Friday, April 28, 2017

CMA

Upcoming Deadlines:

MAY 2, 2017: Medi-Cal Meaningful Use Attestation Deadline for 2016

Click Here for Upcoming Affordable Care Act — ACA or "Obamacare" — Deadlines

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Ongoing Deadlines:

MBC UPDATES: Have you checked your MBC profile lately? California law requires you report each and every address change within 30 days. Click Here

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Deadlines That Have Passed:

MARCH 13, 2017: PQRS EHR Reporting Mechanism Attestation Deadline for 2016

MARCH 13, 2017: Medicare Meaningful Use Attestation Deadline for 2016

MARCH 1, 2017: CURES 1.0 to Be Permanently Taken Offline

JANUARY 1, 2017: Deadline for Physicians to Renew Their 2017 SDCMS-CMA Memberships

DECEMBER 31, 2016: Last Day to Change Your Medicare Participation Status for 2017

DECEMBER 7, 2016: Deadline Extended to December 7 to Dispute 2015 PQRS and QRUR Findings

DECEMBER 1, 2016: Blue Shield Fee Schedule Changes Effective

NOVEMBER 11, 2016: Physicians' Deadline to Verify CHPI Data

OCTOBER 16, 2016: Deadline for Covered Physicians to Post Nondiscrimination Statements

OCTOBER 1, 2016: ICD-10 Grace Period Ends

SEPTEMBER 2, 2016: At CMA's request, United Healthcare (UHC) has delayed the expansion of its Clinical Data Submission Protocol in California. Originally scheduled to take effect July 1, the expansion will now be pushed back until September 2. Click Here for Details

JULY 1, 2016: Will Your Practice Be Ready to Comply With the Requirements Under New Provider Directory Accuracy Law? On July 1, 2016, a new law (SB 137) will take effect that requires plans to ensure that physician directories are accurate and up-to-date. The law includes multiple components aimed at providing patients with more accurate and complete information to identify which providers are in their payors' networks. To accomplish this, payors are required to contact providers in writing, electronically, and by telephone. The payor must document the outcome of each attempt. If the payor is unable to verify the provider’s information, it may remove the provider from the directory and delay payment, but must first provide at least 10 business days advance notice. Click Here

JULY 1, 2016: 2015 Meaningful Use Hardship Exception Filing Deadline: Physicians are urged to preemptively file for a 2015 reporting year hardship exception to avoid 2017 penalties. Filing for a 2015 hardship exception will not preclude physicians from receiving an incentive if they do meet meaningful use requirements, but applying can serve as a safety net in staving off a penalty. Click Here

JULY 1, 2016: Governor Signs AB 679 to Extend CURES Registration Deadline to July 1, 2016: In the final days of the legislative session, CMA worked to pass Assembly Bill 679 to extend by six months the registration deadline for the Controlled Substance Utilization Review and Evaluation System (CURES). All individuals practicing in California who possess both a state regulatory board license authorized to prescribe, dispense, furnish, or order controlled substances and a Drug Enforcement Administration Controlled Substance Registration Certificate (DEA Certificate) now have until July 1, 2016, to register to use CURES. In 2013, Senate Bill 809 required the California Department of Justice (DOJ) to identify and implement a streamlined application and approval process for CURES registration. Currently, the registration process remains highly manual, requiring notarization of documents and reportedly six to eight weeks to process applications. A streamlined process was seen as essential to meeting the January 1, 2016, registration deadline. DOJ has not issued a definite date for when streamlined registration will be available, and so CMA pursued an extension. The bill was signed into law on October 11, 2015. CMA will continue to monitor the situation, communicate with DOJ and update members on progress. CMA recommends that any physicians who need access to CURES not wait for streamlined registration and begin the process for registration as soon as possible.

MAY 15: Open Payments (aka, the Sunshine Act) Review and Dispute Period Closes: Click Here

MARCH 11: 2015 Meaningful Use Attestation Deadline: For physicians who have determined that they can attest to meaningful use for a 90-day reporting period in 2015, CMS has extended the attestation deadline to midnight, March 11, 2016, EST. CMS is only extending the attestation period, not the reporting period, so physicians must have concluded their reporting by December 31, 2015. Click Here

OCTOBER 1: ICD-9 to ICD-10 Transition

JUNE 14: The Department of Health Care Services (DHCS) has extended its meaningful use attestation deadlines for 2014 from May 31, 2015, to June 14, 2015.

  • Background: As a result of the American Recovery and Reinvestment Act, Medi-Cal is able to offer eligible practitioners and hospitals substantial financial incentives to adopt, implement, or upgrade to CMS-certified EHR technologies. Initial payments the first year are based on adoption, implementation, or upgrade of certified EHR technology, while following annual payments are based on the meaningful use of the EHR technology. Incentive payments are available to eligible hospitals over four years and for eligible professionals over six years. In September 2014, CMS published a final rule that revised the meaningful use timeline. Under the rule, eligible professionals can use 2011 Edition certified EHR technology (CEHRT) or a combination of 2011 and 2014 Edition CEHRT for the 2014 EHR reporting period to demonstrate meaningful use. Eligible professionals who were scheduled to begin stage 2 in 2014 will not be required to begin stage 2 until 2015, if they could not fully implement 2014 Edition CEHRT due to delays in availability of 2014 Edition CEHRT for the 2014 reporting period. This has been named the “2014 Flex Rule.”
  • Update: Due to the large number of pending applications from providers for the Medi-Cal EHR Incentive Program under the 2014 Flex Rule, DHCS has decided to extend the deadline for applications from May 31, 2015 to June 14, 2015. DHCS reports it will not be extending the deadline further.
  • Applications for 2015 meaningful use will not be accepted until June 15 due to the 2014 extended deadline.
  • Click here for more information.

MAY 20: Physicians and teaching hospitals have until May 20, 2015, to voluntarily review data reported by drug and medical device makers about them, and, if necessary, dispute payments, before the data is made public on June 30, 2015. Click Here

MAY 22: Deadline to Apply for July ICD-10 End-to-End Testing Extended to May 22: Click Here

APRIL 17: July ICD-10 End-to-End Testing Forms Due

MARCH 20, 2015: New EHR Deadline for Medicare Eligible Professionals to Attest to Meaningful Use for the Medicare EHR Incentive Program 2014 Reporting Year — Click Here for Details

DECEMBER 31, 2014: It's that time of year again, time for physicians to decide about their participation in Medicare. Physicians have until Dec. 31, 2014, to make changes to their status for 2015. In addition to the annual threat of steep payment cuts as a result of the SGR formula, another factor for physicians to consider is that 2015 will be the first year that CMS will impose penalties under the value-based modifier (VBM) program for large medical groups of 100 or more physicians. Click Here for Details

JANUARY 1, 2015: CMS will begin applying a value modifier under the Medicare Physician Fee Schedule (MPFS), meaning that cost and quality data are to be included in calculating payments for physicians. The new payment structure will emphasize value of care as opposed to volume of care. Physicians who do not meet the care criteria will be penalized. By 2017, this Value-Based Payment Modifier will be applied to all physicians who bill Medicare for services provided under the physician fee schedule.

JANUARY 1, 2015: A new law will fully take effect that streamlines and standardizes the prior authorization process for prescription drugs. The law (SB 866) requires all insurers, health plans (and their contracting medical groups / IPAs) and providers to use a standardized two-page form for prior authorizations of prescription medications.Click Here for Details

NOVEMBER 30, 2014: Hardship Exception Applications Due to Avoid the 2015 Medicare Payment Adjustment. CMS will reopen the submission period for hardship exception applications for eligible professionals to avoid the 2015 Medicare Payment adjustments for not demonstrating meaningful use of Certified Electronic Health Record Technology (CEHRT). The new deadline is November 30, 2014 — previously, the hardship exception application deadline for eligible professionals was July 1, 2014. This reopened hardship exception application submission period is for eligible professionals who:

  • have been unable to fully implement 2014 Edition CEHRT due to delays in 2014 Edition EHRT availability; AND 
  • are eligible professionals who were unable to attest by October 1, 2014, using the flexibility options provided in the CMS 2014 CEHRT Flexibility Rule. 

These are the only circumstances that will be considered for this reopened hardship exception application submission period. Applications must be submitted by 11:59 PM EST November 30, 2014. Please visit the Payment Adjustments and Hardship Exceptions webpage for more information about Medicare EHR Incentive Program payment adjustments and to access the hardship exception extension application.

OCTOBER 6, 2014: DEA Final Rule Rescheduling Hydrocodone Combination Products: The final rule provides, in part, that prescriptions for HCPs that are issued before October 6, 2014, that have authorized refills may be dispensed in accordance with DEA rules for refilling, partial filling, transferring, and central filling Schedule III-V controlled substances until April 8, 2015. However, some health insurers and pharmacies may not honor refills on or after October 6, 2014. Therefore, prescribers should be prepared to provide new hardcopy prescriptions for patients beginning on October 6, 2014, rather than have patients use what would have been existing refills.

OCTOBER 1, 2014: New Prescription Drug Prior Authorization Form Required

OCTOBER 1, 2014: New Version of POLST Form

SEPTEMBER 30, 2014: Sunshine Act — CMS Releases Most of the Data on a Public Website

SEPTEMBER 10, 2014: Last Day to Dispute Sunshine Act Data: Click Here for Details

AUGUST 27, 2014: Physicians have until August 27 to review and dispute reports about their financial interactions with manufacturers of drugs and medical devices under the Physician Payments Sunshine Act (also known as the Open Payments program). Click here to learn how to make sure the information reported about you is accurate before the data is released to the public on September 30.

AUGUST 18, 2014: DEA Will Classify Tramadol a Schedule IV Drug

JULY 30, 2014: Health Net Requesting Amendment to Physician Contracts: On June 30, Health Net notified physicians who are currently participating in its Covered California individual/exchange and/or SHOP HMO and PPO products of a request to amend the Health Net Provider Participation Agreement. The notice explains that Covered California has imposed a requirement that qualified health plans (QHPs) make reasonable efforts to obtain agreement from participating physicians to allow plans to share physicians’ reimbursement rates with the exchange. It is each physician’s decision as to whether or not he or she is interesting in amending the contract to allow the sharing of reimbursement rates with Covered California. Physicians who are interested in amending their agreements should contact Health Net Provider Services at hnprovidercontracts@healthnet.com by July 30. Physicians’ participation status will not be affected should they decide not to amend their contracts.

JULY 1, 2014: Deadline for Eligible Professionals to Submit EHR Hardship Exception Applications

JUNE 30, 2014: Deadline for Physicians to Opt out of Anthem Blue Cross's Individual / Exchange Network

JUNE 2014: Sunshine Act — CMS Gives Physicians Access to Their Reports: CMS is expected to provide physicians with access to their individualized, consolidated reports for the prior calendar year. Physicians will be able to access the reports online and will be able to seek correction or modification by contacting the manufacturer/GPO via the web portal.

APRIL 30, 2014: Deadline for 2013 Medi-Cal EHR Incentive Payments Extended: The deadline for providers to apply for Medi-Cal EHR incentive payments for the 2013 program year has been extended by one month to April 30, 2014. After that date, the State Level Registry (SLR) will no longer accept 2013 applications. For the 2014 program year, providers who are attesting to adopting, implementing, or upgrading certified EHRs can currently apply to the SLR for 2014 program year incentive payments. However, the SLR is currently unable to accept applications from providers attesting to meaningful use for 2014. The SLR will not begin accepting 2014 meaningful use attestations until June. For more information and updates, visit the SLR website at www.medi-cal.ehr.ca.gov.

APRIL 8, 2014: Microsoft ends support for Windows XP SP3 and Office 2003

APRIL 1, 2014: Practices Required to Use New CMS 1500 Claim Form

MARCH 31, 2014: 2013 Meaningful Use Attestation Deadline (extended from February 28, 2014 — the criteria, however, still must have been met by December 31, 2013)

MARCH 31, 2014: Sunshine Act — Manufacturers / GPOs Report 2013 Data to CMS

MARCH 14, 2014: Anthem Blue Cross Eligibility, Benefits, and Claim Status Inquiry Functions Moving to Availity

FEBRUARY 28, 2014: Last day to attest to demonstration of meaningful use of the data collected during the reporting period for the 2013 calendar year — for those EPs participating in the Medicare EHR Incentive Program.

JANUARY 9, 2014: 10% Medi-Cal Reimbursement Rate Reduction to Physicians, Pharmacists, and Clinics Begins

JANUARY 6, 2014: Medicare Begins Accepting Paper Claims Submitted on Revised CMS 1500 Claim Form (version 02/12) [Note: These dates are tentative and subject to change. CMS will provide more information as it is available.]

JANUARY 6 – MARCH 31, 2014: Medicare Continues to Accept Paper Claims Submitted on the Old CMS 1500 Claim Form (version 08/15) [Note: These dates are tentative and subject to change. CMS will provide more information as it is available.]

JANUARY 1, 2014: Stage 2 of CMS's Meaningful Use Incentive Program begins for eligible providers (EPs) who treat Medicare and Medicaid (Medi-Cal) patients.

JANUARY 1, 2014: Twenty-two states and the District of Columbia will expand access to Medicaid (Medi-Cal) as called for by the ACA. 

JANUARY 1, 2014: Sunshine Act — Physician Portal Launches: CMS is expected to launch the physician portal that allows physicians to sign up to receive notice when their individual consolidated report is available for review. This portal will also allow physicians to dispute the accuracy of a report.

DECEMBER 31, 2013: Last day of the 2013 meaningful use program year.

DECEMBER 1, 2013: Blue Shield Fee Schedule Changes Take Effect

NOVEMBER 1, 2013: The University of California Releases Its Academic Research — Including Healthcare-related Findings — Online at No Cost to the Public

NOVEMBER 1, 2013: Phase Two of Medi-Cal's Rural Expansion

OCTOBER 24, 2013: Medi-Cal Rate Reduction for Durable Medical Goods Begins

OCTOBER 18, 2013: CMS Extends the PQRS Exemption Deadline to October 18

SEPTEMBER 23, 2013: Deadline to Appeal to U.S. Supreme Court the 10% Medi-Cal Reimbursement Rate Reduction

SEPTEMBER 23, 2013: HIPAA Compliance Deadline: The new regulations, known as the HIPAA Omnibus Rule, implement many of the provisions of the HITECH Act. Covered entities have until September 23 to comply with these changes.

SEPTEMBER 16, 2013: Cutover Date From Palmetto to the New Medicare Part B Fee-for-service Contractor, Noridian

SEPTEMBER 5, 2013: Medi-Cal Rate Reduction for Medical Transportation and Dental Providers Begins

AUGUST 30, 2013: Last Day to Enroll for Noridian Early Boarding

AUGUST 1, 2013: Pharma Sunshine Reporting Starts: Physicians won't see their public reports on the payments and gifts they receive from drug and device manufacturers until September 2014, but companies start collecting data now.

From ModernHealthcare.com: "As of Aug. 1, group purchasing organizations and drug and medical-device manufacturers will have to report any “transfers of value” of $10 or more they make to doctors and teaching hospitals. The new requirement is contained in Section 6002 of the ACA and was known as the Physician Payments Sunshine Act, but was rebranded by the CMS as the “Open Payment Program.” Drug samples for patient use or coupons to receive a sample will not need to be reported."

AUGUST 1, 2013: Healthy Families Medi-Cal Transition May Cause Physicians to Lose Patients: Phase 3 of the Healthy Families transition from fee-for-service to Medi-Cal managed care is scheduled for August 1, 2013. This is the first phase of the Healthy Families transition where patients may be required to change physicians. This phase will impact approximately 107,000 children who have a Healthy Families plan that does not offer Medi-Cal managed care or subcontract with a Medi-Cal managed care plan, thus requiring them to transition to a new plan. Because patients will be switching plans, physician practices are highly encouraged to ask patients for their new insurance cards, to make copies, and then to verify eligibility to prevent payment delays and denials due to incorrect insurance information or out-of-network status. Affected counties include San Diego. For more information on the Healthy Families transition, see the DHCS Frequently Asked Questions at www.dhcs.ca.gov. Contact CMA's reimbursement help line at (888) 401-5911 or at economicservices@cmanet.org.

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