295. Physician Payment
295.985 Physician Preparedness for Payment Reform
Goal
CMS should help physicians to understand, prepare and transition to new and evolving payment system.
Objectives
- Educate physicians about alternative systems of payment and the opportunities and challenges they present for different physician specialties
- Identify opportunities in each specialty for reducing health care costs that do not harm physicians or patients, and identify the barriers to realizing those opportunities
- Develop physician consensus on specific recommendations about payment system design that will best enable physicians to help improve value in health care
- Identify assistance needed to ensure the success of those preferred payment systems
- Identify roles that the Colorado Medical Society can play to ensure that Colorado implements payment and delivery reforms in the most effective way
- Help physician practices make the necessary changes to be successful under new payment models
Strategies
- Develop and drive a multi-pronged educational campaign that helps physicians understand the evolution of payment systems from those that reward volume to those that reimburse for value.
- Contract with nationally-recognized payment reform expert Harold Miller in a three-part engagement to include a multi-specialty summit in the winter, at the 2011 Spring Conference and at the fall 2011 Annual Meeting
- Utilize the Systems of Care/Patient-centered Medical Home Initiative to connect payment reform to existing work on building out patient-centered medical homes, medical neighborhoods and other systems of care
- Create a framework and promote forums for intra- and inter-disciplinary dialogue on payment reform
- Connect reasons why use of data and clinical/business performance improvement activities can help to position a practice/specialty for alternative payment systems and broader system transformation
- Closely coordinate physician education campaign with Colorado’s Center for Improving Value in Health Care (CIVHC), the American Medical Association and other physician-driven organizations
(BOD-1, AM 2011; Reaffirmed, BOD-1, AM 2014)
295.986 Payment Reform
CMS will actively monitor payment reform initiatives at national and local levels, educate physician members on how new payment models can and will impact their practices and the quality and cost of care, and aggressively seek out opportunities to participate in payment reform initiatives in Colorado to ensure that physicians are well represented in new programs from the start.
(COPE-1, AM 2010; Reaffirmed, BOD-1, AM 2014)
295.988 Delivery of Multiple Services to Patients at a Single Encounter
The Colorado Medical Society supports the reform of payment rules amongst all payers that penalize the delivery of more than one service to patients at single encounter or on a single day.
(RES-13, AM 2008; Revised, BOD-1, AM 2014)
295.989 Medical Directors’ Responsibility in Denial of Procedures
(RES-12, AM 2005; Sunset, BOD-1, AM 2014)
295.990 National Prompt Payment
The Colorado Medical Society supports federal legislation that would extend the Colorado Prompt Payment Statute nationwide.
(RES-18, AM 2004; Reaffirmed, BOD-1, AM 2014)
295.991 Reimbursement for Telephonic and Electronic Communications
Physicians should be compensated for their professional services based on a uniform policy, at a fair fee of their choosing, for established patients with whom the physician has had previous face to face professional contact, whether the current consultation service is rendered by telephone, fax, electronic mail or other forms of communication.
The Colorado Medical Society (CMS), both singularly and jointly through their American Medical Association delegation, press the Centers for Medicare & Medicaid Services and other payers for separate recognition of such supplemental communication work as discrete services, not as bundled into existing service codes or, have such services recognized as “not covered by Medicare” and therefore chargeable as a patient convenience outside the benefit package of Medicare.
The CMS shall continue to work with employers and insurers to discuss the value of electronic communications to their employees/insureds both from a triage and cost effective basis and is worthy of coverage. In addition, CMS shall prepare a public education initiative to explain the appropriateness and necessity of paying for physicians’ professional time.
(RES-25, AM 2002; Reaffirmed, BOD-1, AM 2014)
295.992 Retroactive Denial of Payment
The Colorado Medical Society opposes the unfair practice of retroactively denying payment of claims.
(RES-21, AM 2000; Reaffirmed, BOD-1, AM 2014)
295.993 Physician Charge Audit Procedures
The Colorado Medical Society supports the averaging of coding discrepancies with respect to audits of physicians’ charging practices so that both high and low coding is taken into account in arriving at a final audit report.
(RES-14, AM 2000; Reaffirmed, BOD-1, AM 2014)
295.994 Reimbursement for Paperwork Completion
The Colorado Medical Society believes physicians should receive reimbursement for completion of mandated forms.
(RES-36, AM 1993; Reaffirmed, BOD-1, AM 2014)
295.995 Fair and Equitable Payment
The Colorado Medical Society supports the concept of payment that is fair and equitable across specialty lines and across geographic areas.
(RES-48, AM 1993; Reaffirmed, BOD-1, AM 2014)
295.996 Standardized Eligibility for Health Benefits
The Colorado Medical Society supports a standardized system of verifying eligibility for health benefits. Health insurers shall pay physicians for any services rendered to patients whose eligibility for benefits have been verified and approved.
(RES-66, AM 1992; Reaffirmed, BOD-1, AM 2014)
295.997 Reimbursement of Expenses Incurred with Office Procedures
(RES-34, AM 1991; Sunset, BOD-1, AM 2014)
295.998 Excessive Requests for Information
The Colorado Medical Society opposes excessive and unnecessary requests for additional information and unexplained delays in processing and payment by third party insurance carriers where a completed standard claim form for reimbursement has been submitted.
(RES-44, AM 1991; Reaffirmed, BOD-1, AM 2014)