June 2023

Update: Cigna and UnitedHealthcare back down on controversial prior authorization policies

Colorado Medical Society supported national efforts and joined in advocacy against new Cigna and UnitedHealthcare prior authorization policies that would have further burdened Colorado physicians and their patients.

After the public and organizations raised serious concerns, Cigna indefinitely delayed the implementation of the modifier 25 policy which would have required submission of office notes with all claims including evaluation and management (E/M) Current Procedural Terminology (CPT®) codes 99212, 99213, 99214 and 99215 and modifier 25 when a minor procedure is billed. Cigna reports there will be more information on this policy at a later date. Stay tuned.

UnitedHealthcare also changed course after receiving backlash on a plan to require prior authorizations for colonoscopies and other endoscopic procedures (including some cancer treatments and GI diseases). UnitedHealthcare instead decided to put an alternative notification process in place that requires clinicians to collect and submit patient data before performing a procedure. Providers will have to participate in this process if they would like to qualify for a new gold card program next year. UnitedHealthcare maintains they will use the data collected for the gold card program.

Though the plan has changed, the new plan raises similar concerns with providers as the administrative burden on office staff is still unreasonable. Read more here from the California Medical Association.

Interview request: Share your thoughts on culturally responsive networks in Colorado

Colorado recently adopted requirements for health insurance companies to create “culturally responsive [provider] networks” for enrollees in Colorado standardized plans. United States of Care -- a nonpartisan organization committed to ensuring that everyone has access to quality, affordable health care -- seeks to interview health care providers about the unique needs of Colorado patients seeking access to culturally responsive care, and the providers' role in ensuring culturally competent care -- what's working, what the barriers are, and what opportunities for change might exist. 

They will conduct listening sessions between June 27 and July 13; choose a time slot here. Or they are flexible to meet during early mornings, lunch breaks, and in the evening hours. They anticipate the interviews will last between 60 and 90 minutes. 

National study to document changes in physician practice expense

The American Medical Association (AMA) is undertaking a new national study to collect representative data on physician practice expenses. The aim of the Physician Practice Information Survey is to better understand the costs faced by today’s physician practices to support physician payment advocacy. The study will serve as an opportunity to communicate accurate financial information to policymakers, including members of Congress and the Centers for Medicare & Medicaid Services. The AMA has contracted with Mathematica, an independent research company with extensive experience in survey methods as well as health care delivery and finance reform, to conduct the study. 

The Medicare physician payment schedule, maintained by the federal CMS and used by many other payers, relies on 2006 cost information to develop practice expense relative values, the Medicare Economic Index and resulting physician payments. As the U.S. economy and health care system have undergone substantial changes since that time, including inflation and the wide-spread adoption of electronic health records and other information technology systems, practice expense payments no longer accurately reflect the relative resources that are typically required to provide physician services. 

The study will rely on financial experts in the practice to complete an online financial information survey. The number of direct patient care hours is a critical component of the Medicare payment methodology. Therefore, thousands of individual physicians will receive a short patient care hours survey from either their practice directly or from Mathematica. The input from physician practices and individual physicians that are randomly selected to participate in this study is critical for its success. Participation will ensure that practice expenses and patient care hours are accurately reflected. Thank you in advance for your participation, if contacted.

Questions about FAMLI? DLE webinar: June 29

The Colorado Department of Labor and Employment will present their next webinar explaining the ins and outs of Colorado’s new Family and Medical Leave Insurance (FAMLI) program on Thursday, June 29 at 11 a.m. 

The webinar will be live, and registration is required. They will review the newly adopted rules about how employers need to reinstate employees who take FAMLI leave. Legal experts will explain what it means when the law says you can’t interfere with FAMLI leave or retaliate against someone who takes it. The Department will also take your questions about how all this is going to work. Employers, third party administrators, individuals & families and health care providers are all invited to attend.

Thanks to our Partners in Medicine, who support Colorado physicians and practices!

Job board

  • The CSU Health Network is recruiting for a Staff Psychiatrist who will work as a provider of psychiatric care and report directly to the Director of Psychiatry Services. Read the full post here.

  • Looking for a physician to share office space in the Midtown Medical Building, Located in Denver; Ideal for Concierge/DPC; 2 exam rooms, 2 offices; could share expenses and provide some cross coverage; Available immediately; please contact Dr. Michael Keller at 720-600-0802.

Place a job board advertisement by contacting debra_will@cms.org

Latest bulletins
Is your practice on social media? Follow us or reply to this email with your handles so we can follow you back, share content and tag you in posts to promote your practice!
Facebook  Instagram  Twitter  Linkedin  Youtube