On July 29, the Centers for Medicare and Medicaid Services released a proposed rule for the 2020 Medicare Physician Fee Schedule (PFS) and Quality Payment Program (QPP). The rule covers many topics including a new participation framework in the Merit-based Incentive Payment System (MIPS) and new payments for managing patients with opioid use disorder. One piece of good news is that the federal CMS accepted the recommendations from the American Medical Association and RVS Update Committee (RUC) and will not collapse the evaluation and management (E/M) levels with a blended payment rate as previously proposed. Read more here.

The Colorado Division of Insurance issued cease and desist orders for Trinity Healthshare and Aliera Healthcare on Aug. 12. Trinity represents itself as a health care sharing ministry. Aliera is the administrator, marketer and program manager for Trinity. According to a DOI news release, the division is concerned that they may be using misleading marketing practices, blurring the lines between health insurance that complies with the requirements of the Affordable Care Act and non-compliant insurance (like what is offered by health care sharing ministries). Because of this, the DOI says, the companies may be putting consumers at risk and violating Colorado insurance law. Read more here.

The Colorado QPP Coalition presents its August Fast Facts, the latest information on the Quality Payment Program and more that takes just five minutes to read. Check it out here for more on the following topics:

The federal CMS has provided information on the operating rules for adopted HIPAA transactions, highlighting phase I and phase II operating rules for the eligibility and benefits inquiry. An eligibility and benefits transaction covers inquiries and responses about a patient’s eligibility for insurance benefits, including information like co-pays and deductibles. The phase I and phase II operating rules for the eligibility for a health plan and health care claim status transactions were adopted in December 2011 through interim final rulemaking (CMS-0032-IFC) and became required for use on Jan. 1, 2013. All HIPAA-covered entities must comply with these operating rules. Read more here.

The TMF Quality Innovation Network will hold virtual office hours on Wednesday, Aug. 28 at 11 a.m. MT to discuss how to participate in MIPS without an EHR. Many small practices do not use electronic health records and instead maintain patient records on paper. Even those using paper records can participate in the Merit-based Incentive Payment System (MIPS) and perform well! In this webinar, TMF consultants will provide insight into tools that will improve practices' MIPS performance. Register here.

Starting Jan. 1, 2020, all providers must use the Medicare Beneficiary Identifier (MBI). The Centers for Medicare and Medicaid Services will reject claims submitted with the Health Insurance Claim Number (HICN) with a few exceptions, and reject all eligibility transactions.

Many providers are using the MBI for Medicare transactions. For the week ending Aug. 2, providers submitted 77 percent of fee-for-service claims with the MBI. Protect patients’ identities by using MBIs now for all Medicare transactions.

Don’t have an MBI?

For more information, see the MLN Matters Article.

The Colorado General Assembly passed HB 19-1174 during the 2019 legislative session to help protect patients from surprise out-of-network bills. Included in the bill are specifications regarding provider reimbursements for out-of-network emergency and non-emergency visits. The Colorado All Payer Claims Database is identified in the bill as a data source related specifically to the statewide commercial carrier median geographic payments specified in the bill, and CIVHC is working collaboratively with the Division of Insurance to finalize specifics regarding the methodology that will be used and the data elements that will be available to the DOI from the CO APCD. As they're working through the details, CIVHC has compiled a "frequently asked questions" document to provide some guidance to providers. Access the FAQ here.

The recently passed Colorado Candor Act is a bipartisan effort that establishes a voluntary framework for health care providers and facilities to offer compassionate, honest, timely and thorough responses to patients who experience an adverse health care incident. It is designed to benefit patients, their families, clinicians, and health care systems by formalizing a non-adversarial process where there can be open communication about what happened, why it happened, and what can be done to prevent this in the future. COPIC has made available several resources that provide details about the act, the Candor process and sample templates of required forms.  Access the resources here.