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Initiatives

Directed by the board of directors, House of Delegates and councils and committees, the Colorado Medical Society works to strengthen the house of medicine through various initiatives.

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Prescription for a healthier practice: Contract with confidence

The AMA's managed care contracting webinar series will help you understand new provisions that managed care organizations are adding to physician contracts as those organizations implement new physician payment models. The series will empower your practice to conduct business in a way that preserves your rights and maximizes your ability to reach your short- and long-term goals.

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Prescription for a healthier practice: Eliminate manual workers’ comp and auto claims processing

Switch from a manual claims process to electronic billing or “eBilling” for workers’ compensation and auto claims, which will help your practice reduce administrative costs, receive timely acknowledgement of your claims’ status and reduce the time it takes to submit bills. By doing so, physicians get paid faster and eliminate most of the hassles involved with paper billing. The AMA has developed tools to help your practice automate medical billing for workers’ compensation and auto injury. Start with the AMA’s Property and Casualty (workers' compensation and auto injury) Toolkit.

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Prescription for a healthier practice: Empower your practice with the National Managed Care Contract

Take advantage of this comprehensive managed care contracting resource, which is based on the most physician-favorable managed care laws and regulations from all 50 states and the District of Columbia. This advocacy resource and its accompanying supplements address many of the issues that arise in the managed care contracting process and in the subsequent business relationship between physicians and managed care organizations. Developed by the AMA and state medical association attorneys with expertise in managed care contracting issues and regulations, the National Managed Care Contract includes more than 70 pages of model provisions based on state law and is supported by hundreds of legal citations.

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Prescription for a healthier practice: Fight for accurate payment by decoding payer ERAs

The AMA has developed a tool to help address the hassle of decoding electronic remittance advices (ERAs) to determine if a billed claim was properly paid. If your practice performs property and casualty (workers’ compensation and auto injury) e-billing and receives ERAs, the AMA’s Claims Workflow Assistant tool can help you understand and address payment adjustments from payers. You can look up the reason or remark codes that payers place on the ERA to find associated workflows that can assist you in addressing claim denials or non-payments. And, you can look up the reason and remark codes payers place on the remittance advice to explain how the claim was processed and determine what those codes mean. Then, you can follow the steps provided to ensure accurate payment. The Claims Workflow Assistant also provides template appeal letters that physicians can easily modify to use in their practices.

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Prescription for a healthier practice: Get paid what you deserve for out-of-network services

The AMA has developed the educational resource “Out-of-network payment challenges for the physician practice” to provide your practice with resources to understand a third-party payer’s obligation for payment to out-of-network providers. The resource explains some of the payment challenges that arise when a physician who is considered out of network requests payment from a patient and/or health insurer.

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Prescription for a healthier practice: Hold health insurers accountable for out-of-network services

For this month’s practice checkup, ensure that your practice receives payment for out-of-network services it provides. Start with, “Holding health insurers accountable for out-of-network services.”

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Prescription for a healthier practice: Increase your practice’s efficiency

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Prescription for a healthier practice: Know the cost of doing business with your payers

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Prescription for a healthier practice: Learn about vendors offering e-billing solutions

The AMA provides a listing of e-billing vendors physicians may consider using, particularly for workers’ compensation and auto claims, to streamline the process and help you get paid more quickly and with fewer denials. Access the AMA’s workers’ compensation e-billing vendor listing to learn about some of the many practice management system vendors and clearinghouse vendors offering these solutions.

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Prescription for a healthier practice: Move toward real-time adjudication

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Prescription for a healthier practice: Prepare for health insurer retrospective audits

The AMA and the American Academy of Neurology present this AMA-members-only resource "How to prepare for a health insurer retrospective audit" to educate physicians and their staff about the recoupment efforts of health insurers through the retrospective audit process. They encourage physician practices to use this resource to guide them through the retrospective audit process from the initial notification from the health insurer to contesting the audit's findings.

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Prescription for a healthier practice: Receive out-of-network payments for services you provide

It can be challenging to receive fair payments for services provided to patients who have health insurance from a payer with which a physician practice has not contracted. The AMA provides resources to equip physician practices with the knowledge and tools needed to navigate these challenges and ensure fair payment is received. Go to the Out of Networks Payments page of AMA’s website and view a variety of practice management resources on this issue.

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Prescription for a healthier practice: Reduce claim denials

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Prescription for a healthier practice: Select a practice management system to maximize efficiency

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Prescription for a healthier practice: Simplify the claim audit and appeals process

This interactive resource can help reduce the administrative burden by delivering a step-by-step course of action to appeal an underpaid, delayed or inappropriately denied claim. AMA members can access the National Managed Care Contract Database to look up state laws and regulations, which may need to be cited or quoted directly in an appeals letter. Also refer to the issue brief, "Overpayments and underpayments" for additional information.

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