Surprise medical bills from out-of-network providers continue to be a hot issue nationally and in Colorado. During the 2019 legislative session the General Assembly passed HB 19-1174, which aims to limit the impact of these bills on patients. Though the law took effect Jan. 1, 2020, the Colorado Division of Insurance is still working to finalize rules to implement HB 19-1174, specifically regarding payment and provider disclosures. In the meantime, CMS developed a resource for physicians to help you understand how the new law will affect your practice -- and will continue to update this resource as final rules and regulations are published. Access " Out-of-network law: What physicians need to know" here.

The Centers for Medicare and Medicaid Services has opened the data submission period for Merit-based Incentive Payment System (MIPS)-eligible clinicians who participated in the 2019 performance period of the Quality Payment Program. Data can be submitted and updated from 10 a.m. EST on Jan. 2, 2020 until 8 p.m. EDT on March 31, 2020. Read more here.

You can now use the updated federal CMS Quality Payment Program Participation Status Lookup Tool to check on your initial 2020 eligibility for the Merit-based Incentive Payment System (MIPS). Just enter your National Provider Identifier to find out whether you need to participate in MIPS during the 2020 performance period. Read more and access helpful resources here.

Effective Jan. 1, 2020, all claims submitted to Medicare must be billed with the new Medicare Beneficiary Identifier (MBI) in place of the Health Insurance Claim number (HICN). 

Any claim files submitted without the MBI, or with an incorrect MBI will reject on the 277CA claims acknowledgement report with a A7:164:IL (Invalid Information within the Subscriber's contract/member number) before entering the claim processing systems. If you receive this rejection:

Novitas encourages all practice staff to use the MBI Lookup tool in Novitasphere to obtain your patients’ MBIs. View the Novitasphere Portal Center to enroll today. Reminder: the MBI uses numbers 0-9 and all uppercase letters EXCEPT for S, L O, I, B, and Z. This is to avoid confusion when differentiating between certain letters versus numbers like the number zero and the letter O. Review this MLN Matters Article for additional information on using MBIs.

The American Medical Association (AMA) is helping physician practices integrate fundamental changes to the coding and documentation of evaluation and management (E/M) office visit services. New Medicare office-visit coding and documentation guidelines are simpler and more flexible, but physician practices will need to prepare in the new year to get the full benefit of the burden relief the changes are designed to bring.  This 10-point AMA checklist and linked resources will help guide physician practices for a smooth transition to the simpler and more flexible guidelines. To learn more about these significant CPT code set revisions, visit the CPT E/M webpage. Additionally, the AMA has created an interactive educational module, a detailed description of the code and guideline changes, along with a table illustrating medical decision-making revision to educate physician practices.

The Centers for Medicare and Medicaid Services (federal CMS) recently announced that Colorado is one of 10 states selected to receive funding under the Maternal Opioid Misuse (MOM) Model. These selections are part of the agency's multi-pronged strategy to combat the nation’s opioid crisis and address fragmentation in the care of pregnant and postpartum Medicaid beneficiaries with opioid use disorder. The MOM Model will have a five-year period of performance beginning in January 2020 with three different types of funding, totaling approximately $50,000,000. Care delivery begins in the second year of the model. Read more about the MOM Model here.