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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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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 

Got stuff? Sell it with CSEPS

Posted By Kate Alfano, Monday, October 27, 2014

The new website has a classified ads section where, as an exclusive member benefit, CSEPS members can place their ads and other members can see these ads. Reach the top ophthalmologists across Colorado to find or sell the goods and services you need. Advertise your:

Situations and items wanted
Properties for sale or lease
Equipment of sale or lease
Practices for sale

Click here to view current ads and post yours in this online marketplace.

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PQRS and the CMS Value-Based Payment Modifier

Posted By Kate Alfano, Monday, October 27, 2014
Check your 2013 Physician Quality Reporting System (PQRS) feedback reports to see details on how you performed, urges the American Academy of Ophthalmology. These reports were released in August by the Centers for Medicare and Medicaid Services (CMS) and will determine whether you receive a bonus or penalty. The first penalty of 1.5 percent will be assessed in 2015 for those who didn’t meet 2013 participation requirements. The penalty increases to 2 percent in 2016 based on 2014 participation. Those in a group practice of 10 or more providers who don’t successfully report for PQRS this year will receive an additional 2 percent value-based modifier penalty.

To avoid the 2 percent penalty, physicians need to successfully report three quality measures this year. Physicians wanting to earn the 0.5 percent bonus should report nine measures across three domains or use the cataract measures group.

The Center for Healthcare Quality and Payment Reform is calling on CMS to drop its plans to use current cost measures in the value-based payment modifier based on a finding that this action could harm access to care and fail to achieve higher quality and more affordable health care. The value-based modifier is directly tied to PQRS. CMS is required to establish a payment modifier under the Medicare Fee Schedule, based on quality of care provided and resource use. Under the value-based modifier, high-performing physicians would receive bonuses, while lower performers would see reduced payments.

According to AAO, the Center recommends that CMS use its statutory authority to implement payment reform that would enable physicians to improve care delivery in ways that would reduce spending without sacrificing patient care. The organization calls for, at a minimum, a delay of the implementation of the cost-measurement components of the value-based modifier, if not the entire modifier program.

Learn more through an instructional video

CMS has published a 50-minute video through its Medicare Learning Network to give an overview of the value-based payment modifier and how it is tied to PQRS. The video is available on YouTube through the link below; physicians seeking continuing education credit for viewing the video should follow the link in the video description.

The video is intended to help Medicare physicians understand how the value modifier can affect Medicare reimbursement starting in 2015. It walks through a detailed decision tree that has been created to help providers ask the necessary questions on determining how the value modifier in 2016 will be affected by their PQRS participation this year.

Click here to view the video. Click here to read a transcript of the video.

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Health-Care Reform: Considerations for (Physician) Employers

Posted By Kate Alfano, Monday, October 27, 2014
You may have heard that the health-care reform legislation passed in 2010 requires all employers to provide health insurance to their employees. That is not the case. While not requiring the provision of coverage, the law does encourage employers to offer health insurance by imposing penalties on larger employers that don't offer affordable health insurance coverage. Smaller employers are provided the opportunity to claim tax credits by those who do provide their workers with affordable health-care coverage.

Click here to read more on the CSEPS website.

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Tools available: Access fact sheet, bulletin on the 90-day grace period

Posted By Kate Alfano, Monday, October 27, 2014
The Colorado Medical Society has made a fact sheet available on the 90-day grace period. Authorized under the Affordable Care Act, the grace period allows for continuity of care in the case that patients miss health insurance premium payments but could put doctors on the hook for collecting payments from patients for past services. The key to protecting your practice is checking the patient's eligibility status prior to services being provided so that financial arrangements can be made in advance of potential problems later related to unpaid patient premiums.

> Click here to access the fact sheet

Earlier this year the Colorado Division of Insurance (DOI) issued proposed regulations to establish the requirements for the grace period when the policyholder is delinquent in the payment of monthly premiums. CMS and 10 other organizations submitted comments to strengthen the timing of the notification of physician practices and details required to be included in the notice.

While Insurance Commissioner Marguerite Salazar concluded that the DOI does not have the authority under current statute to incorporate the changes requested, she did issue a bulletin, B-4.77, to carriers in August that provides additional direction. Many of the suggestions CMS and other physician organizations made were accepted concerning what information is reported about a patient’s eligibility status within the 90-day grace period and when physicians are alerted. The bulletin also clarifies the relationship between the grace period and the existing statute on eligibility verification.

> Click here to access bulletin B-4.77

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Congressional advocacy

Posted By Chet Seward, Tuesday, July 15, 2014
As the federal election starts to heat up in preparation for November, CSEPS leaders are actively engaged in building relationships with the Congressional Delegation and sharing information about ophthalmology’s priorities. Drs. Richard Kelmenson and Alan Kimura met with Congressman Mike Coffman at the end of May. The conversation focused on the systemic woes within the VA system, transparency in health care marketing issues and electronic health records. Congressman Coffman is locked in a tight race for re-election to Colorado’s 6thCongressional District.

Caption: Drs. Richard Kelmenson (left) and Alan Kimura meet with Congressman Coffman (right).

Tags:  advocacy  Coffman  US Congress 

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Medicaid provider rate increases

Posted By Chet Seward, Tuesday, July 15, 2014

CSEPS joined a number of medical societies and other stakeholders to advocate for increased reimbursement rates for ophthalmologists within Medicaid during the last legislative session. (Read the letter CSEPS sent to the state here.) Access to much needed specialty care has been hampered for some time given low reimbursement rates that frequently do not cover an ophthalmologist’s costs associated with providing care.

The General Assembly and Governor Hickenlooper approved a 2% increase for most fee-for-service benefits including physician and clinic services and vision services.In addition, the legislature approved a series of targeted rate increases for specific providers, codes and specialties. According to a Department of Health Care Policy and Financing fact sheet, “These (targeted) increases are intended to address large inequities in rates and to demonstrate the Department’s priority to pay for services that provide high value for clients.” The objective was to raise codes from current levels to approximately 80% of Medicare rates. Be aware that the following eye codes were positively affected by these changes:

  • Code 92002 – Eye exam, new patient
  • Code 92004 – Eye exam, new patient
  • Code 92012 – Eye exam established patient
  • Code 92014 – Eye exam & treatment
  • Code 92018 – New eye exam & treatment
  • Code 92019 – Eye exam & treatment
  • Code 92020 – Special eye evaluation
  • Code 92060 – Special eye evaluation
The June 2014 Medicaid Provider Bulletin provides more details about both the across the board and targeted rate increases.

Tags:  2014 legislative session  advocacy  Medicaid  reimbursement 

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CSEPS presses for FDA changes on repackaged and compounded drug products

Posted By Chet Seward, Tuesday, July 15, 2014
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Legislative update - July/August 2014

Posted By Chet Seward, Tuesday, July 15, 2014
Dick Brown
by Dick Brown, CSEPS lobbyist

The 2014 Colorado legislative session is now officially on the books and CSEPS has the scoop on the bills that passed that can and will affect you and your practice. We have developed a compendium that identifies and summarizes key bills from the session that are important to ophthalmologists. This is a great resource for physicians and their office staff. The information is organized by subject area including topics like:

  • Criminal offenses;
  • Employer-employee relations;
  • Health care financing;
  • Insurance;
  • Liability and court procedures;
  • Pharmaceuticals;
  • Professions and licensing; and
  • Public health.

While the compiler is not an attorney, the compendium provides a summary and an explanation of each selected new law. Questions regarding a more technical legal question should be referred to an attorney. Access the compendium here.

Tags:  2014 legislative session  advocacy 

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