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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 

AAO 2017: Get ready

Posted By Chet Seward, Wednesday, May 24, 2017

Plan on joining your CSEPS colleagues at AAO 2017 in New Orleans. There will be new inspirations and new solutions. This is a must attend event so be sure to get signed up as soon as registration opens on June 28, 2017. Learn more here.

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Will taxes become more popular in Colorado?

Posted By Chris Howes, Wednesday, May 24, 2017
The Colorado General Assembly found a compromise on a number of topics during the 2017 session. The most notable being the Rubik’s Cube of transportation and hospital funding, known as the “Hospital Provider Fee.” At the beginning of the session, Republicans swore up and down they would stand for lower taxes and refuse moving this fee into an enterprise fund. By May 10, three Republican senators had changed their tunes and voted to fund rural hospitals in their districts with the Democrats’ plan. Will this every spill over into support for even more taxes in the future? Doubtful, but a scathing opinion piece from the executive director of the anti-tax Independence Institute makes for interesting reading on the topic.

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Open payments: Do you know what they report about you?

Posted By Chet Seward, Wednesday, May 24, 2017

Each spring, physicians have the opportunity to review the payments drug or device companies say they made to you in the prior year. If you think the data is incorrect, you can dispute it. 

The drug or medical device company that reported the payment then has 15 additional days after the 45-day review and dispute period to change, correct or validate the data. The data goes public on June 30. 

Check your data regularly. Data can be submitted from previous years. A drug or device company could be new to Open Payments and drug or device companies can always correct or remove records. Check your data annually, even if you are certain you did not receive payments the previous year—past years’ data could have been submitted. If you missed your chance to review the data before publication on June 30, you can still dispute records in the Open Payments system until December 31. Afterwards, the system will not allow you to dispute data.

Register for the open payments system here (get tips on how to register here). You may also download a handy one-page fact sheet here.

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What has CSEPS done for you lately? Find out

Posted By Chet Seward, Friday, March 24, 2017
Three months into the year CSEPS is hard at work pressing ophthalmology’s priorities. Twice a year CSEPS reports to the American Academy of Ophthalmology on recent efforts related to advocacy, membership, education and special initiatives. These semi-annual reports serve as a succinct information source for CSEPS members about current activities. Check out the March 2017 report and then let us know if you have any questions, would like to get involved with any of these initiatives or have ideas for future work that will bring even greater value for your CSEPS dues dollar.

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Codequest helps practices

Posted By Chet Seward, Friday, March 24, 2017
More than 60 ophthalmologists and their practice staff attended this year’s AAO Codequest conference in March. CSEPS is proud to partner with AAO each year to provide this valuable program that helps practices code with confidence, ease and precision. Thanks to AAO’s Joy Woodke for her expert presentation and all those practice managers, billers and eyeMDs that attended this year’s conference.
 
Colorado eyeMD practice leaders hear about the latest coding changes. 

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Alert: HHS OIG Hotline Scam

Posted By Chet Seward, Friday, March 24, 2017

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently confirmed that the HHS OIG Hotline telephone number is being used as part of a telephone spoofing scam targeting individuals throughout the country. These scammers represent themselves as HHS OIG Hotline employees and can alter the appearance of the caller ID to make it seem as if the call is coming from the HHS OIG Hotline 1-800-HHS-TIPS (1-800-447-8477). The perpetrator may use various tactics to obtain or verify the victim's personal information, which can then be used to steal money from an individual's bank account or for other fraudulent activity. HHS OIG takes this matter seriously. We are actively investigating this matter and intend to have the perpetrators prosecuted. 

HHS OIG will not use the HHS OIG Hotline telephone number to make outgoing calls and individuals should not answer calls from 1-800-HHS-TIPS (1-800-447-8477). The agency encourages the public to remain vigilant, protect their personal information, and guard against providing personal information during calls that purport to be from the HHS OIG Hotline telephone number. The agency also reminds the public that it is still safe to call into the HHS OIG Hotline to report fraud, and they encourage those who believe they may have been a victim of the telephone spoofing scam to report that information through the HHS OIG Hotline 1-800-HHS-TIPS (1-800-447-8477) or to  spoof@oig.hhs.gov. Individuals m ay also file a complaint with the Federal Trade Commission 1-877-FTC-HELP (1-877-382-4357). More information is available on the OIG Consumer Alerts webpage.

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Colorado Medicaid interChange: Help for practices

Posted By Chet Seward, Friday, March 24, 2017

Health First Colorado (Medicaid) and Child Health Plan Plus (CHP+) transitioned to a brand-new claims payment system and fiscal agent on March 1.  While more than $280 million have been process by interChange since go live, some providers have experienced challenges. Health First Colorado reports that they are continually identifying issues that need technical intervention and addressing them with the state vendor to ensure providers can provide services and receive appropriate payments for those services. 

Click here to see the latest special provider bulletin from and here to review a brief overview of some of the top claims denial reasons, reminders, and other items to know.

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Blocked health plan mega-mergers are victory for eyeMDs and patients

Posted By Chet Seward, Friday, February 17, 2017

On January 23 and February 9 federal courts issued momentous decisions to block the proposed mergers of four of the five largest health plans in America, capping a victorious, months-long physician-driven opposition campaign.  CSEPS joined the Colorado Medical Society and a host of other medical societies in fighting the proposed Anthem-Cigna and Aetna-Humana mergers on the grounds that they are anticompetitive and fundamentally bad for patients and physicians. Federal cou rts agreed.

Since the rulings, the bad news for huge health plans keeps coming. Aetna was hit with a class action lawsuit by investors because top executives fraudulently misrepresented the withdrawal from some public health insurance exchanges as a business decision instead of an unsuccessful ploy to get its proposed $37 billion merger with Humana past federal regulators. Not to be outdone, the formerly adoring suitor relationship between Anthem and Cigna has blown up into a bitter divorce battle with Cigna suing Anthem to end the deal and tack on almost $15 billion in break-up fees and damages, and Anthem counter suing and winning a temporary restraining order to terminate the breakup. UnitedHealthcare was hit with a “whistleblower lawsuit claiming that UnitedHealth Group and affiliated health plans have been gaming the Medicare program and fraudulently collecting millions of dollars by claiming patients were sicker than they really were,” reported ModernHealthcare.

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CSEPS membership poll

Posted By Chet Seward, Friday, February 17, 2017

CSEPS works hard to represent your interests and provide value for your membership. That’s our true north. While we know that we frequently succeed, we are also honest enough to acknowledge that sometimes we don’t. 

That’s why we need your help, because not knowing what we don’t know is no way to serve you better. All Colorado ophthalmologists will soon receive a CSEPS membership survey via email. We respectfully ask that you promptly and candidly participate. Your opinions matter and we commit to carefully review, consider and act upon the results of this poll as the board of directors works to chart the next course for the organization over the coming year and beyond.

Please watch your email and thank you in advance for sharing your thoughts.

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New Medicaid claims payment system

Posted By Chet Seward, Friday, February 17, 2017

On March 1, 2017, the Department of Health Care Policy and Financing (Department) will launch a new Claims Payment System, the Colorado interChange, for processing payments for services rendered on behalf of Health First Colorado (Colorado's Medicaid program) and Child Health Plan Plus (CHP+) members. In addition, the new Provider Web Portal launched Feb. 6, 2017, and a new Pharmacy Benefits Management System (Pharmacy Point of Sale system) will launch Feb. 25, 2017. This will not only be a transition to new systems, but to new vendors and new processes as well.

The Department has created a guide to help inform and prepare providers for these changes. This document contains general guidelines for our providers and is not intended to provide comprehensive guidance for every situation.

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