Print Page   |   Sign In   |   Join
News & Press: Newsletter Archive

September-October 2013 Newsletter

Sunday, September 1, 2013  
Share |
CSEPS September/October 2013 Newsletter
CSEPS 3
 
E-News for Colorado Ophthalmologists                                                                          September/October 2013
In This Issue
Raise Your Glasses Logo
Register now for CSEPS social mixer on 10/3/13

Make plans to join CSEPS and the at Forest Room 5  in Denver on on Oct. 3 from 6-8 p.m. as we continue our series of social mixers. Reconnect with your colleagues over great food and drink. Don't worry, the bill is on us. Get more details and register here.

Getting paid the right way with CODEquest
From left, Alan Kimura, MD, William Hines, MD, and Ann Hines hit the books at CODEquest 2013.

More than 80 ophthalmologists and their practice staff from across Colorado turned out for an information-packed day on Saturday, Sept. 7.

Sponsored by CSEPS and the American Academy of Ophthalmology Executives, the event featured the latest information on coding updates, best practice tips and preparation for the conversion to ICD-10 next fall. Big changes are in store next year so watch for the 2014 CODEquest conference announcement soon to ensure that you and your team gets paid appropriately for care delivered.

Join the CSEPS Ski Club today
What better way to reconnect with your ophthalmology colleagues than enjoying a few turns together on the slope? Join the CSEPS ski club today. To start we will meet at Breckenridge Peak 9 Lodge at noon on the first Saturday of every month beginning December 7. Depending on popularity, we will select more dates and or alternative locations. Contact Chet in the CSEPS offices for more details and to sign up. 
FDA recall alerts

The FDA is alerting physicians to check their inventory and cease use of two medications produced by Avella Specialty Pharmacy and three medications produced by Leiter's Compounding Pharmacy due to concerns of sterility assurance with their independent testing laboratories.

Avella is recalling the following products:

  • Bevacizumab 1.25mg/0.05 mL PF, Lot Nos. 12-20130508@179, Expiry 11/3/2013
  • Vancomycin PF (BSS) 1%, Lot Nos. 12-20130508@181, Expiry 10/4/2013

Leiter's is recalling the following products:

  • Bevacizumab Lot. No. 08052013@1, expiry 11/03/13
  • Bevacizumab Lot No. 08052013@4, expiry 11/03/13
  • Lidocaine/phenylephrine Lot No. 07302013@6, expiry 10/28/13

Unused portions of the affected items should be returned to Avella or Leiter's, respectively, and any adverse events should be reported to the FDA's MedWatch Safety Information and Adverse Event Reporting Program.

Click here to read the full alert on Avella. Click here to read the full report on Leiter's Compounding Pharmacy.

Leiter's Compounding Pharmacy recall alert

The FDA is alerting physicians to check their inventory and cease use of two medications produced by Avella Specialty Pharmacy due to concerns of sterility assurance with the pharmacy's independent testing laboratory.

Avella is recalling the following products:

  • Bevacizumab 1.25mg/0.05 mL PF, Lot Nos. 12-20130508@179, Expiry 11/3/2013
  • Vancomycin PF (BSS) 1%, Lot Nos. 12-20130508@181, Expiry 10/4/2013

Affected items should be returned to Avella and any adverse events should be reported to the FDA's MedWatch Safety Information and Adverse Event Reporting Program.

Click here to read the full alert.

Children's Eye Health Safety

As kids head back to school this fall, encourage parents to help their kids maintain healthy vision.

Here are a few tips to share with your patients:

  • Get a child's vision screened early - and regularly.
  • Research your family history of childhood eye disease or impairment.
  • Look out for symptoms of eye problems, which may include sensitivity to light, pus or crust, drooping eyelid(s), or bulging eye(s).
  • If your child is found to have an eye condition, encourage them to comply with their treatment while at school.
  • Ensure your child wears protective eye wear during sports activities.

For more information on these tips and many more facts about children's eye health, refer your patients to www.geteyesmart.org.

President's update
GeorgeUlrich
George Ulrich, MD
On the move

Mission of the Colorado Society of Eye Physicians and Surgeons:

  • Promote excellence in patient care
  • Foster professional fellowship and continuing medical education
  • Be a strong advocate for patients and the physicians who serve them.

Things going on right now:

  1. Advocacy - As the health care system continues to evolve and Affordable Care Act controversies flare, CSEPS ophthalmologists are building relationships with Colorado state legislators.  We want legislators to know who we are and what we do.  We want them to understand that we have unique expertise and credibility. We are the best resource for sound advice on health policy as it relates to eye care issues.
  2. State ophthalmology society gathering - I recently joined representatives from other states in Chicago for a meeting with the American Academy of Ophthalmology Secretariat for State Affairs.  Strong state societies contribute to making our profession strong.  We need more members.

Things coming up this fall:

  1. We continue to work on conducting a glaucoma laser treatment day at the Stout Street Clinic in Denver in cooperation with Colorado Coalition for the Homeless.  We are standing by as the Stout Street Clinic obtains authorization to conduct treatment at their facility.
  2. Plan on joining us for our annual meeting during lunch at the 17th Annual Ophthalmology Symposium on October 11.
  3. CODEquest coding college was another success this year. Next year will bring huge coding changes thanks to ICD-10 so we hope to hold another CODEquest session in the spring next year rather than the typical fall date.
  4. Ski Club - we invite fellow ophthalmologists and families to ski together this winter.  We will meet at Breckenridge Peak 9 Lodge at noon the first Saturday of every month beginning December 7. Contact CSEPS executive director Chet Seward for more details and to RSVP.

We want to grow our membership:

  1. We fight for our priorities in the state legislature. All of our funding for advocacy comes from membership dues.
  2. There are numerous critical issues in health care reform currently being considered in our legislature.  We must take part in the conversation and advocate for policies and laws that serve our patients well.
  3. Organization and numbers give us credibility and influence.
  4. The more members we have, and the stronger our organization - and the more effective we are in promoting our profession.

If you are not a member, you need to participate and contribute.  Click here for an application.  If you prefer to support the organization and mission without joining you can send a check.  Click here.

 

If you are a member, talk to non-member ophthalmologists you know about the importance of joining.  Have them contact our executive Chet Seward at: 303-810-8689.

George G. Ulrich, MD    

 

Legislative update: Advocacy training
Stephanie Vance

The Colorado Society of Eye Physicians and Surgeons is pleased to share information about an upcoming advocacy seminar hosted by the political action committees of the American Medical Association, Colorado Medical Society and Colorado Academy of Family Physicians.

The Regional Campaign and Grassroots Seminar will be held on Saturday, Oct. 12, 2013, 8 a.m. - 3 p.m. MDT at the COPIC building in Denver. There is no fee to attend.

Stephanie Vance is the keynote speaker. She's a 25-year veteran of the Washington, D.C. political scene and has held positions as a lobbyist, grassroots consultant and Congressional aide. She is the author of five books including the recently released "The Influence Game." The first 100 registrants will receive a copy of her book.

Click here for more information and to register. All CSEPS members are invited and encouraged to attend.

Register for the 17th Annual Ophthalmology Symposium - Oct. 11-12, 2013

CSEPS is once again supporting the annual Ophthalmology Symposium at the University of Colorado School of Medicine. The program, this year held Oct. 11-12 at the University of Colorado Anschutz Medical Campus in Aurora, features some of the best and brightest local and national ophthalmologists focusing on topics covering oculoplastics, biologics, cornea and refractive surgery, glaucoma and vitreoretinal diseases. 

CSEPS will also be holding our annual meeting in conjunction with this conference. 

Registration will open soon. Learn more information about the program here. All CSEPS members are invited and encouraged to attend. 

Connect for Health Colorado:
What eye physicians need to know about new health insurance exchange

Connect for Health Colorado is the state's new health insurance marketplace called for under federal law (sometimes called the health benefit or health insurance exchange). Starting in October 2013, individuals, families and small employers with 2-50 employees will be able to use this online marketplace to purchase health insurance and, if eligible, receive federal tax subsidies and credits to help cover the costs.

With an estimated 74,000 to 240,000 Coloradans expected to enroll in the exchange in 2014, physicians must proactively prepare for how the exchange may affect their patients and their practice.

One of the most important things for physicians to be aware of is the 90-day grace period. Per federal rule, patients that receive federal subsidies to purchase exchange plans (< 400 percent FPL) have a 90-day grace period for non-payment of premiums. During the first 30 days the health insurance plan must pay for claims as if the patient was eligible, but in the last 60 days they can suspend claims. If the patient's coverage is cancelled after 90 days because of non-payment of premiums, the insurer may deny all suspended claims for services furnished during the 31-90 day time period. Physician practices could therefore be in a position of providing services for up to 60 days, only to be stuck with the prospect of either having to absorb the costs as bad debt or attempting to collect arrears from patients that may well not have the means to pay these bills given that they couldn't pay for their premiums.

You are not required by federal law to contract with exchange plans or accept exchange patients. However, if you have an existing contract with an "all products" clause then you are bound by the terms of that contract. Health insurers may either send you a separate contract for new exchange products, or they may send you an amendment adding this product to your existing contract. Here are a few things to consider before signing:

  • Understand response deadlines - Once contract amendments are received you have 30 days in which to notify a plan that you want to opt out of a new product.
  • Check for disclosures - If you didn't receive a disclosure statement and a copy of the fee schedule with the contract, then request and review it.
  • Reimbursement rates - Read your contracts carefully to understand reimbursement rates.
  • Administrative requirements - As with any contract or amendment, it is important to determine what the administrative requirements are including timely filing and your responsibilities associated with complying with audits.
  • Prepare for churn - The potential for this particular patient population to move back and forth from exchange plans to public programs like Medicaid is high. Evaluate your payment and collections policies and implement electronic eligibility verification if not already in place. Take steps to make this electronic eligibility verification part of your practice's daily workflow for every patient.
Perform blepharoplasties? Study the LCD carefully and document thoroughly

The number of blepharoplasties paid for by Medicare has more than tripled over the past 10 years, accounting for a rise in costs from $20 million in 2001 to $80 million in 2011. As a result, these procedures have come under intense scrutiny by Medicare's Recovery Auditors (formerly called Recovery Audit Contractors). The RAs are a network of so-called "bounty hunters" who review medical records looking for inappropriate payments, collecting overpayments and paying out underpayments for medical services performed within the past three years. Colorado's RAC is Connolly Healthcare.

The local carrier determination, or LCD, for blepharoplasty has changed within the last year to specify documentation for the effect on the patient's daily life, the quality of photographic evidence of eyelid droopiness and a more stringent visual field test. Click here to view the current LCD.

Michael McCraken, MD, an oculoplastic surgeon in Denver, is currently under review for eight blepharoplasty cases and has heard similar accounts from his colleagues around the state and nation that indicates the scrutiny will only intesify. "If you find yourself in an audit, I think that the first thing to do is to contact your malpractice carrier to see if they provide coverage for an attorney," he says. "I would at least consult with an attorney whether or not you decide to work with one."

He also urges his colleagues to review the LCD carefully. "For the last year, if people have been doing business as usual and not knowing what the new LCD is, particularly the restrictions on how the visual field is obtained, they may be vulnerable and not know it. They may be playing by the rules but just the wrong set of rules."

Improving quality through innovation:  
Introducing the AAO IRIS Registry

The American Academy of Ophthalmology (AAO) has launched the IRIS™ Registry (Intelligent Research in Sight), the first comprehensive, electronic health record-based eye disease clinical registry. The initiative will enable thousands of ophthalmologists across the country to statistically review and analyze their own care and compare it to benchmarks and peer physician performance. CSEPS wants Colorado to have the highest percentage of state users and we encourage you to sign up as soon as it's available.

The IRIS Registry will be available for participation in early 2014 and the first 2,000 AAO members to sign up will receive free access for two years. A small group of ophthalmologists and ophthalmology practices are currently enrolled in the registry in an early-access phase. Those interested in learning more about gaining early access should contact irisregistry@aao.org.

Click here to watch a recording of the Aug. 12 IRIS Registry webinar and the video announcement by Academy CEO David Parke II, MD. Go to www.aao.org/iris-registry for more information, including the benefits of participating.

Preview federal value-based modifier
and share information with AAO

The American Academy of Ophthalmology (AAO) reports that the Centers for Medicare and Medicaid Services will give physicians a preview of the value-based modifier that will be added to 2017 Medicare payment calculations. Beginning Sept. 16, physicians in groups of 25 or more Medicare eligible professionals can access their 2012 Medicare Quality and Resource Use Reports at https://portal.cms.gov.

The reports offer an early glimpse of performance on some of the cost and quality measures that CMS will use for the value-based modifier.

The federal CMS will host a conference call on Thursday, Sept. 24, at 1 p.m. MDT to explain the reports and how they relate to implementation of the value-based modifier. AAO asks ophthalmologists who receive a report to share some of the details to influence future advocacy efforts. Ophthalmologists can contact healthpolicy@aaodc.org to provide feedback on or share their reports.

CMS releases plan to resolve denied claims
tied to NCCI edits

The Centers for Medicare and Medicaid Services has released a plan to resolve denied claims related to National Correct Coding Initiative (NCCI) edits implemented on July 1, the American Academy of Ophthalmology reports. Click here to view a letter explaining the plan.

According to CMS, the denials are occurring as a result of a computer system issue that fails to recognize the appropriate modifiers (-24, -25, -57). The new edits apply to any global surgical code billed with an established patient eye-visit code appended with one of the appropriate modifiers. The agency said it will stop applying the new edits for all surgical codes to work on a permanent solution beginning on Oct. 1; the solution will be retroactive to July 1.

Three Medicare Administrative Contractors have implemented temporary fixes; Colorado's Novitas is not one of them. In this case, CMS says that ophthalmologists may hold claims until Oct. 1, at which time those and others that have been inappropriately denied may be submitted or resubmitted for payment.

AOA, with input from the American Society of Retina Specialists, continues to work directly with CMS on a permanent resolution. In addition, the Academy is working with Medicare Administrative Contractors through its Carrier Advisory Committee liaisons to implement temporary fixes before Oct. 1. For more information, contact the AOA Governmental Affairs Division at (202) 737-6662.

CSEPS is the Colorado ophthalmology society 
Join us in helping to ensure excellence in Colorado eye care. Maybe you think you're already a member. Check the CSEPS website to confirm you are a member. If you're not, please contact Chet Seward in the CSEPS offices by e-mail or by phone at (720) 858-6336 to renew or join today.
The Colorado Society of Eye Physicians and Surgeons is the Colorado ophthalmology society representing Colorado ophthalmologists who specialize in the medical and surgical treatment of eye disease. This newsletter is published by the CSEPS communications division, which works with CSEPS physician leadership and the American Academy of Opthalmology to advocate on behalf of physicians. Please direct questions to cseps@cms.org or call (720) 858-6336.

We want to hear from you! Contact CSEPS at 720-858-6336 or cseps@cms.org Link

Copyright © 2013. All Rights Reserved.