This holiday season and all year long the Colorado Medical Society is grateful for the opportunity to serve Colorado physicians and practice staff by bringing you the latest information and resources to make your job a little easier. Thank you for all that you do to improve the health of Coloradans. We wish you a wonderful holiday season and a prosperous 2018, and we look forward to working with you in the coming year. Don't hesitate to reply to this email with your questions, comments or concerns.

Anthem announced on Dec. 1 that they intend to reduce payment by 50 percent for an Evaluation and Management service when billed on the same day as a minor procedure, even when the modifier 25 is appended to the visit code. The health plan gave physicians a deadline of Dec. 15 to respond with objections. According to the contracting physician's rights under C.R.S. 25-37-104, a health plan must provide notice of a material change 90 days before the effective date.

Having been aware of this change being implemented in other states, the Colorado Medical Society has been working with the American Medical Association and a coalition of state and specialty societies to bring our concerns to Anthem's national headquarters. Due to the immediacy of this action for Colorado physicians, CMS is also sending a letter to the local Anthem office expressing that the reduction in the value of the E/M visit by 50 percent when billed with a minor procedure on the same day is arbitrary and is detrimental to physicians who are trying to practice medicine according to the needs of their patients. 

The intent of modifier 25, according to Current Procedural Terminology (CPT) guidelines, is to describe a significant, separately identifiable, and medically necessary E/M service performed on the same day as a procedure, outside of the global fee concept. In the course of performing the patient's history and examination, if the physician determines that a procedure is medically necessary, such as a biopsy or destruction of a lesion, and the documentation supports it, the physician's work should be recognized and reimbursed appropriately. 

The Colorado Medical Society and the other coalition partners have requested that Anthem reconsider implementation of its new modifier 25 policy as it inappropriately reduces the value of E/M services. Stay tuned.

In 2017 the Colorado General Assembly passed legislation requiring greater transparency in provider prices enabling consumers to be better informed. Beginning Jan. 1, 2018 physicians will need to disclose to consumers their charges for the 15 most common services they provide when payment is made directly by the patients rather than by a third party.

This applies to physicians in a solo practice, medical group, independent practice association or professional corporation. Health care providers are required to make available to the public the prices for at least the 15 most common health care services provided. Such information should be available in a single document, either electronically or by posting conspicuously on the provider's website if one exists.

Read more about the new provision on CMS.org.

The Colorado Quality Payment Program (CoQPP) Coalition has released their Five Fast Facts for December to help physician practices navigate the program. View the fast facts here to get answers to the following questions:

1. Who can join a virtual group? 
2. How are virtual groups treated? 
3. Can a virtual group qualify for small or rural considerations?
4. How do I join a virtual group?
5. Why would I join a virtual group?

The Centers for Medicare and Medicaid Services recently provided the RVU files related to the 2018 Physician Fee Schedule (PFS). The RVU files can be accessed in spreadsheet and other formats on the CMS.gov website. The PFS contains a number of updates impacting Medicare payment and policies, including expanded coverage of telehealth services and retroactive reductions to PQRS reporting requirements and associated penalties.

At this point, there are two big items that should be on physicians' to-do list regarding their 2017 obligations for the new Medicare Merit-based Incentive Payment System (MIPS): Verify that they that they are on the right path for their goals for the program; and, if not, take advantage of the "one patient, one measure" reporting option to avoid a 4 percent payment penalty in 2019.

Read more in this article from the AMA, which includes more on exemptions, a tutorial on "one patient, one measure," and other resources.

The highly anticipated 2017 Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults was released Nov. 13 at the American Heart Association's (AHA) Scientific Sessions.

The American Medical Association and American Heart Association also announced the launch of two national campaigns -- one for consumers and one for health care providers -- designed to improve blood pressure control in the U.S. The first campaign features heart attack and stroke survivors who underscore the importance of re-engaging with a physician to get back on a management plan before it's too late. The campaign is available in English and Spanish at LowerYourHBP.org and BajeSuPresion.org.

Second, to prepare health care providers for a productive dialogue with patients, AMA and AHA launched the Target: BP Improvement Program -- a suite of tools and resources that incorporates the new 2017 hypertension guideline. Target: BP also offers access to the latest guideline information, making it a single source of guidance to achieve improved blood pressure control among adult patient populations.

From April 2018 to April 2019, the Centers for Medicare and Medicaid Services will mail new Medicare cards to all active Medicare beneficiaries. The New Medicare Card removes Social Security numbers from Medicare cards due to concerns about identity theft. The new cards have a Medicare Beneficiary Identifier (MBI) instead of the Social Security Number-based identifier known as the Health Insurance Claim Number (HICN).

Practices must be prepared to use MBIs starting April 1, 2018, as patients new to the Medicare program beginning in April 2018 will only have cards with MBIs. From April 1, 2018 to Dec. 31, 2019, the federal CMS will accept both HICNs and MBIs on Medicare transactions (including eligibility requests and claims) for beneficiaries in the Medicare program prior to April 1, 2018 (i.e., those who received a HICN). Beginning in January 2020, physicians may only use MBIs. (Exceptions may include appeals and retrospective adjustments.)

Read more here from the AMA about how to prepare your practice and your patients. Read more here from the federal CMS.