End of Year Fax Facts
December 23, 2011
*Available in PDF version by download.
MEDICARE PAY CUT AVERTED; CONGRESS OKS TWO-MONTH PATCH
Physicians got a brief reprieve from a 27 percent Medicare pay cut today when the U.S. House of Representatives reached agreement with the Senate on a two-month extension of important policiesthat expire on Jan. 1.
The U.S. Senate last week voted to extend current Medicare payment rates for two months. After first balking at the two-month extension earlier in the week, the House reached an agreement with the Senate to extend the payment rates, as well as the 2 percentage point Social Security tax cut and to extend unemployment benefits.
“Physicians will be treating patients on Christmas and we expect you to do your job as stewards of the Medicare program,” wrote CMA President James T. Hay, MD to the legislature earlier in the week when an agreement was not met. See page three to read the letter in its entirety.
A House-Senate conference committee will convene in January to work on a longer-term agreement.
At a press conference, House Speaker John Boehner (R-Ohio) said the goal is to extend all the expiring programs for a full year, except for the physician payment cut reprieve, which is to be extended for two years.
2012 ANNUAL MEDICARE PARTICIPATION ENROLLMENT PROGRAM EXTENSION
CMS is extending the 2012 Annual Participation Enrollment Period through Tue Feb 14, 2012. The enrollment period now runs Mon Nov 14, 2011 through Tue Feb 14, 2012.
The effective date for any participation status change during the extension, however, remains Sun Jan 1, 2012, and will be in force for the entire year.
Contractors will accept and process any participation elections or withdrawals made during the extended enrollment period that are post-marked on or before Tue Feb 14, 2012.
GOLD COAST HEALTH PLAN (MEDI-CAL MANAGED CARE) PROVIDER CLAIMS SUBMISSION HELPFUL TIPS
Gold Coast Health Plan (GCHP) apologizes if you have experienced any inconvenience or delay in processing your claims submission. After having addressed and corrected systemic computer start-up issues, Gold Coast Health Plan anticipates a reduction in pended claims and denials; backlogged payments are now being processed more smoothly. They suggest following these helpful tips when submitting your claims:
1. Verifying Member eligibility at time of service
2. Following Medi-Cal billing guidelines
3. Using the appropriate claim form
4. Providing valid procedure and diagnosis codes (do not include any additional zeros or numbers)
5. Including appropriate revenue codes (must be included on UB04)
6. Providing the Tax ID Number (TIN)
7. Providing the NPI for the billing provider, rendering provider and attending physician, as appropriate
8. Denoting whether the Member has other health insurance (OHI)
9. Submitting your claims electronically
a. Enroll as a Trading Partner and submit claims electronically. Gateway EDI is currently enrolled with ACS for GCHP, and is available to our Providers at no cost. Enroll here: https://edidirect.acs-inc.com
b. Contact Gateway EDI Customer Support at 800-952-0495 for technical issues
c. Contact the EDI customer support team for information regarding Gateway EDI and WINASAP software, or learn more at https://edidirect.acs-inc.com/edidirect/info/winasap.jsp
10. Submitting paper claims by mail (we cannot process claims submitted via facsimile) to:
Gold Coast Health Plan
Attn: Claims
P.O. Box 9152
Oxnard, CA 93031
Questions may be directed to Provider Services at 888-301-1228.
CMA’S REIMBURSEMENT HELPLINE (888) 401-5911
Through this members’ only service, CES provides one-on-one educational assistance and payor advocacy to physician members and their staff. The helpline is staffed by practice management experts with a combined experience of over 125 years in medical practice operations. Practices can call on CMA’s Center for Economic Services reimbursement experts to discuss economic issues affecting their practice, including but not limited to billing and collections, coding and documentation, and managed care contracts..
“CERTIFIED MEDICAL OFFICE MANAGER” COURSE
January 25, February 1, 8, 15, 2012
This program is recommended for experienced medical office managers who want to take their skills to the next level. Learn to initiate policies and protocols that will improve, protect and stabilize the financial security of the practice.
When: Four Wednesdays
9:00a.m. – 4:00p.m
Where: VCMA Conference Room
601 E. Daily Dr. #129. Camarillo, CA 93010
Cost: for VCMA member physicians/staff
Earlybird $649 (registration received w/ payment by 12/23/11)
Member Price after 12/23/11: $749 (new 2012 rate)
Includes certification exam.
LIMITED TO FIRST 20 REGISTRANTS
Presented by Practice Management Institute and hosted by the Ventura County Medical Association and the California Medical Association.
For a registration form or more information, please call VCMA at 805-484-6822.
CMA HAS CONCERNS ABOUT NEW CMS RULE GOVERNING SCOPE OF PRACTICE FOR MEDICAL STAFFS
CMA is asking federal regulators to abandon aspects of a recently proposed revision to hospital Medicare and Medicaid participation requirements.
Stemming from the Obama administration’s effort to reduce regulatory provisions on hospitals that must comply with Medicare and Medicaid, the Centers for Medicare & Medicaid Services (CMS) published a propose rule – “Reform of Hospital and Critical Access Hospital Conditions” – last October.
After a review, CMA has found that the proposed regulation poses serious threats to a hospital medical staff’s ability to oversee quality of care and could significantly expand the scope of practice for non-physicians working in hospitals.
Hoping to avoid such revisions, CMA has submitted comments to CMS outlining its various concerns.
Specifically, CMA believes that a section of the proposal allowing for multi-hospital systems to establish single governing boards could “drastically reduce, if not completely eliminate, input from each hospital’s medical staff and local community.” Such a change would result in diminished patient care and “does not reflect the local needs of each hospital,” according to CMA’s comments.
The proposal also calls for possible scope of practice expansions, including sections that could see drugs and biologicals being prepared and administered by a wide variety of practitioners, potentially expanding this ability to those who may lack the appropriate training and experience.
If accepted, the proposed rule would also do away with the five-year sunset provision that allows all orders to be dated, timed and authenticated by the ordering practitioner, as well as removing the requirement that all orders be authenticated within 48 hours. Finding the current regulations to be unduly burdensome, CMA is supportive of such changes.
CALENDAR OF EVENTS
December 26-30, CMA and VCMA offices closed for the holidays
We will reopen Tuesday January 3rd.
UPCOMING CMA WEBINARS
FREE live webinars. Space is limited so register soon.
Go to: www.cmanet.org/calendar and choose to Filter by Event Type-Webinar
or contact:
CMA Member Help Center, (800) 786-4262, memberservice@cmanet.org.
February 1, Key Financial Ratios to Increase Profitability
12:15pm - 01:15pm
February 15, HIPAA Risk Analysis for Meaningful Use
12:15pm - 01:15pm
March 21, HIPAA Update 2012
12:15pm - 01:15pm
These and more Webinars are available on demand.
CMA PRACTICE RESOURCES (CPR)
CMA Practice Resources (CPR) is a free monthly e-mail bulletin from the California Medical Association’s Center for Economic Services. This bulletin is full of tips and tools to help physicians and their office staff, improve practice efficiency and viability.
SUBSCRIBE NOW: Sign up now for a free subscription at cmanet.org
ARCHIVES: past issues of CPR are available at cmanet.org
