November Fax Facts
November 21, 2011
*Available for download in PDF version above
SUPER COMMITTEE DECLARES DEFEAT
Monday, the Joint Congressional Committee on Deficit Reduction (otherwise known as the Super Committee) declared defeat and will not reach agreement on a package to reduce spending by $1.5 trillion.
What does this mean for physicians?
The law now requires across-the-board spending cuts, called sequestration, which will begin January 1, 2013. The entire Medicare program will take a 2% cut, including GME, Medicare Advantage and other programs within Medicare. However, the Medicaid program is protected from cuts under the sequestration agreement.
What about 2012?
There will not be a complete repeal of the Medicare SGR payment formula this year. And the 27.4% Medicare SGR payment cut still looms on January 1, 2012.
The good news is that there are several large issues that Congress must address before the end of the year and the leaders have listed the Medicare physician payment cut as a major priority.
What can you do?
Please keep calling, writing and meeting with your Members of Congress. It is imperative that we stop the 27% cut before Jan 1, 2012.
Use the AMA Grassroots Hotline at 800 833 6354; plug in your zip code and it will automatically connect you to your Representative/Senator.
CMA will be aggressively pushing Congress to stop the cut.
“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 Thursdays 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’S 2011 LEGISLATIVE WRAP-UP IS NOW AVAILABLE!
It was a year fraught with budget woes, redistricting chaos and an unpredictable new Administration. CMA overcame these shifts in the legislative and political landscapes to successfully protect physicians from a number of threats.
For more information, please visit: 2011 Legislative Wrap-Up: Batten Down the Hatches - Resource Library and Store - California Medical Association
CMS RELEASES FINAL 2012 MEDICARE FEE SCHEDULE
On November 1, CMS released the final 2012 Medicare physician payment rule, which indicates that (absent congressional action) the SGR formula will cut Medicare payments by 27.4 percent on January 1, 2012.
As a result of intense CMA lobbying, CMS adjusted the fee schedule so that an even larger percentage (3 percent) of the payments are adjusted for geographic differences in practice costs, which prevented large cuts in 2012 and will help California physicians enormously in future years.
E-prescribing
CMS finalized its proposal for the 2012 and 2013 incentive, and 2013 and 2014 penalty programs. Despite continued CMA and AMA opposition, physicians will need to report 10 times during the first six months of 2012 and 2013 to avoid application of e-prescribing penalties in subsequent years. Physicians may use claims, registry or electronic health record (EHR)-based reporting methods.
Physician Quality Reporting System CMS finalized its proposal to provide interim feedback reports for physicians reporting individual measures and measure groups through claims-based reporting for 2012 and beyond. CMS finalized its proposal to use 2013 as the reporting period for the 2015 PQRS penalty. If CMS determines that a physician or group practice has not satisfactorily reported quality data for the 2013 reporting period, then its 2015 payments will be reduced 1.5 percent. The rule also redefined “group practice” under the Group Practice Reporting Option as a group of 25 or more eligible professionals.
Value modifier
CMS finalized its proposal to base payment adjustments in 2015 on yet-to-be-determined cost and quality measures to be finalized in November 2012. Quality measures for the modifiers will most likely be based on PQRS and EHR measure sets. Cost measures to be used in the modifier will be based on average total per capita cost for the physician’s patients, and per capita cost for four conditions.
Multiple procedure cuts
In response to comments from AMA, the AMA/Specialty Society RVS Update Committee (RUC) and many specialties, CMS scaled back its proposal to apply a 50 percent reduction to the professional component (PC) of certain imaging services. Instead, the rule applies a 25 percent reduction to the payment for the PC of second and subsequent CT, MRI and ultrasound services furnished by the same physician on the same patient in the same session on the same day.
Lab test signatures no longer required
CMS has retracted the requirement for physicians to sign paper lab requisitions for clinical diagnostic laboratory tests.
Annual wellness visit (AWV) changes CMS is increasing the payment for the AWV codes to recognize additional resources associated with adding a health risk assessment to the service’s requirements, but is continuing its policy of not covering a physical exam as part of these services.
RUC
The RUC persuaded CMS that the resources involved in hospital observation care visits and hospital inpatient visits are equivalent.
Open enrollment
The open enrollment period that will allow you to change your participation status in the Medicare Program is available until December 31, 2011. Changes are effective as of the next calendar year on January 1. To learn more about Medicare participation, see medical-legal document #0151, "Medicare Participation (and Non-Participation) Options."
The Fee Schedule and additional information is available on the CMS website at www.cms.gov/physicianfeesched.
CMA FILES LAWSUIT AGAINST DHCS AND HHS OVER MEDI-CAL REIMBURSEMENT CUTS
CMA joined with other professional associations to file a lawsuit against the California Department of Health Care Services (DHCS) and the U.S. Department of Health and Human Services (HHS) Monday. The suit is in response to the recent approval of a 10 percent reimbursement rate cut for Medi-Cal providers.
According to Silva, federal law requires that Medi-Cal patients have the same access to physicians and other health care providers as the general insured public.
California's Medi-Cal rates are already almost the lowest in the nation. Currently, half the doctors in the state cannot afford to participate in the program. The gaping hole in California’s safety net will be further exacerbated by the 3 million uninsured newly eligible for Medi-Cal in 2014 under federal health reform legislation.
An independent study recently commissioned by CMA found that 49 percent of Medi-Cal patients are unable to get health care when they need it, compared to just 26 percent of privately insured patients.
What you can do
CMA and its member physicians want to make sure that Medi-Cal patients have access to health care. But we need your help. Contact CMA if you, your clinic or medical group can no longer afford to treat Medi-Cal patients, cannot find specialists who take Medi-Cal patients, or would otherwise be negatively impacted by the recent cuts that California made to the Medi-Cal program. You can also download a form to give to your patients to determine how they're being affected.
You can help us in our efforts to reverse these cuts.
Contact: Michelle Rubalcava, (916) 551-2543 or mrubalcava@cmanet.org.
CMA’S CENTER FOR ECONOMIC SERVICES RECOUPS ALMOST $3 MILLION FOR MEMBERS IN 2011
For the second year in a row, CMA’s Center for Economic Services (CES) has recouped more than $2.7 million from payers on behalf of its members. The center’s reimbursement help line has fielded almost 2,400 calls about billing and contracting issues from more than 1,200 different physician practices.
Founded in 1999, CES provides members with one-on-one assistance for billing, contracting and payment problems that may arise. With more than 125 years of combined medical practice operations experience, CES staff helps members with issues ranging from underpayment or denials by payers to assisting with contract analysis during negotiations.
Assistance from CES can range from education on how to increase a practices’ efficiency to direct intervention with payers or regulators. This support is reserved exclusively for CMA members.
CES also provides members with access to CMA Practice Resources, a regular bulletin offering tips for improving practice efficiency and viability.
Contact CES staff through its reimbursement helpline (888) 401-5911.
For practical tools, newsletters and other online assistance, visit cmanet.org/ces.
FINAL RULES FOR MEDICAID RACS PUBLISHED BY CMS
The Patient Protection and Affordable Care Act directs states to enter into contracts with one or more recovery audit contractors (RAC) to identify overpayments and underpayments in the Medicaid program and recoup overpayments. CMS released a State Medicaid Director letter that provided preliminary guidance to states on the Medicaid RAC program, including guidance that states needed to attest that they would establish a Medicaid RAC program.
States must implement the RAC program by January 1, 2012.
Contact: David Ford, (916) 551-2554 or dford@cmanet.org.
OBAMA ADMINISTRATION TAKES ACTION TO REDUCE PRESCRIPTION DRUG SHORTAGES IN THE U.S.
President Barack Obama issued an executive order directing the FDA and Department of Justice to take action to help further reduce and prevent drug shortages, protect consumers and prevent price gouging. The number of reported prescription drug shortages in the U.S. nearly tripled between 2005 and 2010, going from 61 to 178.
The Obama administration also sent letters to drug manufacturers reminding them of their legal responsibility to report discontinuation of certain drugs to the FDA. It also increased staffing resources for the Drug Shortages Program to address increased workload, and released a report from the Department of Health and Human Services that assesses the underlying factors that lead to drug shortages.
Contact: Elizabeth McNeil, (415) 882-3376 or emcneil@cmanet.org.
MEDI-CAL PATIENTS TRANSITIONING TO MANAGED CARE HAVE THE RIGHT TO CONTINUE WITH PREVIOUSLY PRESCRIBED MEDICATIONS
Physicians should be aware that there have been recent reports of Medi-Cal patients being switched to generic drugs when transitioning from fee-for-service to Medi-Cal managed care. In addition to this, it has also been reported that some Medi-Cal patients have not been allowed to continue to use single source drugs as required by law. Single-source drugs are defined as drugs with no generic equivalent.
Managed care plans must allow a Medi-Cal beneficiary to continue using a single-source drug that is part of a therapy prescribed prior to enrollment, whether or not the drug is covered by the plan, until the prescribed therapy is ended by the contracting physician.
If your Medi-Cal patient has transitioned from fee-for-service to Medi-Cal managed care, make sure to ask them to bring in their medication list to check whether they continue to have access to the medicines you've prescribed. If your patient experiences a substitution of their medicine, you should consider contacting the Medi-Cal managed care health plan office responsible for drug authorization.
Contact: CMA's reimbursement helpline, at (888) 401-5911 or economicservices@cmanet.org.
CALIFORNIA YOUNG PHYSICIANS TEAM UP WITH ANAHEIM BOYS AND GIRLS CLUB
CMA’s Young Physicians Section (YPS) joined with the Anaheim Boys and Girls Club and local hero and chef Bruno Serato to feed hundreds of homeless children on October 14, 2011.
Physicians, including 2012 VCMA President Lynn Jeffers, M.D., participated in the Anaheim Boys and Girls Club Motel Kids Outreach Program, which works with the more than 2,000 homeless children living in Anaheim motels.
“We wanted to do something to give back to the community,” said YPS Chair Dr. Jeffers. “We’re here together as a group, talking about what young physicians can do to improve the health and wellness of our patients. Contributing to the community is absolutely part of that.”
The YPS is composed of CMA members who are newly licensed (in practice for 8 years or less) or are under 40 years of age.
Q & A: HOW TO BILL FOR DOCTORS COVERING YOUR PRACTICE
You may need to find a substitute physician to cover your medical practice, whether for a vacation, illness, maternity or some other temporary situation that takes you away from your practice.
In some instances, physicians may have reciprocal coverage arrangements with their colleagues. In other instances, physicians typically find a covering physician through a locum tenens placement agency. Whatever the circumstances, you should be aware of the billing rules that apply with certain third-party payors.
CMA offers guidance through medical-legal document #0107 "Covering Physicians (Locum Tenens)," which discusses how a physician may find a substitute physician to cover his or her practice. The document also discusses billing issues, such as how to provide call coverage for a group and have the group bill the insurer on behalf of the physician using its own name and provider number.
The document also includes information on how medical groups can add a new physician to a plan's participating provider panel. A sample letter requesting authorization to bill for a particular substitute physician may be found at the end of the document.
Contact: Samantha Pellon, (916) 551-2872 or spellon@cmanet.org
CMS ANNOUNCES HIPAA 5010 ENFORCEMENT EXTENSION
The CMS Office of E-Health Standards and Services announced it would not initiate enforcement action against entities who had not adopted the new electronic transaction standards and codes until March 31, 2012. What this means for physicians is that while the implementation date of January 1, 2012, is still in effect, contractors will not reject claims submitted in the 4010 electronic formats until March 31, 2012.
The California Medical Association encourages all physicians to continue working with their vendors, clearing houses and billing services to transition to the 5010 format as soon as possible. Offices that transmit directly must ensure their software is updated.
Contact: CMA Reimbursement Helpline, (888) 401-5911 or mkelly@cmanet.org.
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.
November 30, Provider Enrollment in the Medi-Cal EHR Incentive Program
12:15pm - 01:15pm
Representatives from ACS (the Medi-Cal fiscal intermediary) will walk through the process for individual providers to enroll in the incentive program, and answer questions you may have.
December 7, Medicare 2012: Final Rules
Share12:15pm - 01:15pm
Michele Kelly from CMA's Center for Economic Services will cover the final 2012 Physician Fee Schedule changes and of other changes which physicians and their staff should be aware.
December 14, Individualized Treatment Plans for Patients with Diabetes
12:00pm - 01:00pm
The CMA Foundation is planning a webinar to support physicians and other health care providers in improved diabetes management. Led by Dr. Anne Peters.
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
MEMBER BENEFITS
- FRESH RESUMES AVAILABLE!
Need to fill a position? Always check with VCMA first. Resumes have recently been collected for the positions of Office Manager, Front/Back Office Medical Assistants, Nurses, Billers, and Receptionists. Resumes will be faxed upon request. Call 484-6822.
- COMMUNICATION SYSTEMS SERVICES
E-mail a one page practice announcement to VCMA to have it immediately faxed to every VCMA member or purchase a set of members mailing labels (sorted by zip code) for practice or meeting announcements; $100 members, $400 non-members.
- 2011 STAFF SALARY SURVEY RESULTS are now available. All requests must come from physician. Call VCMA Office 484-6822.
- INSURANCE PROGRAMS
Medical, workers’ comp, long term disability, long term care, life, employment practices liability, and business overhead expense insurance: Members receive discounted rates on insurance products for solo, small, medium and large groups from Marsh. Call a Marsh representative at (800) 842-3761.
- HEARTLAND PAYMENT SERVICES
Looking for a new merchant credit card and/or payroll service? Heartland offers great options for physicians. For more information, call (805) 217-6704 or visit HeartlandPaymentSystems.com/BrianHartmann
Mention your VCMA membership for a discount.
