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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 

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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Low vision: There is something you can do

Posted By Chet Seward, Saturday, December 24, 2016
A new resource from the American Academy of Ophthalmology can help you with patients with low vision. There Is Something Else You Can Do is a new video that emphasizes the impact of vision loss on individuals and the responsibility of eyeMDs to refer or provide vision rehabilitation. With advances in technology, modern vision rehabilitation can help most patients with any degree of vision loss. Providing or referring patients to vision rehabilitation is now the standard of care for all who experience vision loss. Be sure to review this video and other resources at the Academy’s ONE Network.

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Health advisory alert: Request for cases of adverse reactions to ocular Avastin injections

Posted By Chet Seward, Saturday, December 24, 2016

The following is an important health advisory alert from the Colorado Department of Public Health and Environment (CDPHE).

  • CDPHE is investigating a cluster of adverse outcomes following intravitreal injections with Avastin to treat macular degeneration. The investigation is ongoing.
  • The patients experienced inflammatory reactions, including clouded vision, decreased vision and floaters within a few days after intravitreal injection with Avastin. All patients recovered following treatment with topical steroids.
  • CDPHE requests any cases of inflammatory reactions following ocular Avastin use be reported to the Communicable Disease Branch by contacting Devra Barter at 303-692-2706 or devra.barter@state.co.us. You also may contact Devra Barter for more information.

Tags:  Avastin  health advisory alert 

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Don't forget to revalidate with Medicare

Posted By Chet Seward, Tuesday, December 6, 2016

Medicare requires that enrolled providers and suppliers revalidate per the Affordable Care Act. Revalidation are due on the last day of the month according to your revalidation schedule. The local Medicare Administrative Contractor Novitas should send you a revalidation notice about two-three months prior to your due date. If you're curious about what your date is then search here.

Find out all you need to know about provider revalidation here. Avoid holds on your Medicare payment or deactivation of your Medicare billing privileges by keeping your provider revalidation up to date. Contact Novitas if you have any questions.

Tags:  practice management 

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Physicians must post notices of non-discrimination by Oct. 17, 2016

Posted By Chet Seward, Tuesday, December 6, 2016

Under new HHS rules implementing the ACA nondiscrimination provision, covered entities (which includes most health care providers) must post and publish new mandatory nondiscrimination statements and taglines by October 17, 2016. The final rule coordinates existing federal nondiscrimination laws, regulations, and policy regarding race, color, national origin, age, and disability as they apply to health care coverage and care. The rule codifies HHS’s long-standing policy guidance on language assistance for individuals with Limited English Proficiency (LEP), and incorporates provisions of the Americans with Disability Act (ADA) to prohibit disability-based discrimination in health programs and activities.

The rule applies to those who provide or administer health-related services or insurance coverage and receive “federal financial assistance.” Federal financial assistance includes Medicare, Children’s Health Insurance Program, Medicaid, meaningful use incentive payments, HHS grants, Centers for Medicare and Medicaid Services gain-sharing demonstration projects, federal premium and cost-sharing subsidies, etc.

The rule does not apply to physicians who only receive payments from Medicare Part B (traditional Medicare), unless they are also receiving meaningful use incentive payments.

Covered physicians must:

  • By October 17th post a notice of nondiscrimination and taglines in the top 15 languages in the state.
  • Designate a compliance coordinator and adopt grievance procedures (applicable to group practices with 15 or more employees).
  • Covered entities are encouraged to develop and implement a language access plan.

For more information and sample documents click here.

Tags:  practice management 

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