthalmology that Colorado practices currently face a number of types of audits. All of them are CMS audits – no Medicare Advantage or commercial plan audits –set forth by Part B and customized by Novitas. CSEPS encourages you and your practice team to review the following information carefully and take necessary steps so that when you are audited the payer cannot recoup money. Start by visiting the expert information at AAO.org/audits. The following is a known list of audit targets for this region:

Office of Inspector General (OIG)

  • Monitor physician payments linked to new Medicare MBI cards that should have been returned to CMS because patient is deceased or never received the new card
  • Administration of Lucentis injections for wet AMD more than once every 28 days (based on local coverage determinations)
  • Billing for a second cataract surgery on the same day
  • Submitting disproportionately more claims for complex than standard cataract surgery
  • Telemedicine services that failed to meet the requirements for billing Medicare
  • Postoperative visits

Contivity: Recovery Audit Contractor (RAC)

  • Cataract surgery: Meeting the payer requirements for CPT codes 66830, 66840, 66850, 66852, 66920, 66930, 66940, 66982, 66983, 66984
  • Excessive units for cataract surgery
  • E/M exams billed same day as minor surgeries with 0-day and 10-day global periods
  • E/M exams billed within global period major surgeries
  • Reporting excessive units of inpatient hospital E/M services
  • Office visits billed incorrectly for hospital inpatients
  • New patient exams including E/M and eye visit codes when not considered new
  • Add-on condes paid without primary code and/or denied primary code
  • Automated global vs. TC/26 split reimbursements
  • Excessive units of initial critical care
  • Part B physicians performing radiology services furnished to inpatients (TC component)
  • Excessive or insufficient drugs and biologicals units billed
  • Exact duplicate claims
  • Skilled nursing facility consolidated billing

Target, Probe and Educate (TPE)

  • Inpatient E/N 99223, 99233
  • Critical care 99291-99292
  • Subsequent inpatient 99232-99233
  • Office new patient E/M 99201-99205
  • Office established E/M 99211-99215
  • Emergency department 99-281-99285
  • Lucentis J2778
  • Eylea J0178

Zone Program Integrity Contractor (ZPIC)

  • The agency investigates suspected fraud, waste and abuse based on provider medical review, beneficiary complaints and data analysis

This post has not been tagged.

Share |
PermalinkComments (0)
 

Call for nominations: 2019

Posted By Chet Seward, Friday, June 7, 2019
CSEPS is seeking nominations for president-elect. The term for this position is calendar year 2020. The position will assume the presidency in 2021.

Help lead CSEPS and Colorado ophthalmology into the future. Submit your nominations or self-nominations to cseps@cms.org by November 15. A member-wide election will be held later this year. Contact CSEPS Executive Director Chet Seward if you have any questions.

This post has not been tagged.

Share |
PermalinkComments (0)
 

Executive director's update: Your voice in action

Posted By Chet Seward, Wednesday, May 15, 2019

Chet Seward,
Executive Director


During dinner parties I like it when I get the invariable question, “What’s new at work?” Now you might be thinking that I like getting the chance to geek out on the latest in health policy (my wife likely would agree with you). But the fact is that despite how confounding health care is today, almost everyone has a story about trouble with or the importance of vision. So, I get to relate the latest CSEPS work to those stories and today’s challenging policy concepts come to life.

That type of storytelling has been a powerful part of CSEPS advocacy on your behalf this year on topics ranging from protecting peer review and the state’s stable liability climate, to health plan over-reach, to prescription drug costs. The annual legislative reception earlier this month was rife with storytelling as ophthalmologists from around the state connected with policymakers and their staff on your priorities. The same was true at the AAO Mid-Year Forum (MYF) where Colorado eyeMDs took to Capitol Hill on your behalf. 

Whether you attended MYF or our legislative reception, CSEPS is your voice in action. We are your professional advocates championing world-class physician and surgeon eyecare in Denver, DC and even at dinner parties. Thank you for being a member. Pass the potatoes.

This post has not been tagged.

Share |
PermalinkComments (0)
 

CSEPS 2019 legislative reception

Posted By Chet Seward, Wednesday, May 15, 2019

Ophthalmologists from across Colorado converged at the University Club, just two blocks from the state capitol, on April 4 for the annual legislative reception. The event provided an opportunity to connect with Colorado legislators and their aides on issues that are critically important to the profession. It also offered a chance to share some stories and a few laughs, as well as build lasting relationships. Key policy priorities included protecting vision by ensuring that surgery is only done by surgeons, preserving peer review protections, fighting attempts to increase the non-economic damage caps, ensuring appropriate health plan provider networks, and reducing prior authorization burdens. Check out some of the pictures from the event here.

It wasn’t all socializing and policy problem solving. Thanks to the work of CSEPS Past-president Leo Seibold, MD, and residents and fellows at the University of Colorado, a video of common eye surgeries was shown. In addition, thanks to friends at Zeiss, an OCT machine was on-hand to provide eye scans for legislators. The video and the scans helped to underscore the complexity, delicacy and importance of vision, proper prevention, the need for skilled eye physicians and surgeons. 

A thank you goes out to all of our members that made time to invest in their future and the future of eye care in Colorado by attending this event.

Leo Seibold, MD, explains results from an imaging exam. From left Drs. Eric Williams, Ron Pelton, Rob Fante, Vivek Koduri and Austin Rohl made time to attend.
Sen. Paul Lundeen hears about the importance of surgery being done by surgeons from Robert Fante, MD, and Lyrssa Dragan, MD. From left, Drs. Taylor Slingsby, Eric Weldy, Garrison Weir and Cullen Ryburn enjoy a little time together.

This post has not been tagged.

Share |
PermalinkComments (0)
 

DC advocacy makes a difference

Posted By Chet Seward, Wednesday, May 15, 2019
https://cdn.ymaws.com/www.cseps.org/resource/resmgr/media/myf2019movie2.mp4


Another strong contingent of Colorado ophthalmologists made the trek to DC to participate in the AAO Mid-Year Forum (MYF) on April 10-13. The trip included visits with the Colorado congressional delegation to champion eyecare priorities. Key topics included streamlining and standardizing prior authorization requirements in Medicare Advantage programs, urging more generic drug competition and a better supply of critical ophthalmic medicines, opposing STEP therapy requirements that usurp physician-patient relationships and clinical judgement, and calling for continued vision research funding. 

CSEPS thanks Drs. Leo Seibold, Alan Kimura, David Johnson, Prem Surbramanian, Rebecca Braverman and soon-to-be-Coloradan Roman Krivochenitser for expertly representing the state’s patients and the eye physicians and surgeons that serve them. Big thanks also goes out to Colorado residents Tori Miller, MD, and Eric Williams, MD, who were AAO Advocacy Ambassadors. 

Have you ever wondered why busy ophthalmologists make time for these critical advocacy trips? Get inspired to get involved and attend the next Mid-year Forum by watching a video of Drs. Krivochenitser, Seibold and Williams. See other pictures from the trip here.

















(Top left) From left Leo Seibold, MD, Eric Williams, MD, Tori Miller, MD, Roman Krivochenitser, MD, Alan Kimura, MD, MPH, David Johnson, MD, Chet Seward, Prem Subramanian, MD, and Rebecca Braverman, MD, enjoy a little springtime advocacy.

(Top right) Eye surgeon leaders Drs. Roman Krivochenitser, Leo Seibold and Eric Williams.

(Bottom left) Charging on – Drs. Kimura, Johnson, Seibold, Subramanian and Williams after a meeting at Sen. Bennett’s office.

(Bottom right) AAO Advocacy Ambassadors Eric Williams, MD, and Tori Miller, MD.




This post has not been tagged.

Share |
PermalinkComments (0)
 

Check out your MIPS scores on Physician Compare

Posted By Chet Seward, Wednesday, May 15, 2019
Your patients are watching. As demand for more transparency in health care increases you should be aware of what your patients see about you. Scores for the 2017 Merit-Based Incentive Payment System are now available for download from the Centers for Medicare & Medicaid Services’ Physician Compare database. Act now to take advantage of the preview period which ends on April 27. The American Academy of Ophthalmology and CSEPS recommend that you prepare you for that a patient might have regarding your performance. Download your 2017 performance results.

This post has not been tagged.

Share |
PermalinkComments (0)
 

Codequest 2019 in the books

Posted By Chet Seward, Wednesday, May 15, 2019
Thanks to all those that turned out for the latest installment of cutting-edge ophthalmology coding education at the AAO Codequest conference on March 9 in Denver. Almost 60 physicians, practice managers and coding specialists from across the state learned how to avoid the latest regulatory roadblocks and the complex maze of federal and commercial payers’ rules to help maximize reimbursements appropriately. CSEPS extends a hearty thank you to AAO for once again partnering to bring this important program to Colorado.

This post has not been tagged.

Share |
PermalinkComments (0)
 

Executive Director's Update: Putting the work in

Posted By Chet Seward, Thursday, February 7, 2019

Chet Seward,
Executive Director
Growing up my dad’s interpretation of a great weekend was to order dump truck loads of fill dirt and bedrock so that we could all have “some fun” building new garden planters. As a northern Illinois family physician who wasn't beyond making a house call for busy farmer patients during the corn harvest, Dad wasn’t afraid to work hard. Rather than spending carefree Saturdays riding dirt bikes, my teenage brother and I served as free labor and became great friends with shovels, wheelbarrows and blisters. 

At CSEPS we know that one of the primary jobs you “hire” us to do is to advocate for your priorities and those of your patients at the state capitol. We have an incredible team of eyeMD leaders and outstanding lobbyists that work hard for you under the gold dome. It is important to remember that the power of their public affairs punch is dependent upon you. We need your help, especially this year given the activist nature of the legislature and the keen interest to address pressing health care problems. Get plugged into our advocacy activities, respond promptly to legislative alerts, invite a legislator to visit you at your practice to see a surgery, donate to Colorado EYEPAC and the AAO Surgical Scope Fund, and plan on attending the upcoming legislative reception. It will be time well spent.

I can only imagine the brother bellyaching that my father endured at the time, but as I look back now I have fond memories of being out in the yard with him. Yes it was hard, but there was also joy and purpose in the work. The same is true today with the CSEPS mission. Join us in the work ahead – blisters not included.

This post has not been tagged.

Share |
PermalinkComments (0)
 
Page 1 of 12
1  |  2  |  3  |  4  |  5  |  6  >   >>   >|