GLMS Weekly Updates 09
SPECIAL EDITION - 2017 ANNUAL UPDATE
The GLMS Physician Education and Practice Support Department sends Weekly Hassle Updates via email to keep other members informed of issues being reported to GLMS and items of interest to physician practices.
Below are some highlights of 2017 updates
December 14, 2017
Passport Health Plan Average Sale Price Drug Fee Schedule Rate Update
Passport Health Plan reviews fee schedules quarterly to ensure they are current and compliant with federal and state billing guidelines, industry standards and provider contracts. Passport has updated this fee schedule in accordance with the 2017 quarterly revisions to the Medicare Part B Drug Pricing list published by the Centers for Medicare and Medicaid Services - More information here.
Please be advised of the following production date when the rates went into effect in our claims processing system: Average Sales Price (ASP) Quarter 3 and Quarter 4 Rates: 10/1/2017. No Provider action is needed at this time. Claims with dates of service on or after the effective date which are impacted and have already been adjudicated will be reprocessed within 30 days. For questions about fee schedule updates, please contact Provider Services, 800-578-0775 or your Provider Relations Specialist.
Payment Reduction for X-Rays Taken Using Computed Radiography
CMS stated that Change Request (CR) 10188 announces that beginning January 1, 2018, and including Calendar Year (CY) 2018-CY 2022, a payment reduction of 7 percent applies to the technical component (and the technical component of the global fee) for computed radiography services that would otherwise be made under the Physician Fee Schedule (PFS) (without application of subparagraph (B)(i) and before application of any other adjustment), or under the hospital Outpatient Prospective Payment System (OPPS). Read more.
Providers and Practices Posting Nondiscrimination Notices and Taglines in “Significant” Publications
Wyatt, Tarrant & Combs, LLP recommends that healthcare providers should add nondiscrimination notices and taglines to significant publications and communications, according to the HIPAA Notice of Privacy Practices. Section 1557 of the Affordable Care Act prohibits certain health care providers from discriminating on the basis of race, color, national origin, sex (including discrimination based on pregnancy, gender identity and sex stereotyping), age, or disability in health programs and activities. Providers are required to inform consumers of their nondiscrimination rights by posting an English-language notice and taglines in 15 languages advising consumers of the availability of free language assistance services. The U. S. Dept. of Health & Human Services (HHS) has helpfully drafted sample notices and taglines.
These notices and taglines must be (1) posted in a conspicuous location on the home page of the website, (2) posted in a conspicuous physical location where the covered entity interacts with the public, and (3) included in “significant” publications and communications targeted to beneficiaries, enrollees, applicants, or members of the public, which may include patient handbooks, outreach publications, or written notices pertaining to rights or benefits or requiring a response from an individual.
Wyatt, Tarrant & Combs is available to provide further guidance on Section 1557 requirements and to assist providers with questions in applying them to their practices. Read more information here. Wyatt’s Health Care Service Team members are ready to assist providers.
December 7, 2017
All ORP Providers must be enrolled in Kentucky Medicaid and be included on Claims
Effective February 1, 2017, all claims (UB-04 and HCFA) submitted involving an ORP physicians must include ORP information, including NPI and /or taxonomy (if applicable), or it will be denied. Please see CMS-1500 claim form and instructions. Specifically, all services billed to any provider involved in the care of a Passport member must include the appropriate ORP provider(s), listed above. To verify that an ORP provider is enrolled in Kentucky Medicaid, please see the Kentucky Medicaid Provider Directory. If a provider is not enrolled with Kentucky Medicaid, please submit a Map-811 Provider Enrollment Application to Passport Enrollment, ProviderEnrollment@passport.. If you have any questions about this updated regulation, please contact Provider Services (800) 578-0775 or your Provider Relations Specialist.
Providers Need to Submit Quality Payment Program Hardship Exception Applications by December 31, 2017.
The Centers for Medicare & Medicaid Services (CMS) would like to remind providers that the Quality Payment Program Hardship Exception Application for the 2017 Transition Year is available on the
Quality Payment Program Website. The deadline for submitting a Quality Payment Program Hardship Exception Application is December 31, 2017. For more information, contact the Quality Payment Service Center at 1-866-288-8292.
Renew Recovery Centers Partner with Humana to Provide Opioid Addiction Services in Kentucky
Renew Recovery Centers and Humana Inc. have signed a contract that provides in-network access for Humana employer plan members at Renew Recovery Facilities in Kentucky. The agreement provides in-network access to comprehensive addiction treatment services for Humana members who are covered by employer plans. Renew Recovery Centers are located in Louisville, Georgetown, and London, Kentucky. Services include medication assisted treatment, psychiatric evaluation and management, psychotherapy in individual, group, and family formats, and case management for outpatient and intensive outpatient levels of care. For more information call 866-957-9365.
Delay in Implementation of the Revision to UnitedHealthCare’s Consultation Services Reimbursement Policy
UnitedHealthCare previously announced that certain revisions to the Consultation Services Reimbursement Policy would become effective for United Healthcare Commercial members on October 1, 2017. In an effort to give care providers more time to adjust to potential changes in their submission of procedure codes for consultation services, United Healthcare will be delaying implementation of the revisions to the Reimbursement Policy for services reported with consultation codes 99241-99245 and 99251-9925. Additional updates relating to this policy will be shared in future editions of United Healthcare’s Network Bulletin at .
November 22, 2017
UnitedHealthcare Review at Lunch Drug Program begins January 1, 2018
The U.S. Food and Drug Administration (FDA) is approving medications at an accelerated pace, and UnitedHealhcare (UHC) wants to make it easier for care providers to manage members’ access to new drug therapies as they become available. In Kentucky, Review at Launch will apply to UnitedHealthcare’s All Savers Plan for newly FDA-approved, physician-administered drugs covered under the member’s medical benefit.
Beginning January 1, 2018 UnitedHealthcare will maintain a list of new-to-market medications and a related policy that care providers can access online. Drugs will remain on the Review at Launch list until UHC communicates otherwise. The Review at Launch list and policy will be posted on .
UHC strongly encourages providers to request pre-service coverage reviews so they can check whether a medication is covered before providing services. Clinical coverage reviews can also help to avoid starting a patient on therapy that may later be denied due to lack of medical necessity. If a practice requests a pre-service coverage review, they must wait for UHC’s determination before rendering the service. If the practice does not wait for the determination before rendering the service, the claim may be denied and the practice cannot bill the member for the service.
Affordable Care Act Enrollment underway until December 15.
Open enrollment for 2018 health insurance plans sold on has begun and December 15 is the last day to enroll. Consumers should enroll early since there is not a guarantee the federal government will extend the enrollment date for those who have started the application process prior to December 15, as they have in the past. Also, the federal government has announced that the website will be shut down every Sunday from noon to midnight EST (except December 10) for maintenance. In Jefferson County, CareSource is the only payor offering plans on the exchange.
Need help lowering your stress levels? Want to improve your work/life balance for a more ideal practice?
The annual GLMS Leadership Workshop is here to help you feel more comfortable and empowered in your practice. This year, GLMS is hosting Dr. Dike Drummond, founder of The Happy . Topics include navigating medical bureaucracy, burnout proofing your life and planning a balanced work blueprint. This exclusive event is open to GLMS members and/or their office managers only.
Saturday, December 2
8 a.m. to Noon
GLMS Office- 328 E. Main Street
Information & Register Here
GLMS Fleur-De-Lis Connection
GLMS is proud to present The Fleur-De-Lis Connection digital newsletter Read the latest issue here.This publication is sent to all GLMS members, practice managers and other health care professionals. Be sure to check your spam folder in the event the newsletter is landing there. Please let us know if you are not receiving this important and current information by contacting McKenna Byerley, PR & Membership Specialist at 502.736.6362 or mckenna.byerley@
November 9, 2017
Affordable Care Act Enrollment underway until December 15.
Open enrollment for 2018 health insurance plans sold on has begun and December 15 is the last day to enroll. Consumers should enroll early since there is not a guarantee the federal government will extend the enrollment date for those who have started the application process prior to December 15, as they have in the past. Also, the federal government has announced that the website will be shut down every Sunday from noon to midnight EST (except December 10) for maintenance. In Jefferson County, CareSource is the only payor offering plans on the exchange.
New Medicare Card: Provider Ombudsman Announced
The Provider Ombudsman for the New Medicare Card serves as a CMS resource for the provider community. The Ombudsman will ensure that CMS hears and understands any implementation problems experienced by clinicians, hospitals, suppliers, and other providers. Dr. Eugene Freund will be serving in this position. He will also communicate about the New Medicare Card to providers and collaborate with CMS components to develop solutions to any implementation problems that arise. To reach the Ombudsman, contact: NMCProviderQuestions@cms..The Medicare Beneficiary Ombudsman and CMS staff will address inquiries from Medicare beneficiaries and their representatives through existing inquiry processes. Visit for information on how the Medicare Beneficiary Ombudsman can help you.
From KMA: Avoid the Medicare Penalty, Take Action Now
Physicians must take action now to avoid the four percent payment reduction under the Medicare Quality Payment Program, which includes the Merit Based Incentive Payment System or MIPS.
Read More.
Web Event: MIPS Q&A Town Hall Event for Small Practices & Solo Practitioners
Small practices and solo practitioners face many challenges and questions as they prepare their 2017 MIPS information. This event features a panel of experts that understand MIPS and work regularly with small practices. Join the QPP SURS CentraLSupport Team for an open Question and Answer Town Hall event designed for: 1) MIPS-eligible clinicians from solo and small practices with 15 or fewer clinicians. 2) Practice Managers and other staff tasked with submitting MIPS Data 3) Clinician stakeholders such as State and Medical Associations assisting small practices preparing to participate in MIPS. See this flyer to learn more. Two sessions of the presentation are being offered. Click the following date and time to register for the session you prefer. Tuesday, November 14, 11 am-Noon (Eastern) or
Thursday, November 16, 3:30-4:30 pm (Eastern)
Need help lowering your stress levels? Want to improve your work/life balance for a more ideal practice?
The annual GLMS Leadership Workshop is here to help you feel more comfortable and empowered in your practice. This exclusive event is open to GLMS members and/or their office managers only.
Information & Register Here
November 3, 2017
FREE Medicare Update Workshops for Small Practices
CGS is pleased to offer Small Practice Workshop in Louisville, Kentucky, on November 13, 2017. Please check here for details, dates/times, and links to register. Attendance is limited so register TODAY!
“Tackling the Challenges Facing Physicians Today” – Wednesday, November 15
The next LKCMGMA Program is Wednesday, November 15 at Hurstbourne Country Club. Lunch begins at 11:30. “Tackling the Challenges Facing Physicians Today” begins at Noon. Dr. Clive Fields, president of Village Family Practice, a Houston-based practice with a team of more than 40 clinicians that is recognized by CMS for its quality of care, will address the challenges physicians and practices face today, never thought of just five or ten years ago. Practice options must not only meet existing needs of physicians, but must address changes in patient care delivery systems. Six practice options that are available today will be examined, highlighting the pros and cons of each. This program is sponsored by
State Volunteer Mutual Insurance Company. For more information and to register: Click here.
CMS Finalizes Quality Payment Program Rule for Year 2 to Increase Flexibility and Reduce Burdens
On November 2, the Centers for Medicare and Medicaid Services (CMS) issued the final rule with comment for the second year of the Quality Payment Program (calendar year 2018), as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) as well as an interim final rule with comment.
CMS listened to feedback from the health care community and used it to inform policy making. As a result, the Year 2 final rule continues many of the flexibilities included in the transition year, while also preparing clinicians for a more robust program in Year 3. Quality Payment Program Information.
Register here to join CMS on November 14 for a public webinar on the Quality Payment Program Year 2 Final Rule with comment.
October 27, 2017
Practice Manager Discussion Forum November 1
The Managed Care Committee of LCKMGMA willing be hosting a Practice Management Discussion Forum to discuss current issues/trends affecting medical practices.
Wednesday, November 1
8:00 to 9:00 a.m. EST
The Eye Care Institute
1536 Story Avenue, Louisville, KY 40206.
RSVP to stephanie.woods@
FREE Medicare Update Workshops for Small Practices
CGS is pleased to offer Small Practice Workshop in Louisville, Kentucky, on November 13, 2017. Please check here for details, dates/times, and links to register. Attendance is limited so register TODAY!
Anthem Changes to Reimbursement Policies Effective January 1, 2018 - Anthem October 2017 Network Update - page 25
KY, OH, WI: Evaluation and Management Services and Related Modifiers -25 & -57
Beginning with claims processed on or after January 1, 2018, evaluation and management services that are eligible for separate reimbursement when reported by the same provider on the same day as a minor surgery (“0” or “10” day global period) will be reduced by 50%.
KY, MO, OH: Laboratory and Venipuncture Services
For claims processed on and after January 1, 2018, when routine venipuncture CPT code 36415 is reported with evaluation and management (E&M) office visit codes (99201-99205 and 99211-99215), it is included in the reimbursement for office visit E&M services and is not eligible for separate reimbursement.
October 19, 2017
Last Chance to RSVP for the October 26 GLMS Private Payer Roundtable
GLMS will be hosting its annual Private Payer Roundtable on Thursday, October 26 at 7:30 a.m. at the Foundation for a Healthy Kentucky with representatives from Anthem, Humana and United Healthcare. The purpose of this meeting is to facilitate dialogue between practices and payer representatives. Payer representatives will also be available immediately following the meeting to talk with attendees individually.
GLMS Private Payer Roundtable
October 26, 2017, 7:30 a.m. - 9:30 a.m.
Foundation for a Healthy Kentucky
1640 Lyndon Farm Court – Louisville, KY 40223
RSVP here by Monday October 23
CareSource Non-Renewal of Medicare Advantage Plans for 2018
As of Jan. 1, 2018, CareSource is exiting the Indiana and Kentucky Medicare Advantage markets. They will no longer offer their CareSource Medicare Advantage® plans in Indiana and Kentucky. These plans will end on December 31, 2017. In the next few months, CareSource Medicare Advantage members in Indiana and Kentucky will transition to other Medicare coverage. Because of this change, it is important to carefully check all patients’ ID cards and verify their eligibility before rendering services. As of Jan. 1, 2018, health partners should no longer accept CareSource Medicare Advantage member ID cards. See more information here.
Community Resources for Recovery Options from Metro Dept. of Health and Wellness
The Office of Addiction Services for Metro Louisville Department of Health and Wellness compiled a list of community organizations and resources to have at your practice’s disposal to refer patients needing
assistance. See the list here.
LCKMGMA Practice Manager Discussion Forum November 1
The Managed Care Committee of LCKMGMA willing be hosting a Practice Management Discussion Forum to discuss current issues/trends affecting medical practices.
Wednesday, November 1
8:00 to 9:00 a.m. EST ‘
The Eye Care Institute, 1536 Story Avenue, Louisville, KY 40206.
RSVP to stephanie.woods@ by Friday October 27.
2017 Medicaid Managed Care Forums
The Cabinet for Health and Family Services, in partnership with the managed care companies, once again is sponsoring forums across Kentucky in October and November 2017. For dates, locations, times and registration information, please refer to the MCO Forum Announcement.
Louisville MCO Forum Information Sheet
Monday, October 23, 2017
University of Louisville-Shelby Campus
450 North Whittington Parkway, Louisville, KY
Onsite Registration will begin Monday, October 23rd @ 8:00 a.m
October 13, 2017
Passport - Corrected Claims Need Original Claim Number
Passport Health Plan (Passport) has historically accepted corrected claims (electronic or paper) requiring only the frequency code. However, to help expedite the corrected claim processing and for providers to receive their reimbursement more timely, Passport will begin requiring all corrected claims to also have the original claim number.
Professional Claims (CMS 1500): Per industry standards, please include the appropriate frequency code “7” in Box 22 (loop and segment 2300 REF01) on the left-hand side. On the right-hand side, please also include the original claim number in Box 22 (loop and segment 2300 REF02). Institutional Claims (UB 04): Please include the frequency code in Box 4 (loop and segment 2300 REF01). Please also include the original claim number in Box 64 (loop and segment 2300 REF02). Effective immediately, all corrected claims must include the frequency code and the original claim number. Please be sure to follow the above instructions to avoid a denied claim.
“Marketing Your Practice 101” – Wednesday, October 18
The next LKCMGMA Program is Wednesday, October 18 at Hurstbourne Country Club. Lunch begins at 11:30, the annual Business Meeting is at 11:45 with the election of officers for 2017 – 2018. “Marketing Your Practice 101” will begin at Noon, presented by Jason Clark, CEO of VIA Studio, a digital agency in Louisville. Mr. Clark has won several advertising and design awards, including 2017 Judges Choice Award at the AAF Louies. This program is sponsored by Professionals' Insurance Agency, Inc. For more information and to register: Click here.
KY Performance Measures Alignment Committee Seeking Members
The Kentucky Department for Medicaid Services and Kentuckiana Health Collaborative is seeking individuals and organizations to participate in a public-private partnership in Kentucky to create a core healthcare measurement set that aligns the priorities of healthcare stakeholders across the Commonwealth. Members of the Kentucky Performance Measures Alignment Committee (PMAC) will create a core healthcare measurement set expected to be adopted by public and private organizations to better focus improvement efforts toward shared areas.
If interested in serving on PMAC, please complete the application at this link by Wednesday, October 26. Members will be chosen jointly by KHC and KMDS. November 3 is the PMAC kick-off call. More information may also be found at .
Last Chance to RSVP for the October 26 GLMS Private Payer Roundtable
GLMS will be hosting its annual Private Payer Roundtable on Thursday, October 26 at 7:30 a.m. at the Foundation for a Healthy Kentucky with representatives from Anthem, Humana and United Healthcare. The purpose of this meeting is to facilitate dialogue between practices and payer representatives. Payer representatives will also be available immediately following the meeting to talk with attendees individually.
GLMS Private Payer Roundtable
October 26, 2017, 7:30 a.m. - 9:30 a.m.
Foundation for a Healthy Kentucky
1640 Lyndon Farm Court – Louisville, KY 40223
RSVP here
September 28, 2017
Send issues and topics for Annual GLMS Private Payer Roundtable by October 6
GLMS will be hosting its annual Private Payer Roundtable on Thursday, October 26 at 7:30 a.m. at the Foundation for a Healthy Kentucky with representatives from Anthem, Humana and United Healthcare. The purpose of this meeting is to facilitate dialogue between practices and payer representatives. Payer representatives will also be available immediately following the meeting to talk with attendees individually.
To prepare for an effective meeting with the Insurance Company Representatives, we need your help collecting issues and topics for discussion before the meeting. Download the form below to submit questions or issues for discussion by Friday, October 6.
Save the Date - GLMS Private Payer Roundtable
October 26, 2017, 7:30 a.m. - 9:30 a.m.
Foundation for a Healthy Kentucky
1640 Lyndon Farm Court – Louisville, KY 40223
Light breakfast will be provided
RSVP here
Submit questions/issues here
MIPS 90-day reporting period deadline: Oct. 2
Group practices and eligible clinicians (ECs) seeking to earn a bonus in the Merit-Based Incentive Payment System (MIPS) in 2019 have until Oct. 2 to begin reporting one or more quality measures, improvement activities, or Advancing Care Information measures for the minimum 90 consecutive days. Conversely, group practices and ECs have through the end of the calendar year to avoid a 4% MIPS penalty in 2019 by reporting at least one quality measure on one patient. MGMA encourages practice executives to protect their practice from a Medicare payment cut by reporting more than one measure as an insurance policy in case the group encounters any data submission issues or inaccuracies. For resources to help your practice successfully participate in MIPS, visit MACRA.
Anthem Imaging Program Level of Care Reviews
Beginning with dates of service on or after July 1, 2017
• When providers select a hospital-based outpatient facility as the level of care, a list of alternate
freestanding imaging centers will be made available. If providers still select the hospital-based
outpatient facility, they will be prompted to indicate the reason that this location is medically
necessary.
• If a request for a hospital-based level of care does not meet medical necessity criteria upon
review by a physician, the request will not be approved. We encourage you to discuss the
alternate sites with the member.
September 22, 2017
Attention Medicare Providers - Beneficiaries Enrolled in the Qualified Medicare Beneficiary (QMB) Program Cannot be Billed
The CGS Part B Provider Contact Center (PCC) has received an increase in telephone calls from providers about the Qualified Medicare Beneficiary (QMB) Program. The QMB Program is a State Medicaid Benefit that assists low-income Medicare beneficiaries with Medicare Part A and Part B premiums and cost sharing, including deductibles coinsurance and copays. Federal law prohibits Medicare providers from billing beneficiaries who are enrolled in the QMB program for Medicare Part A and Part B deductibles, coinsurance, or copayments. Read More.
CMS Reveals New Medicare Card Design
The new Medicare card contains a unique, randomly-assigned number that replaces the current Social Security-based number. See image here. CMS will begin mailing the new cards to people with Medicare benefits in April 2018 to meet the statutory deadline for replacing all existing Medicare cards by April 2019. CMS has assigned all people with Medicare Benefits a new, unique Medicare number, which contains a combination of numbers and uppercase letters. People with Medicare will receive a new Medicare card in the mail, and will be instructed to safely and securely destroy their current Medicare card and keep their new Medicare number confidential. Issuance of the new number will not change benefits that people with Medicare receive.
Healthcare providers and people with Medicare will be able to use secure look-up tools that allow quick access to the new Medicare numbers when needed. There will also be a 21-month transition period where doctors, healthcare providers, and suppliers will be able to use their current SSN-based Medicare Number or their new, unique Medicare number, to ease the transition.
This initiative takes important steps toward protecting the identities of people with Medicare. CMS is also working with healthcare providers to answer their questions and ensure that they have the information they need to make a successful transition to the new Medicare number. For more information, visit: newcard
UnitedHealthcare Revision to Consultation Codes Policy changing October 1
Effective for claims with dates of service on or after October 1, 2017, UnitedHealthcare will align with the Centers for Medicare & Medicaid Services (CMS) and will reimburse the appropriate evaluation and management (E/M) procedure code which describes the office visit, hospital care, nursing facility care, home service or domiciliary/rest home care reported in lieu of a consultation services procedure code. They will no longer reimburse consultation services represented by CPT codes 99241-99245 and 99251-99255. CMS and UnitedHealthcare conducted data analysis and found misuse of consultation codes for this population. For more information call 877-842-3210.
September 14, 2017
Reducing Medicare Audit Burden with Help from KMA
According to Medicare, more than $6.5 billion in claims are now tied up in pending appeals. The backlog, in part can be attributed to wide-spread and often aggressive audits by Medicare Administrative Contractors (MACs). KMA has successfully helped members appeal adverse audit decisions while bringing attention to audit tactics that sometimes don’t follow standard CPT coding guidelines or established Medicare or Medicaid regulations. Read More
CareSource Provider Education Forums
CareSource will be holding two provider education session on Oct. 13, 2017 at the LFPL Southwest Regional Library in Louisville. Humana CareSource Medicaid providers are invited to the morning session where they will be serving breakfast at 9:30 a.m. followed by a 90 minute Educational Forum to begin at 10:00 a.m. CareSource Medicare Advantage providers will be offered lunch at 12:30 and an Education Forum beginning at 1:00pm. If you have not yet done so, please take the opportunity to send an email to KYProviderEngagement@ reserve your spot at one of these sessions.
Kentucky Regional Extension Center Reminders
FINAL MIPS 90-DAY REPORTING PERIOD FOR 2017 STARTS OCTOBER 3
As the first performance year of the Centers for Medicare & Medicaid Services' (CMS) Quality Payment Program (QPP) moves into September, the last 90-day period for partial year reporting is approaching quickly. Clinicians who want to participate for a partial year and possibly earn a positive Medicare payment adjustment in 2019 need to begin taking steps now and prepare to capture data starting no later than October 3. (90 days left till year-end.) Kentucky Regional Extension Center is here to support your efforts. We provide: MACRA Individualized Assistance: We offer support to healthcare organizations and leaders that will help them assess the current opportunities under MACRA as well as other payment models, identify gaps in critical capabilities and develop an individualized plan to master the move to value-based care. Individualized assistance includes: in-person and remote education, in-depth gap analysis and action plan, ongoing support for improvement, and assistance with registration, data submission and attestation.
FREE QPP Support for Small, Rural, Underserved Practices
Through a CMS contract, Kentucky REC provides free, high-level assistance to eligible clinicians as they navigate participation in the Quality Payment Program. The newly established Quality Payment Program Resource Center™ is focused on supporting providers in small practices (15 or fewer Eligible Clinicians), especially those in rural or underserved areas. To sign up, go to and click Join Now! Once you have joined the Resource Center™ web portal, our expert QPP Advisors are available via live chat, email, or phone support during regular business hours to help you effectively use the resources and guidance available through our portal and help you understand MIPS reporting requirements.
September 8, 2017
MIPScast – FREE Tool to Estimate MIPS Score
MIPScast™, an interactive web-app designed to accurately estimate your MIPS final score, is now available for FREE for those signed up for the Quality Payment Program Resource Center . MIPScast™ is designed to easily import your actual practice data to calculate your points earned, and accurately estimate your Merit-based Incentive Payment System, or MIPS, Final Score under the Centers for Medicare & Medicaid Services’ Quality Payment Program (QPP). MIPScast™ provides simple score comparisons so you can pick the quality measures, specialty set, and reporting methods that yield the highest scores across all MIPS categories, allowing you to prioritize your quality improvement efforts.
If you are a small practice (15 or fewer clinicians) that provides Medicare Part B services, you can get started using MIPScast™ for free by becoming a member of the Quality Payment Program Resource Center™. Go to and click Join Now to register or Login if you are already a member. After you have gone through the steps of creating your practice profile and viewed the educational materials, you will complete your Readiness Assessment and then have access to MIPScast™ along with all of our other helpful tools and resources. Call 859-323-3090 with questions or for further information.
Kentuckiana Health Collaborative announces HealthDoers Network: The “Facebook” of Health Improvement
A new initiative by the Network for Regional Healthcare Improvement (NRHI) has developed a platform for those working in community health and healthcare to share articles, experts and initiatives from across the country. The HealthDoers Network online and in-person offerings are designed to rapidly identify and spread what works, foster meaningful connections, and incorporate feedback to set priorities in community healthcare. If you would like to learn more about HealthDoers, call the Kentuckiana Health Collaborative at 502-238-3603.
Submit Items for Discussion for the Annual GLMS Private Payer Roundtable
GLMS will be hosting its annual Private Payer Roundtable on Thursday, October 26 at 7:30 a.m. at the Foundation for a Healthy Kentucky with representatives from Anthem, Humana and United Healthcare. The purpose of this meeting is to facilitate dialogue between practices and payer representatives. Payer representatives will also be available immediately following the meeting to talk with attendees individually.
To prepare for an effective meeting with the Insurance Company Representatives, we need your help collecting issues and topics for discussion before the meeting. Download the form below to submit questions or issues for discussion by Friday, October 6.
Save the Date - GLMS Private Payer Roundtable
October 26, 2017, 7:30 a.m. - 9:30 a.m.
Foundation for a Healthy Kentucky
1640 Lyndon Farm Court – Louisville, KY 40223
Light breakfast will be provided
RSVP here
Submit questions/Issues here
September 1, 2017
CMS Issues a Correction to a Previous Explanation of Special Status Under MIPS
On Friday August 4th, CMS issued a correction of a previously released explanation of special status email. In this correction, CMS points out that the initial post might lead to confusion regarding reporting requirements for Year 1 of MIPS. Please make sure that you verify eligibility and reporting requirements by visiting The Quality Payment Program Website or call CMS at 859-323-3090.
Explanation of Special Status Calculation – Correction
On July 24, the Centers for Medicare & Medicaid Services (CMS) distributed an email update with an explanation for its special status calculation for the Quality Payment Program. The message incorrectly stated that clinicians considered to have “special status” would be exempt from the Quality Payment Program.
Special status affects the number of total measures, activities, or entire categories that an individual clinician or group must report. Individual clinicians or groups with special status are not exempt from the Quality Payment Program because of their special status determination.
To determine if a clinician’s participation should be considered special status under the Quality Payment Program, CMS retrieves and analyzes Medicare Part B claims data. Calculations are run to indicate a circumstance of the clinician’s practice for which special rules would apply. These circumstances are applicable for clinicians in: Health Professional Shortage Area (HPSA), rural, non-patient facing, hospital-based, and small practices.
August 25, 2017
MIPS 2017 ACI Hardship Exception Application Now Available
The 2017 hardship exception application for the Advancing Care Information (ACI) category of the Merit-Based incentive Payment System (MIPS) is now available. Eligible clinicians (ECs) and groups may submit these applications to have their ACI score weighted to 0% of their final MIPS score for one of the following reasons:
• Insufficient internet connectivity
• Extreme and uncontrollable circumstances
• Lack of control over the availability of CEHRT
Certain MIPS ECs are exempt from ACI or will have their ACI scores reweighted to zero automatically and do not need to submit a hardship exception application. For more information on MIPS exceptions and exclusions, access this resource.
As a reminder, clinicians who are transitioning to MIPS in 2017 and never participated in Meaningful Use before may apply for a one-time hardship exception from 2016 Meaningful Use requirements and potentially avoid a 2018 payment adjustment. Applications are due by Oct. 1, 2017 and instructions are available from CMS.
Submit Items for Discussion for the Annual GLMS Private Payer Roundtable
GLMS will be hosting its annual Private Payer Roundtable on Thursday, October 26 at 7:30 a.m. at the Foundation for a Healthy Kentucky with representatives from Anthem, Humana and United Healthcare. The purpose of this meeting is to facilitate dialogue between practices and payer representatives. Payer representatives will also be available immediately following the meeting to talk with attendees individually.
To prepare for an effective meeting with the Insurance Company Representatives, we need your help collecting issues and topics for discussion before the meeting. Download the form below to submit questions or issues for discussion by Friday, October 6.
Save the Date - GLMS Private Payer Roundtable
October 26, 2017, 7:30 a.m. - 9:30 a.m.
Foundation for a Healthy Kentucky
1640 Lyndon Farm Court – Louisville, KY 40223
Light breakfast will be provided
RSVP here
Submit questions/issues here
GLMS News is now The Fleur-De-Lis Connection
GLMS is proud to present our newest publication, The Fleur-De-Lis Connection. Read the August Issue Here. This digital newsletter is sent to all GLMS members, practice managers and other health care professionals. Be sure to check your spam folder in the event the newsletter is landing there. Please let us know if you are not receiving this important and current information by contacting McKenna Byerley, PR & Membership Specialist at 502.736.6362 or mckenna.byerley@
August 18, 2017
Last Chance to Register! Compliance UNcomplicated
• Are you and your team current on your annual compliance?
• Do some of your employees need to complete their CPR renewal?
• Did you know there are new workplace safety requirements?
Bring your team members with you and split off into various sessions to maximize your training - choose from the following sessions: CPR Renewal, OSHA, HIPAA Compliance, Cybersecurity, OIG Compliance, and HR Requirements
When - Thursday, August 24, 2017 5:30 to 8:30 pm (Registration begins at 4:30pm)
Where - Louisville Marriott East, 1903 Embassy Square Boulevard.
Cost - $35 per person. Register Here
Corrected from Last Week - Passport Provider Workshops: Training on New Claims Systems
Passport Health Plan (Passport) holds annual provider workshops to educate providers on Medicaid processes, procedures and more. This year, Passport’s workshops will be dedicated to training on the new claims system, provider portal and electronic remittance advice (ERA)/. electronic fund transfer (EFT). Passport and Evolent Health have partnered to integrate clinical and administrative capabilities to improve Passport’s ability to conduct business in Kentucky on a single, scalable platform.
• Training opportunities in the Louisville area include:
Friday, September 22, Monday, September 25 or Wednesday, September 27
Norton Suburban Hospital, Plaza 1; 4001 Dutchman’s Ln, St. Matthews, KY 40207. The training sessions will be held from 10:00 to 1:00 p.m. EDT and will include lunch
• Corrected email address -providerinquiries@
To register, select a date above then email providerinquiries@ or go to the Educational Resources section of Passport’s website then click on Provider Workshops. For questions about the 2017 Provider Workshops, please call Provider Services, 800-578-0775 or contact your provider relations specialist.
MGMA Reports CMS Plans to Cancel Mandatory Payment Models; back CJR
This week, MGMA reported that CMS issued a proposed rule that would cancel planned implementation of mandatory Episode Payment Models and the Cardiac Rehabilitation Incentive payment model, which were both scheduled to begin Jan. 1, 2018. The same rule would also scale back the Comprehensive Care for Joint Replacement Model (CJR) by cutting the number of mandatory participating geographic areas in half (from 67 to 34) and making participation voluntary, rather than compulsory, in the remaining 33 locations and for low-volume and rural hospitals. In the accompanying press release, the administration reaffirmed its preference for voluntary over mandatory payment models. Public comments will be accepted by the agency until Oct. 16.
August 10, 2017
Upcoming 2017 Passport Provider Workshops: Training on New Claims Systems
Passport Health Plan (Passport) holds annual provider workshops to educate providers on Medicaid processes, procedures and more. This year, Passport’s workshops will be dedicated to training on the new claims system, provider portal and electronic remittance advice (ERA)/. electronic fund transfer (EFT). Passport and Evolent Health have partnered to integrate clinical and administrative capabilities to improve Passport’s ability to conduct business in Kentucky on a single, scalable platform.
Training opportunities in the Louisville area include:
Friday, September 22, Monday, September 25 or Wednesday, September 27
Norton Suburban Hospital, Plaza 1; 4001 Dutchman’s Ln, St. Matthews, KY 40207.
The training sessions will be held from 10:00 to 1:00 p.m. EDT and will include lunch. If you are unable to attend any of these dates, training webinars will also be offered on Tuesday, September 19 and Tuesday September 26, both at 2:00 EDT. Please be on the lookout for more details.
To register, select a date above then email providerinquiries@ or go to the Educational Resources section of Passport’s website then click on Provider Workshops. For questions about the 2017 Provider Workshops, please call Provider Services, 800-578-0775 or contact your provider relations specialist.
United Healthcare Commercial Reimbursement Policies and Notice Regarding Claim Projects for Code 96160
CPT codes 96160 and 96161 became new codes on Jan. 1, 2017. At the time, the Centers for Medicare & Medicaid Services (CMS) developed bundling edits for these services in the National Correct Coding Initiative (NCCI), and UnitedHealthcare aligned with these changes on Feb. 11, 2017.
When CMS decided to reverse the NCCI edits retroactive back to the beginning of 2017 and develop different editing relationships (add-on code), UnitedHealthcare made revisions on May 20, 2017. Claims projects are being run to overturn applicable rebundling denials for code 96160 for claims processed from Feb. 11, 2017 to May 20, 2017. Code 96160 (administration of patient-focused health risk assessment instrument with scoring and documentation, per standardized instrument) may still be subject to other reimbursement policy edits, coverage and/or benefit determinations.
UnitedHealthcare Commercial Plan claims will not be overturned for code 96161 (administration of caregiver-focused health risk assessment instrument for the benefit of the patient, with scoring and documentation, per standardized instrument).UnitedHealthcare Commercial Plans do not provide reimbursement for the evaluation or treatment of a caregiver or family member of the person covered under the commercial policy. Read UHC's August Network Bulletin.
August 4, 2017
News from CMS: 2017 Quality Payment Program Hardship Exception Application Open/
Presentations from Quality Payment Program Webinars/CMS Office Hours Webinar
The Quality Payment Program Hardship Exception Application for the 2017 Transition Year is now available on the Quality Payment Program website. MIPS eligible clinicians and groups may qualify for a reweighting of their Advancing Care Information performance category score to 0% of the final score, and can submit a hardship exception application, for one of the following specified reasons: 1) Insufficient internet connectivity. 2) Extreme and uncontrollable circumstances. 3) Lack of control over the availability of Certified EHR Technology (CEHRT).
There are some MIPS eligible clinicians who are considered Special Status, who will be automatically reweighted (or, exempted in the case of MIPS eligible clinicians participating in a MIPS APM) and do not need to submit a Quality Payment Program Hardship Exception Application. In addition to submitting an application through the website, clinicians may also contact the Quality Payment Program Service Center and work with a representative to verbally submit an application. Visit the Quality Payment Program website for more information. You may also contact the Quality Payment Service Center at 1-866-288-8292 or TTY: 1-877-715-6222 or QPP@cms..
New Pharmacy PA Request Forms Available for Passport Health Plan
As a part of Passport Health Plan’s efforts to provide members with access to high quality, cost-effective
care, they have created new, easier-to-use prior authorization (PA)Forms. Please continue to request PAs, formulary exception, or appeal for Passport members using the following phone and fax numbers:
Phone: 844-380-8831/Fax: 844-802-1406. As a reminder, there are two Universal Forms (general request and substance abuse treatment using buprenorphine products) available for use in addition to drug-specific forms. To provide more complete information to review PA requests, please use the drug-specific PA forms which have been categorized by specialty or non-specialty drug status. Effective immediately, please submit PAs using the new forms, which outline required information needed to process a request for the members. Please note: Existing prior authorization forms will continue to be accepted. For questions regarding this change, please contact Provider Services, 800-578-0775, or your provider relations specialist.
July 28, 2017
FREE Macra Webinar – August 10, 2017 at Noon
CMS recently released a notice of proposed rule-making (NPRM) for program changes to the Quality Payment Program under MACRA (Medicare Access and CHIP Reauthorization Act of 2015). The federal register version is over 1000 pages and there are some significant changes. Most of these changes will affect Year 2 of the Quality Payment Program, not the current Year 1 requirements.
Join The Kentucky Regional Extension Center on August 10th at Noon (EST) for a FREE webinar which will discuss the new NPRM and changes to the Quality Payment Program that will affect your organization. Register Here.
Upcoming GLMS IIRC Meetings with payers
Humana on August 7 & Anthem on August 10. We meet quarterly with payers to discuss issues that are reported to us from practices such as yours. If you have any issue that needs to be addressed with Humana, contact physician.education@ or call 502-736-6350 by Wednesday, August 2.
Long Hold Times with Payers?
Click here for a form to track hold times with payers. Send your competed form to GLMS (mary.hess@) and we can help identify the source of the recent surge in hold time issues.
Don’t Miss LCKMGMA Annual Planning Meeting August 16!
LCKMGMA will hold a planning meeting on Wednesday, August 16 from 8:30 to 11:30 at Hurstbourne Country Club to discuss all programs for the coming year. FREE breakfast, goodie bags and no meeting fee! All members are encouraged to attend. Everyone’s input is needed to plan an interesting, informative and fun year for 2018. RSVP by Wednesday, August 9 to larahuff@.
If you can’t attend, please email any ideas for topics, speaks, meals, etc. to Lara also. Donations are needed for Goody Bag items. If you have items (40 each) that you would like to donate to promote your business or practice, contact Cheri McGuire at 502.736.6336 or cheri.mcguire@. Donations are needed by August 9. Click here for complete information.
GLMS News is now The Fleur-De-Lis Connection
GLMS is proud to present our newest publication, The Fleur-De-Lis Connection. Read the July Issue Here. This digital newsletter is sent to all GLMS members, practice managers and other health care professionals. Be sure to check your spam folder in the event the newsletter is landing there. Please let us know if you are not receiving this important and current information by contacting McKenna Byerley, PR & Membership Specialist at 502.736.6362 or mckenna.byerley@
July 20, 2017
LCKMGMA Wants to unCOMPlicate Compliance for your Practice
The Louisville Chapter of KMGMA is hosting a compliance symposium on Thursday, August 24, 2017 at the Louisville Marriott East, 1903 Embassy Square Boulevard from 5:30 to 8:30 p.m. Cost is $35 per person. Heavy hors d’oeuvres and soft drinks will be provided. Attendees can choose from the following sessions: CPR Renewal, OSHA, HIPAA Compliance, Cybersecurity, OIG Compliance, and HR Requirements. For further information: Symposium Flyer or Register Here.
KMA Annual Meeting – Helping Physicians Meet the Mandates for CME Credit for HB 1
KMA’s 2017 Annual Meeting and Meet the Mandates Educational offering is scheduled for August 25 through 27, 2017 at the Hyatt Regency Louisville at 311 South Fourth Street.
• Earn CME Credit in the KMA Meet the Mandates Educational Session-This activity is approved to meet the 4.5 hour HB1 requirement, the Domestic Violence requirement and the Pediatric Abusive Head Trauma requirement.
• Earn CME Credit at Leadership in Action: Take the Lead in Solving the Opioid Epidemic. This activity is approved to meet the 4.5 hour HB1 requirement.
• Register Now
New Numbers for Patients Medicare Cards: Changes You May Need to Make
The Medicare Access and CHIP Reauthorization Act of 2015 requires CMS to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. CMS will begin mailing new Medicare cards with a new Medicare number (currently called the Medicare Claim Number on cards) to your patients in April 2018.
You may need to change your systems to:
• Accept the new Medicare number (Medicare Beneficiary Identifier or MBI). Use the MBI format specifications if you currently have edits on the current Health Insurance Claim Number (HICN).
• Identify your patients who qualify for Medicare under the Railroad Retirement Board (RRB). You will no longer be able to distinguish RRB patients by the number on the new Medicare card. You will be able to identify them by the RRB logo on their card, and we will return a message on the eligibility transaction response for a RRB patient. The message will say, “Railroad Retirement Medicare Beneficiary” in 271 Loop 2110C, Segment MSG. If you use the number only to identify your RRB patients beginning in April 2018, you must identify them differently to send Medicare claims to the RRB Specialty Medicare Administrative Contractor, Palmetto GBA.
• Update your practice management system’s patient numbers to automatically accept the new Medicare number or MBI from the remittance advice (835) transaction. Beginning in October 2018, through the transition period, CMS will return your patient’s MBI on every electronic remittance advice for claims you submit with a valid and active HICN. It will be in the same place you currently get the “changed HICN”: 835 Loop 2100, Segment NM1 (Corrected Patient/Insured Name), Field NM109 (Identification Code).
If you use vendors to bill Medicare, contact them if they haven’t already shared their new Medicare card system changes with you; they can also tell you how they will pass the new Medicare number to you. Visit the New Medicare Card Provider webpage for the latest information.
July 14, 2017
Medical Liability Reform Bill Passes House of Representatives
Last week, the House of Representatives passed the Protecting Access to Care Act of 2017 (H.R. 1215), which now advances to the Senate for consideration. The Medical Group Management Association (MGMA) encourages everyone to access their Contact Congress portal to urge your senator to take action to support medical liability reform legislation. H.R. 1215 would offer additional protections to physician practices against the threat of frivolous lawsuits by imposing certain limits on medical malpractice litigation, thereby helping to curb insurance premiums and ensure affordable access to healthcare services. The bill is estimated to cut federal healthcare spending by $44 billion and reduce the deficit by $50 billion in over a decade.
OCR FAQs on Section 1557 clarify language assistance requirements
The Office for Civil Rights (OCR) released FAQs on its final rule implementing Section 1557 of the Affordable Care Act that offer much needed clarification for covered medical group practices on language access requirements for individuals with limited English proficiency (LEP) stemming from a final rule implementing Section 1557 of the Affordable Care Act. Section 1557 builds on longstanding civil rights laws and provides additional nondiscrimination requirements for covered group practices, including posting taglines taglines alerting LEP individuals to the availability of language assistance services. Notably, the FAQs clarify that the phone number displayed on each tagline should be your group practice’s phone number. For more information about how to comply with Section 1557, download MGMA’s member resource entitled, “Section 1557: What Your Practice Needs to Know.”
UnitedHealthcare Medicare Solutions New Drug Testing Reimbursement Policy
United Healthcare will implement a new drug testing reimbursement policy for claims with a date of service on or after October 1, 2017. The policy applies to paper form CMS-1500 and Electronic Data interface (EDI) transaction 837P claim file. In accordance with Centers for Medicare & Medicaid Services (CMS) regulations and the CPT code description, the policy will only allow one Presumptive Drug Class procedure per drug class (codes 80305, 80306, and 80307) per member, per date of service, whether submitted by the same or different provider. The policy will also only allow one Definitive Drug Class procedure per drug class (codes G0480, G0481, G0482, G0483 and G0659) per member, per date of service, whether submitted by the same or different provider. Providers performing validity testing on urine specimens utilized for drug testing cannot separately bill for validity testing.
Upcoming Anthem Coding Education Webinar
Anthem Blue Cross and Blue Shield Medicaid invites all network providers, coders, billers, and practice managers to participate in upcoming coding education webinars on August 17, 24 or 31, 2017. Register online or contact kyproviderrelationsmedicaid@ to register.
Update all Insurance Payers with Availity Portal
Availity can assist any provider with keeping directories and practice information current. Availity works with most of the nation’s largest payers to pre-fill your information through their Directory Verification online forms. You can verify your information, fix any incorrect information and submit it to send to all insurance payers. You can then download a PDF report to send to other payers. For further information,
go to Availity Web Portal Reference Guide.
July 6, 2017
Changes to Passport Medicaid Claims Payment System and Provider Portal Effective October 1, 2017
Passport Health Plan (Passport) launched the Medicaid Center of Excellence in 2016 with its strategic partner Evolent Health. As a part of this continuous improvement toward value-based care in the delivery of Medicaid, Passport is making operational changes to enhance your experience with them. Beginning October 1, 2017, Passport will have a new claims payment system and provider portal.
No immediate action is required of you. In the coming weeks, however, you should expect additional communications from Passport. They will provide more information about the payment system migration, your new Passport provider ID, new address and/or payer ID for claims submissions, provider portal training opportunities and more. Claims submissions for Medicaid behavioral health, dental, vision and pharmacy services as well as Passport Advantage (Medicare) will not change.
Passport’s provider portal will also be changing. This provider portal account will allow you to check member eligibility, claims status, etc.
Individual Health Insurance Plans Offered by Only Two Companies in 2018
Kentucky Health News is reporting that Kentucky will be down to two participating health plan insurers in 2018: Anthem Health Plans of Kentucky, Inc. and CareSource Kentucky Co. Anthem will be the only insurer offering individual plans statewide and CareSource will offer exchange plans in 61 counties – leaving 54 of the state’s 120 counties with only one insurer.
The two companies are requesting rate increases averaging 27.5 percent; Anthem requested an increase of 34.1 percent for its 2018 individual polices and CareSource requested an increase of 20.8 percent. The rate requests reflect a base rate that will fluctuate with individual consumers based on their age, whether they smoke and where they live. Insurers offering small-group plans are asking for average hikes of almost 10 percent. Kentucky had 81,155 people enroll in coverage through its exchange during the 2017 open enrollment period. Open enrollment in for plan year 2018 begins November 1. The state Department of Insurance notes that all rates are subject to change and will be finalized by August 16.
New Comment Period for 1115 Medicaid Waiver Modifications ends August 2
A new 30-day comment period is in progress regarding Kentucky’s 1115 Medicaid Waiver Modifications.
Kentucky Voices for Health encourages all healthcare providers, Medicaid members, and other stakeholders to examine the proposed changes and to express any questions or concerns through the following channels:
Read the public notice and summary of proposed modifications.
Submit comments by August 2nd at 11:59 PM to kyhealth@.
Copy Kentucky Health News at kymedicaidchanges@, if you want your comments to
be shared with the public
Attend a public hearing and testify - July 14th in Somerset or July 17th, 10am-12pm ET, at the Capitol Annex: 702 Capital Ave, Frankfort
June 21, 2017
Proposed Rule by CMS for 2018 Medicare Quality Payment Program
CMS recently released a proposed rule for the 2018 Quality Payment Program. The proposal contains several provisions that address concerns raised by the AMA and other physician groups that will help minimize the number of physicians who face penalties under the program. Links to the proposed rule and a fact sheet follow:
For a fact sheet on the proposed rule, please visit:
The proposed rule (CMS-5522-P) can be downloaded from the Federal Register:
Proposed Rule Comment Period: The Quality Payment Program proposed rule (CMS-5522-P) was released on Tuesday, June 20. The 60-day comment period for the proposed rule ends on Monday, August 21.
Join CMS Webinar on Proposed Rule for Year 2 of the Quality Payment Program
On Monday, June 26 at 1:00 p.m. ET, the Centers for Medicare & Medicaid Services (CMS) will host an overview webinar on the Medicare Quality Payment Program Year 2 proposed rule. Join the webinar to hear CMS policy experts provide an overview of proposed participation requirements for the second year of the Quality Payment Program.
Webinar Details
Title: Medicare Quality Payment Program Year 2 Proposed Rule Overview
Date: Monday, June 26
Time: 1:00 – 2:30 p.m. ET
Register:
Please note:
+ Space for this webinar is limited. Register now to secure your spot. After you register, you will
receive a follow-up e-mail with step-by-step instructions about how to log-in to the webinar.
+ The audio portion of this webinar will be broadcast through the web. You can listen to the
presentation through your computer speakers. If you cannot hear audio through your computer
speakers, please contact CMSQualityTeam@.
+ There will a Q&A session if time allows. However, CMS must protect the rulemaking process
and comply with the Administrative Procedure Act. Participants are invited to share initial
comments or questions, but only comments formally submitted through the process outlined by
the Federal Register will be taken into consideration by CMS. See the proposed rule for
information on how to submit a comment.
June 13, 2017
Louisville Health Department Childhood Lead Poisoning Prevention Program
A toolkit has been created by Louisville Metro Public Health and Wellness Childhood Lead Poisoning Prevention Program with the goal of equipping area providers with the necessary tools and knowledge to effectively screen Jefferson County children for lead poisoning and to collaboratively follow through with any subsequent care. This toolkit’s intended audience is primary care providers and is designed with two primary components. The first component is designed to equip all area providers with lead specific guidance concerning identification of patients, determining when to screen, and follow-up actions for monitoring blood lead levels. The second component provides this guidance in easy to use tools to be utilized during an exam and educational material for parents or guardians to prevent lead exposure and how to reduce blood lead levels. Utilization of this toolkit will create a cohesive understanding of childhood lead poisoning, screening, monitoring, and prevention for primary care providers in the Louisville Metro area. Click on the title above to access the toolkit.
Reporting Neonatal Abstinence Syndrome (NAS)
Healthy Babies Louisville is working with the State to promote the change in the statewide practice of reporting Prenatal Substance Abuse. The statewide practice will include reporting ALL babies who are exposed to prenatal substance abuse, not just those with symptoms of NAS. Healthy Babies Louisville is sharing the information on this change and, also providing training opportunities to well-woman/pre-natal care providers on how to screen respectfully for substance abuse BEFORE pregnancy and/or BEFORE birth to increase the opportunity to seek treatment, reduce NAS, and keep families together.
They are working on a CME opportunity in the fall to assist providers in screening and referral before birth. The Schedule of upcoming Advisory Board Meetings is below and they invite any practitioners who would like to participate:
RSVP to pihn@ or 502-574-6520
July 20, 2017 4:30PM
October 24, 2017 7:30am
January 23, 2018 7:30am
April 24, 2018 7:30am
Select the link for more information on the KRS law regarding hospital Neonatal abstinence screening and reporting: KY Department of Public Health NAS Guidance Document
Tomorrow - Practice Manager Discussion Forum (LCKMGMA Managed Care Committee
This month we will be discussing current issues with payers. Hope to see you in the morning!
June LCKMGMA Practice Management Discussion Forum – Current Issues
Wednesday, June 14, 2017 8:00 a.m. – 9:00 a.m.
Location: GLMS, 328 E Main St Louisville, KY 40202
Open to all active Louisville Chapter KMGMA members / RSVP to Stephanie.woods@
June 5, 2017
Center for Clinical Standards and Quality: Antibiotic Stewardship in Outpatient Setting is Everyone’s Responsibility
Antibiotic resistance is a serious health issue leading to infections that do not respond to antibiotic medications. Antimicrobial stewardship programs are being implemented worldwide, because they are effective in optimizing antimicrobial therapy, and improving patient safety and quality of care. The Centers for Medicare & Medicaid Services (CMS) Quality Innovation Network Quality Improvement organizations (QIN-QIO) is employing a community-based antibiotic stewardship program designed to assist facilities in monitoring and optimizing the use of antibiotics using a multidisciplinary team and strategic approach, based on established guidelines. Additional information on the QIN-QIO program is available at:
Medicare Requirements for Providers Submitting Automatic External Defibrillators (AED) Claims
Providers, both physicians and non-physician practitioners must follow Medicare requirements when
submitting claims for Automatic External Defibrillators:
Before Delivery of the AED, examine the beneficiary in-person within six months prior to the
date of the written order.
Document that the beneficiary was evaluated and/or treated for a condition that supports the need for the AED.
Sign and date the order. As of November 10, 2015, physicians are not required to co-sign face-to-face encounters performed by non-physician practitioners.
For Further Information:
July 2016 Issue of the Medicare Quarterly Provider Compliance Newsletter, pages 1-3
Local Medicare Coverage Policy Articles Effective October 2015 for AEDs
Medicare Program Integrity Manual, Chapter 5
They Drive Me Crazy! The Millennial Story You HAVEN'T Heard-June LCKMGMA Meeting
This month Leah Brown, talent retention strategist for Crescendo Strategies, Louisville, Kentucky will present a program on Millennials in the workforce and revamping traditional business principles for improving management effectiveness in order to reduce unnecessary employee turnover, particularly among the youngest generation in an organization.
Wednesday, June 21, 11:45 to 1:30 p.m.
Hurstbourne Country Club, 9000 Hurstbourne Club Lane, Louisville, Kentucky 40222,
Register online at by 06/16/2017
PLEASE EMAIL larahuff@ FOR MORE INFORMATION
The GLMS News Includes A Monthly Report by Your PEPS Team – Read the May Issue Here
The GLMS News is a monthly digital newsletter sent to all GLMS members, practice managers and other health care professionals. Be sure to check your spam folder in the event the newsletter is landing there. Please let us know if you are not receiving this important and current information by contacting McKenna Byerley, PR & Membership Specialist at 502.736.6362 or mckenna.byerley@
May 15, 2017
Anthem Medicaid Webinars - Claim edits for Ordering, Referring, Prescribing and Attending Providers
Anthem Blue Cross and Blue Shield Medicaid (Anthem) cordially invites a representative from your office to attend one of the following webinars. Anthem staff will provide additional education and billing guidance on the Ordering, Referring, Prescribing and Attending Provider claim edits.
Click here for information on registering:
May 16, 2017 May 16, 2017 May 17, 2017 May 17, 2017
11:30 a.m.-12:30 p.m. 2 p.m.-3 p.m. 11:30 a.m.-12:30 p.m. 2 p.m.-3 p.m. ET
Unsure of your participation status in the Merit-based Incentive Payment System (MIPS)?
Clinicians can now use an interactive tool on the CMS Quality Payment Program website to determine if they should participate in the MIPS track of the Quality Payment Program in 2017.
To determine your status, enter your national provider identifier (NPI) into the entry field on the tool which can be found on the Quality Payment Program website at . Information will then be provided on whether or not you should participate in MIPS this year and where to find resources.
If you are new to Medicare in 2017, you do not participate in MIPS. You may also be exempt if you qualify for one of the special rules for certain types of clinicians, or are participating in an Advanced Alternative Payment Model (APM). To learn more, review the MIPS Participation Fact Sheet. If you are not in the program in 2017, you can participate voluntarily and you will not be subject to payment adjustments.
Participation Notification Letters – CMS recently sent letters in the mail notifying clinicians of their MIPS participation status. See a sample of the letter (zip) on the Education page of . This tool is another resource for clinicians to use to determine their status.
Switch out your ABN forms now to avoid technical noncompliance later! (Message from Kathie McDonald-McClure, Wyatt, Tarrant & Combs)
The Centers for Medicare and Medicaid Services (CMS) recently announced the Office of Management and Budget's approval in March 2017 of the Advance Beneficiary Notice (ABN) (Form CMS-R-131) for another 3 years. Even though the only change to the form is a new expiration date of March 2020, CMS cautioned that, starting June 21, 2017, providers "must use the most recent version of the CMS-R-131 to deliver a valid ABN." A link to Wyatt's client alert found here provides more detail on the upcoming changes and how you can avoid technical noncompliance.
May 9, 2017
Tomorrow - Practice Manager Discussion Forum on Antibiotic Use
“Antibiotics are among the most commonly prescribed drugs and save millions of lives each year. However, widespread, long-term use has led to an alarming rise in antibiotic-resistant bacteria that, in the U.S. alone, cause 2 million illnesses and 23,000 deaths each year. The Centers for Disease Control and Prevention (CDC) and the World Health Organization have declared antibiotic resistance to be one of the most serious national and global health problems (PAC).” Please join the LCKMGMA Practice Manager Discussion Forum on May 10 from 8:00 to 9:00am EST to hear Mary Bardin, Quality Improvement Advisor for Qsource, present on the topic of Antibiotic Stewardship. She will be providing an overview on antibiotic use, the CDC’s Four Core Elements of Antibiotic Stewardship, and assistance available to outpatient providers in combatting antibiotic-resistant bacteria and improving patient outcomes. This assistance is aligned with a national CMS focus undertaken by each state's Quality Improvement Organization. Location: GLMS, 328 E Main St, Louisville, KY 40202
Open to all active Louisville Chapter KMGMA members / RSVP to Stephanie.woods@
The Wear the White Coat Experience shared on KET!
The 2016 Wear the White Coat Experience was a special one. 25 Physicians and 25 Louisville leaders were partnered to share a day of medical practice. And, this time, a KET film crew came along for the ride. GLMS proudly presents videos from two Wear the White Coat Experiences that allow a behind the scenes look for primary and emergency care. Click here to watch
UnitedHealthcare Provider Information Expo - Space is limited so register today if you have not already done so
Please join us for our free Provider Information Expo on Thursday, June 8th, 2017 to meet with UnitedHealthcare representatives and hear the latest information about our products, resources and services.
FREE! No cost to attend
Registration from 8:15 a.m. to 8:45 am. Come when it’s convenient for you or spend the entire day!
Multiple sessions on different topics—check out those most applicable to your practice
Expert staff from Link, Direct Connect, UHC OnAir, Provider Data Attestation (My Practice Profile), EDI, Premium Designation, Star Quality, UMR, UHC Network Contracting, Sales, UHC Payment Integrity and Prior Authorizations.
Additional exhibitors include the Kentucky Medical Group Management Association (KYMGMA) and the Greater Louisville Medical Society (GLMS).
Door prize entry when you visit all stations
kentucky country day (kcd)
4100 Springdale road
louisville, ky 40241
You can register either electronically or by fax. Click on or type in the link below to register electronically. If you choose to fax in your registration, please complete the form on the following two pages and fax it in to the number listed.
April 25, 2017
A Monthly Report by Your PEPS Team
The April GLMS News includes a new series for practice managers to stay up to date on issues discussed at Insurance Issues Resolution Committees and other items of interest from the GLMS Physician Education and Practice Support Department. View the April issue here. The GLMS News is the monthly digital newsletter which is emailed to all GLMS members, practice managers and other health care professionals. Be sure to check your spam folder in the event the newsletter is landing there. Please let us know if you are not receiving this important and current information by contacting McKenna Byerley, PR & Membership Specialist at 502.736.6362 or mckenna.byerley@
Insurance verification form for time spent on the phone
Over the years, some insurance hassles come and go in waves. In the past several months, we have heard an increase in hold times with Anthem. Attached is a form created by our Anthem IIRC LCKMGMA representative to track these hold times wo we can report back to Anthem with more concrete data. Hopefully this will help them to identify the source of the recent surge in issues. If you could have your team fill this out for any Anthem phone calls and return it to Stephanie.woods@, that would be great. You can send it to us weekly or monthly if you prefer.
LCKMGMA Managed Care Committee Practice Manager Discussion Forum – May 10
This month we will have a guest speaker from Qsource discussing Antibiotic Stewardship – “Antibiotics are among the most commonly prescribed drugs and save millions of lives each year. However, widespread, long-term use has led to an alarming rise in antibiotic-resistant bacteria that, in the U.S. alone, cause 2 million illnesses and 23,000 deaths each year. The Centers for Disease Control and Prevention (CDC) and the World Health Organization have declared antibiotic resistance to be one of the most serious national and global health problems (PAC).” Please join the LCKMGMA Practice Manager Discussion Forum on May 10 from 8:00 to 9:00am EST to hear Mary Bardin, Quality Improvement Advisor for Qsource, present on the topic of Antibiotic Stewardship. She will be providing an overview on antibiotic use, the CDC’s Four Core Elements of Antibiotic Stewardship, and assistance available to outpatient providers in combatting antibiotic-resistant bacteria and improving patient outcomes. This assistance is aligned with a national CMS focus undertaken by each state's Quality Improvement Organization.
Wed, May 10,2017 / 8:00 a.m. – 9:00 a.m. / Location: GLMS, 328 E Main St, Louisville, KY 40202
Open to all active Louisville Chapter KMGMA members / RSVP to mary.hess@
National Prescription Drug Take Back Day - April 29
Do you know the expiration dates of the medicines that have been piling up in your kitchen cabinet? If not, you might want to check those dates and throw away old medicine as part of the National Prescription Drug Take Back Day Saturday, April 29. The Kentucky State Police are partnering with the U.S. Drug Enforcement Agency to not only encourage citizens to remove potentially dangerous medicines from their homes, but to also dispose of them safely. This year, KSP has again set up 16 locations throughout Kentucky to serve as collection points for the safe, convenient and responsible disposal of unused or expired prescription drugs. For a list of locations click here. Collection activities will take place from 10:00 a.m. through 2:00 p.m. on Saturday, April 29. For more information about the ‘Take Back’ program, contact KSP at 502-782-1780 or visit the DEA website.
April 11, 2017
TOMORROW - LCKMGMA Practice Manager Discussion Forum
Wed, April 12, 2017 / 8:00 a.m. – 9:00 a.m.
Location: GLMS -New Office, 328 E Main St Louisville, KY 40202
Purpose: For managers to discuss current issues and trends affecting your practice. Open to all active Louisville Chapter KMGMA members
Parking: Please note the location for the meeting will be the new GLMS office at 328 E. Main St. There are plenty of metered parking spaces on Main Street and Preston Street that are free until 10am.
RSVP today to Stephanie.woods@ or 502-736-6350
MGMA - New CMS remittance advice resources available
CMS is offering remittance advice (RA) resources and supporting software. RAs give explanations and guidance as to why a payment was or was not made, or if the payment differs from what the practice submitted. The electronic RA (ERA) conveys itemized information for each claim and/or line and Medicare Administrative Contractors can automatically post an ERA file created by Medicare to the practice’s accounts receivable system. Once the ERA is in place, the payment posting process is more efficient and accurate. Medicare provides free downloadable translator software (Remit Easy Print) that can read ERAs and print RAs. This free software enables practices to store, view, export, and print RAs, thus eliminating the need to file a separate request or await mail delivery of paper RAs. Access additional information regarding RA and the CMS Remit Easy Print software.
Redesigned PCMH Recognition
The National Committee for Quality Assurance (NCQA) has introduced a new version of its Patient-Centered Medical Home (PCMH) Recognition program. The streamlined program includes a new process that reduces paperwork and requirements that allow primary care practices to focus more on providing strong, patient-centered care.
Medicaid Issues Needed for Roundtable
The 2017 GLMS Medicaid Roundtable will be held on Thursday, April 20, 2017 beginning at 7:30 a.m. at the Foundation for a Health Kentucky,1640 Lyndon Farm Court, Louisville KY 40223. This roundtable provides an opportunity for medical practices to speak to Medicaid representatives, ask questions and hear what other practices are experiencing with Medicaid in Kentucky. Representatives from Aetna Better Health, Anthem Medicaid, Humana CareSource, Passport Health Plan, WellCare and the Kentucky Department for Medicaid Services have been invited to participate in this forum.
Send issues today -submitting issues* in advance enables the payers to investigate concerns to prepare responses in preparation for the meeting. Download the issue form here. RSVP Here
Office Manager/Administrators
Are you receiving the GLMS News electronic monthly newsletter? If not, contact mckenna.byerley@. View the March issue here.
April 5, 2017
Learn about your required Security Risk Analysis. Stay compliant!
Join the Kentucky REC for a discussion on the HIPAA Security Rule basics and best practices on April 11th at 12:00 PM EST. Learn More Here. We will cover tips, tools, and tactics for implementing thorough compliance in 2017
Kentucky lawmakers have passed several health-related bills to deal with the opioid epidemic, and could pass several more (Kentucky Health News)
The 2017 General Assembly has passed several bills meant to put more "tools in the toolbox" as the state works to combat its growing opioid epidemic. And several more are in the pipeline to pass when lawmakers come back March 29 and 30. Those two days are provided to reconsider any bills Gov. Matt Bevin vetoes, but legislation in the pipeline can also get initial passage. It would be subject to a veto without the opportunity for an override. Read More about the bills here.
Visit the Educational Resources Page for New Materials on the Quality Payment Program
The Centers for Medicare & Medicaid Services (CMS) recently posted new resources to the Quality Payment Program website to help clinicians successfully participate in the first year of the Quality Payment Program.
CMS encourages these clinicians to visit the website to review the new materials and information, including:
MIPS Measures for Cardiologists– This brand new resource provides a non-exhaustive sample of measures for Quality, Advancing Care Information, and Improvement Activities that may apply to cardiologists participating in MIPS.
Alternative Payment Models (APMs) in the Quality Payment Program– Includes a comprehensive list of all APMs operated by CMS, including Advanced APMs and MIPS APMs for the Quality Payment Program.
Support for Small Practices– Contains contact information for the local, experienced organizations that will help clinicians in small and rural practices participate in the Quality Payment Program.
4TH Annual GLMS Medicaid Roundtable April 20th
The 2017 GLMS Medicaid Roundtable will be held on Thursday, April 20, 2017 beginning at 7:30 a.m. at the Foundation for a Health Kentucky,1640 Lyndon Farm Court, Louisville KY 40223. This roundtable provides an opportunity for medical practices to speak to Medicaid representatives, ask questions and hear what other practices are experiencing with Medicaid in Kentucky. Representatives from Aetna Better Health, Anthem Medicaid, Humana CareSource, Passport Health Plan, WellCare and the Kentucky Department for Medicaid Services have been invited to participate in this forum. Submitting issues* in advance enables the payers to investigate concerns to prepare responses in preparation for the meeting. Download the issue form here. RSVP Here
Office Manager/Administrators – are you receiving the GLMS News electronic monthly newsletter?
If not, contact mckenna.byerley@. View the March issue here.
March 28, 2017
Office Manager/Administrators – are you receiving the GLMS News electronic monthly newsletter? If not, contact mckenna.byerley@. View the March issue here.
Data Collection Required by MACRA to Accurately Value Global Packages
CMS finalized a strategy to collect data needed to value global surgical services. Providers in Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon and Rhode Island will be required, beginning July 1, 2017, to report claims showing that a visit occurred during the post-operative period for select global services.
Practitioners in settings with fewer than 10 providers may participate but will not be required to do so.
Reporting will apply to specific high-volume/high-cost services
Visits reported using CPT code 99024
CMS will also survey providers on the services furnished during the post-op period. More information is available here.
CGS to send Letters to providers about (QPP) Quality Payment Program Eligibility
For 2017, QPP applies to providers that are in an Advanced APM or providers that bill Medicare more than $30,000 a year AND provide care for more than 100 Medicare patients a year (both minimum billing and the number of patients must be met to be in the program. CGS will be sending letters to each individual Tax ID number that will identify which NPI’s in their group are eligible to report in the MIPS program or APM.
Banking Fraud Prevention, Speaker: Nick Volz, Business Relationship Manager, Chase
LCKMGMA Meeting
Wednesday, April 19, 2017
11:45am-1:00pm
Hurstbourne Country Club
Registration begins at 11:30 A.M.; Luncheon & Announcements begin at 11:45 A.M. Program will begin at Noon
RSVPS ARE DUE 04/14/2017. Register online here.
PLEASE EMAIL larahuff@ FOR MORE INFORMATION
4TH Annual GLMS Medicaid Roundtable April 20th
The 2017 GLMS Medicaid Roundtable will be held on Thursday, April 20, 2017 beginning at 7:30 a.m. at the Foundation for a Health Kentucky,1640 Lyndon Farm Court, Louisville KY 40223. This roundtable provides an opportunity for medical practices to speak to Medicaid representatives, ask questions and hear what other practices are experiencing with Medicaid in Kentucky. Representatives from Aetna Better Health, Anthem Medicaid, Humana CareSource, Passport Health Plan, WellCare and the Kentucky Department for Medicaid Services have been invited to participate in this forum. Submitting issues* in advance enables the payers to investigate concerns to prepare responses in preparation for the meeting. Download the issue form here. RSVP Here
March 7, 2017
CGS Medicare UPDATE: Claims Processing Issue Affecting Units Field
On January 19, 2017, we informed you of an issue we detected with our claims processing system that impacted the way the “units” field on Part B claims was processed. This affected claims submitted from December 31, 2016 - January 5, 2017. Effective immediately, no further action is required of you. We will perform mass adjustments on most claims that have not already been brought to our attention. Please allow 4-6 weeks for the mass adjustment to complete. If, after that time, your claims have not been adjusted, please contact our Provider Contact Center. The mass adjustment will apply to any claim that includes at least ONE line that was processed as 00001 in error. Claims with additional line items submitted with 2-9 units that were incorrectly processed as 00002-00009 will also be adjusted. There is an exception for claims with additional line items billed with 10 or more units. Those claims WILL NOT be included in the mass adjustment. Again, there are exceptions to the mass adjustment. The following exceptions WILL NOT be automatically adjusted:
Any claim that DOES NOT have at least one line on the claim that processed as 00001 incorrectly. For example, if your claim has a single line item that was processed with a unit of 00002, it WILL NOT be automatically adjusted.
Any claim that has a line processed with units billed of 10 or more incorrectly. For example, line one was processed as 00001 incorrectly; line 2 was billed with 11 units and processed as 00011 incorrectly.
Any ambulance claim.
Any anesthesia claim.
For claims that fall into these exceptions, please continue to following the instructions outlined in the January 19, 2017, article to initiate an adjustment.
$5.5 million HIPAA settlement highlights importance of audit controls (MGMA)
The U.S. Department of Health and Human Services (HHS) and a large health system agreed to a $5.5 million settlement for potential violations of the HIPAA Privacy and Security Rules and implementation of a corrective action plan. The nonprofit corporation operates six hospitals, an urgent care center, a nursing home, and a variety of ancillary health care facilities. It is also affiliated with a number of physician offices. The organization reported to HHS that the protected health information (including names, dates of birth, and social security numbers) of 115,143 individuals had been impermissibly accessed by employees and disclosed to affiliated physician office staff. While it had workforce access policies and procedures in place, HHS alleged it failed to implement adequate procedures with respect to reviewing, modifying and/or terminating users’ right of access, as required by the HIPAA Rules. Access the MGMA HIPAA Resource Center for privacy and security tools and resources.
SAVE THE DATE – 4TH Annual GLMS Medicaid Roundtable April 20th
The 2017 GLMS Medicaid Roundtable will be held on Thursday, April 20, 2017 beginning at 7:30 a.m. at the Foundation for a Health Kentucky,1640 Lyndon Farm Court, Louisville KY 40223. This roundtable provides an opportunity for medical practices to speak to Medicaid representatives, ask questions and hear what other practices are experiencing with Medicaid in Kentucky. Representatives from Aetna Better Health, Anthem Medicaid, Humana CareSource, Passport Health Plan, WellCare and the Kentucky Department for Medicaid Services have been invited to participate in this forum. Submitting issues* in advance enables the payers to investigate concerns to prepare responses in preparation for the meeting. Download the issue form here. RSVP Here
February 28, 2017
Anthem provides new or additional evidence considered during an appeal
The Department of Labor (DOL), Health and Human Services (HHS) and the Treasury published final ACA Market Reform regulations. Under the rule, issuers must automatically provide impacted members (free of charge) a copy of any new or additional evidence considered in conjunction with the appeal of a claim. This information must be provided in advance of a final adverse benefit determination. Please be advised, in accordance with the regulation, Anthem Blue Cross and Blue Shield (Anthem) will send new or additional evidence to impacted members. This includes any information providers submit that is used in decision making for a grievance or appeal request.
Humana Updates Assistant Surgeon Reimbursement
Humana’s reimbursement policy for a physician acting as an assistant surgeon has changed for Humana commercial plans. The standard amount allowed for a physician acting as an assistant-at-surgery, identified by modifiers 80, 81 or 82, is changing from 20 percent to 16 percent. The standard amount allowed for a non-physician acting as an assistant-at-surgery, identified by modifier AS, is not changing and remains at 10 percent. Impacted products: Select self-funded* products, Commercial fully insured products Note: Only Humana commercial plans are affected by these changes. Humana Medicare Advantage plans currently allow 16 percent of the maximum amount allowable under the member’s plan. We previously posted this notification on Oct. 22, 2016, on the Claim Processing Edits page. The notification can be viewed here.
Passport Health Plan Members Can Now Visit The Little Clinic
Read the GLMS News article here. You may have heard by now that as of January 1, 2017, The Little Clinic is contracted with Passport Health Plan. The GLMS Passport Insurance Issues Resolution Committee is preparing a letter to Passport in response to this decision and the affects it could have on members and the physician-patient relationship. If you have any questions, concerns or to add your comments to the letter, please email Physician.Education@ by Friday, March 3.
SAVE THE DATE – 4TH Annual GLMS Medicaid Roundtable April 20th
The 2017 GLMS Medicaid Roundtable will be held on Thursday, April 20, 2017 beginning at 7:30 a.m. at the Foundation for a Health Kentucky,1640 Lyndon Farm Court, Louisville KY 40223. This roundtable provides an opportunity for medical practices to speak to Medicaid representatives, ask questions and hear what other practices are experiencing with Medicaid in Kentucky. Representatives from Aetna Better Health, Anthem Medicaid, Humana CareSource, Passport Health Plan, WellCare and the Kentucky Department for Medicaid Services have been invited to participate in this forum.
Submitting issues* in advance enables the payers to investigate concerns to prepare responses in preparation for the meeting. Download the issue form here. RSVP to physician.education@ or 502-736-6354.
February 21, 2017
Humana says it will pull out of government health-insurance exchanges next year (Kentucky Health News )
Humana Inc. announced Feb. 14 that it would stop selling health insurance through the government marketplaces created by federal health reform. That made the Louisville-based company "the first major insurer to cast a no-confidence vote over selling individual plans on the public exchanges for 2018," The New York Times noted. The company said its early analysis of Obamacare enrollment for this year showed “further signs of an unbalanced risk pool,” meaning too many "customers with expensive medical conditions continued to enroll as compared with healthy people," Reed Abelson explains for the Times.
The change will mean relatively little to Kentucky, since Humana was selling on the federal exchange in only nine counties (Bourbon, Bullitt, Clark, Fayette, Jefferson, Jessamine, Oldham, Scott and Woodford) and off the exchange in nine (Boone, Bullitt, Campbell, Gallatin, Grant, Jefferson, Kenton, Oldham and Pendleton).
"Humana is not a major player in the individual exchanges and is among the national insurers, like Aetna and UnitedHealth Group, that have struggled to make money in the market," Abelson notes. Humana and Aetna abandoned their planned merger after a federal judge ruled it would violate antitrust laws.On the Obamacare exchanges, "The company has steadily scaled back its presence, selling policies for 2017 in just 11 states," Abelson notes. "The company’s main focus has been selling private insurance under Medicare," under the brand Medicare Advantage.
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Dually Eligible patients - Hard-to-Reach Populations: Innovative Strategies to Engage People with Mental Health Conditions or Substance Use Disorders
Date: Friday, February 24, 2017 Time: 12:00PM to 1:30PM ET / Registration Link
Many providers serving dually eligible individuals face challenges engaging enrollees living with mental illness or substance use disorders. Health plans and health care providers must develop innovative approaches to locate these enrollees and connect them to primary and behavioral health care, social services, and long-term services and supports that they may need.
The full schedule for the webinar series is included below:
Disability-Competent Access (February 22, 2017 at 2:00PM to 3:00PM ET)
Disability-Competent Primary Care (March 1, 2017 at 2:00PM to 3:00PM ET)
Disability-Competent Care Coordination (March 8, 2017 at 2:00PM to 3:00PM ET)
Disability-Competent Long-Term Services and Supports (March 15, 2017 at 2:00PM to 3:00PM ET)
Disability-Competent Behavioral Health (March 22, 2017 at 2:00PM to 3:00PM ET)
Registration Information: After registering at the links above, you will receive an email from webinars@ containing event log on information. Please contact RIC@ or Gretchen.Nye1@cms. with any questions.
February 7, 2017
Attest to 2016 EHR Incentive Program Requirements by March 13 to Avoid a 2018 Payment Adjustment
The Centers for Medicare & Medicaid Services (CMS) has extended the attestation deadline for providers participating in the Medicare EHR Incentive Program to Monday, March 13, 2017, at 11:59 p.m. PT.
Providers participating in the Medicare EHR Incentive Program must attest to the 2016 program requirements by March 13, 2017 to avoid a 2018 payment adjustment.
If you are participating in the Medicaid EHR Incentive Program, please refer to your state’s deadlines for attestation information.
If you are eligible to participate in both the Medicare and Medicaid EHR Incentive Programs, you MUST demonstrate meaningful use to avoid the Medicare payment adjustment. You may demonstrate meaningful use under either Medicare or Medicaid. If you are eligible to participate in both the Medicare and Medicaid EHR Incentive Programs, you MUST demonstrate meaningful use to avoid the Medicare payment adjustment. You may demonstrate meaningful use under either Medicare or Medicaid.
Attestation Resources
Registration and Attestation System
Eligible Professional (EP) and Eligible Hospital and Critical Access Hospital (CAH) Attestation Worksheets
EP and Eligible Hospital and CAH Attestation User Guides
EP and Eligible Hospital and CAH Registration User Guides
Attestation Batch Upload Webpage
Passport Webinar Session Tuesday, February 14th @3:00pm EST: Understanding Provider Credentialing and Enrollment
Background: Passport Health Plan holds webinars on a quarterly basis as a service to providers. Training webinar opportunities, including past presentations, are posted on the educational resources section of Passport’s website.
Passport’s Credentialing and Enrollment experts Judy Parnell and James Wood will present helpful information on Passport’s credentialing process, tips and contact information as well as cover the importance of submitting and maintaining accurate provider data before, during and after enrollment. Accurate provider data helps to ensure claims get paid; members have access to correct provider information in directory and more!
Provider Action Needed: Please join Passport for the Understanding Provider Credentialing and Enrollment webinar to be held on Tuesday, February 14 at 3:00pm EST/2:00 CST. To register, please click here. All attendees will be placed in a drawing for one $25 gift card!
January 24, 2017
Judge pulls plug on Humana-Aetna deal (Courier-Journal)
A federal judge has dealt a huge blow to health insurer Aetna's $37 billion bid to acquire Louisville-based Humana, ruling that combining the companies would stifle competition in hundreds of health insurance markets around the country.
Although Aetna indicated that it may appeal Judge John Bates' decision, the ruling means more months of uncertainty and costly litigation, which has torpedoed other deals. “We’re reviewing the opinion now and giving serious consideration to an appeal after putting forward a compelling case,” Aetna spokesman T.J. Crawford told reporters. Full article here:
Subscribe to the Quality Payment Program Listserv
The Quality Payment Program’s first performance period opens on January 1, 2017 and closes December 31, 2017. Participation in MIPS can start as early as January 1, 2017 or as late as October 2, 2017. The first payment adjustments based on performance go into effect on January 1, 2019. Subscribe to the Quality Payment Program listserv to receive reminders for all of these important deadlines.
To subscribe, visit the Quality Payment Program portal and select “Subscribe to Email Updates” in the footer. The Education & Tools page includes program resources to help you learn more about eligibility and how to participate.
GLMS Rosters Coming Soon
You may have noticed that you didn’t receive your GLMS Roster at the usual time last fall. GLMS converted to a new membership database in 2016 causing a delay in the roster printing by almost 4 months. The rosters are printing now and you should receive yours in the mail by mid-February. Thank you for your patience.
January 17, 2017
EMR and Practice Management Software Recommendations?
Recently a small practice contacted us for EMR and PM Software recommendations. They currently use a company that has announced they will not continue to support these products and suggest they use Athena. I am calling on the expertise of the many practices that receive this weekly update for help! If you have a recommendation for this practice (allergy & immunology), please email stephanie.woods@.
KMA MIPS and MACRA — The Time is Now!
Starting in 2017, physicians must make an important decision each year—one that will affect Medicare reimbursements. The new Medicare Quality Payment Program, which includes the Merit Based Incentive Payment System (MIPS), has an implementation date of Jan. 1, 2019, but physicians must take action starting in 2017 to avoid payment reductions or have a chance to receive payment incentives in 2019 of up to 4 percent.…Lindy Lady will explain these changes impacting reimbursement for physicians who participate in Medicare in a fast-paced one-hour presentation at the KMA Physicians’ Day at the Capitol Feb. 22. Read full article or find out more here
LET THEM IN! THEY ARE NOT DRUG REPS
They may look like drug reps. They want to see your docs like drug reps. They are even willing to provide food like drug reps.
Let them in! They are not drug reps. They are trained specialists bringing free helpful tools and information on lung cancer care for all the primary care providers (PCPs) in your practice. It only takes 5-10 minutes of provider attention and they can receive free CME credit for the time spent! Lastly, PCPs earn a $100 Amazon gift card for rating the toolkit online.
The educational effort is part of the Kentucky LEADS Collaborative, spearheaded by the Kentucky Cancer Program at the University of Louisville (UofL). The goal is to lower Kentucky’s lung cancer rates -- the nation’s highest -- by increasing the numbers of eligible patients screened for lung cancer. The specialists from UofL and University of Kentucky deliver toolkits that assist in making referrals to low-dose CT screening, including reimbursement tips. Also included is information on tobacco treatment for PCPs and patients, as well as exam room posters on screening and smoking cessation.
Since early 2016, more than 600 Kentucky PCPs been served through the project. To schedule a visit for your PCPs, email a request to kyleads@louisville.edu or call 852-6318. Meanwhile, if the Kentucky LEADS specialist calls on your office, make them welcome. You will be glad you did! For more information, see and click on Provider Education.
Humana Issues?
GLMS will be meeting with Humana on February 6th for a quarterly Insurance Issues Resolution Committee meeting. If you have Humana hassles that remain unresolved after going through the proper channels, email Stephanie.woods@.
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