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"News You Can Use" <> April 7, 2015



Senate Delays Vote on SGR Until mid-April • CMS to Delay 21% Cuts Until Mid-month: How to bill for Medicare and what the impact will be on your Medicare receivables:

  • The current payment patch expired on April 1. As a result, all physician services provided on or after April 1 will be subject to a cut of 21%. The Centers for Medicare & Medicaid Services (CMS) is instructing its carriers to “hold” for 10 business days any claims for services provided on April 1 and beyond, until legislation can be passed and signed into law that reverses the 21% cut. The 10-business-day hold means that April claims will be held through Tuesday, April 14. Since no claims by law can be paid sooner than 14 calendar days from their receipt, this hold should have little practical impact on Medicare remittance in the short-term, although billing for copayments and claims reconciliation will be more complicated.
  • In the meantime, some practices are asking what they should charge. By law, Medicare is required to pay physicians the lesser of the submitted charge or the Medicare-approved amount. For this reason, AMA is advising against submitting claims with reduced amounts reflecting the 21% cut. Instead, AMA recommends physicians either continue charging the current 2015 rates for April dates of service or defer submitting claims until after final action on the legislation. In the unexpected event that Congress allows the 21% cut to take effect, Medicare would pay physicians at the reduced amount no matter what the physician billed and no further action would be necessary. However, non-participating physicians who have collected balance billing amounts for unassigned claims based on the currently allowed amount could be required to make refunds to their patients based on new, lower balance billing limits.

It’s Free & It’s Fun — Mingle, Socialize, and Network With Your Fellow Physicians on Friday, April 24, 5:30pm–8:00pm Near Scripps Mercy: Complimentary hors d'ouvres and hosted wine and craft beer. Bring a nonmember — everyone welcome! Where: 57 Degrees, 1735 Hancock Street, San Diego 92101. Questions? Contact Jen Ohmstede at (858) 300-2781 or at JOhmstede@SDCMS.org. RSVPs required as space is limited — click here to RSVP. We hope to see you there! This event is sponsored by the Cooperative of American Physicians.

Supreme Court Limits Avenues Providers Can Use to Sue States Over Medicaid Funding: Click Here

CMA Submits Letter to CMS Requesting Assessment of Medi-Cal Rates: Click Here

So What Have We Done for Our Members Lately? Here’s a Great Example: As a result of an EHR audit, one of the physicians of a medium-sized group was being penalized for not meeting one of the meaningful use measures. He in turn was being asked to return all of the incentive monies he received for stage one. Not knowing what to do, he reached out to SDCMS, and we were able to assist him with his appeal, which was upheld. Total Saved: $18,000

Work-Life Balance Workshop on Saturday, May 2: Feeling burned out? Want to regain your love of medicine and excitement with life? Join your colleagues and Helane Fronek, MD, certified physician development coach, to take an honest look at your life, reacquaint yourself with what you find most meaningful, and then make the changes that will bring your life into greater balance. Saturday, May 2, from 9:00am to noon. Email Dr. Fronek at hsfronek@aol.com for details or to reserve your spot.

June 6 Members-only Workshop on Financial & Legal Life Skills: Covering investing, insurance, real estate, taxes accounting, and much more. Saturday, June 6, 8am–12pm. For SDCMS members only. Email me at Gehring@SDCMS.org for information or to RSVP.



Question: We’ve had several missed appointments at our office over the past few weeks. These patients have had these appointments for months, and they don’t call in to reschedule or notify us that they will not be coming in. Can we charge patients for missed appointments? Click Here for the Answer



CMA Joins Vaccine Advocates to Launch “I Heart Immunity” Campaign in Support of Senate Bill 277: Click Here

April Is National Organ Donation for Life Month • Be a Hero • Sign up to Save Lives: Click Here



Open Payments Physician and Teaching Hospital Review and Dispute Period Begins April 6 and Will Last for 45 Days: Click Here

Reminder: July ICD-10 End-to-End Testing Forms Due by April 17: Click Here for Details

Medicare RAC Court Case Keeps Collections on Uncertain Footing: A federal court decision in early March means the auditing program will be put on hold until CMS determines how to contract with its RACs. Click Here for Details



California Has One of the Lowest Acceptance Rates for New Medi-Cal Patients: Click Here

CMA Takes on Public Health, Medi-Cal With 2015 Sponsored Legislation:

  • Cigarette and Tobacco Products Taxes (SB 591): Would increase California’s tobacco tax by $2 per pack, allocating those funds to tobacco prevention and education.
  • Tobacco Tax Funding Implementation for Medi-Cal Use (AB 1396): Would provide oversight for allocation of the funds raised by SB 591 for Medi-Cal use.
  • Medi-Cal Reimbursement Rates (SB 243 & AB 366): Would repeal cuts to Medi-Cal provider reimbursement rates and more.
  • POLST Forms (AB 637): Would allow NPs and PAs, under physician supervision, to sign POLST forms.
  • Assignment of Reimbursement Rights (AB 1086): Would require healthcare service plans to honor assignment of benefit agreements.
  • Health Insurance Regulators (AB 1434): Would close a loophole that allows Blue Cross and Anthem to choose the regulator with which to file their PPO products.
  • Residency Training Program Grants (SB 22): Would enable grants to residency programs in areas with the greatest need.
  • Telephonic and Electronic Patient Management Services (SB 289): Would require health insurers to pay providers for telephone and telehealth services.
  • Workers’ Compensation — Utilization Review (SB 563): Would require employers and insurers to disclose payment methodologies for those involved in providing medical services to injured workers.
  • Emergency room physicians (SB 781): Would provide treating physicians fair payment.

For more information on these and other bills of interest to physicians, subscribe to CMA’s Legislative Hot List at www.cmanet.org/newsletters. Click Here for Details

United Healthcare Introduces Group Medicare Advantage PPO Product: Physicians who received the amendment, mailed February 24, have 30 days from the date of receipt to notify UHC if they wish to opt out of participation in the new product without affecting their underlying United Healthcare contract. Click Here for Details

DHCS Identifies Another Glitch in Issuing Primary Care Rate Increase for CHDP Claims: CMA has learned that CHDP providers practicing as part of a group will be required to re-attest as a group to get paid. Previously, physicians had been instructed to only attest as individuals. Click Here for Details

DWC Implements Annual Changes to Workers’ Compensation Physician Fee Schedule — Effective for Dates of Service on or After March 1, 2015: Click Here for Details

New Fee Reduction for Workers’ Compensation Independent Medical Review and Independent Bill Review Submissions: Click Here for Details



Recent SDCMS-CMA Success Stories:

  • A 32-year member needed assistance after finding out his license had expired. His practice had to cancel all of his surgeries the day of the expiration, and his office manager contacted SDCMS. As a result of SDCMS-CMA advocacy, this physician had his license changed to renewed and current status within hours of reaching out to us.
  • CMA’s economic advocacy team had been chasing ACA primary care rate increases for historic crossover claims for several months on behalf of an internist member — the internist had been waiting since 2013 to receive these monies. After reaching out to CMA, the first wave of payments finally started coming in. Total Saved: $80,000

CMA Updates Physician Guide to Getting Started With PQRS: Click Here

New Social Media Resource Center for Physicians: These resources from The Doctors Company can help you get started on social media and expand your online presence. Click Here

Is Your Office Working on ICD-10 Compliance? Click here to see a number of members-only resources, including CMA’s ICD-10 Transition Guide for Physicians. Be on the lookout as well for a two-day training through CMA in conjunction with the AAPC in late June. Details to follow shortly. October 1 is closer than you think!!!

SDCMS Members: Take Advantage of Discounted Services for Help With EHR Meaningful Use!

  • Physicians and practices challenged by the adoption and implementation of electronic health records, help is at hand! From selection through attestation for Meaningful Use Stages 1 & 2, the SDCMS Foundation can provide technical assistance to make you and your staff’s lives easier. The fee is $90 per hour for SDCMS members, $150 per hour for nonmembers. For more information, email Victor.Bloomberg@SDCMS.org.
  • Meaningful Use Pre-attestation audit services now available! SDCMS members can now obtain an inexpensive, pre-attestation audit for their Meaningful Use submissions to either Medicare or Medi-Cal. Members receive a $50 discount each for the low cost of $250! The audit will ensure that your reporting and documentation is complete and assist you in putting together an audit binder. Collectively, the services will ensure you are more likely to pass an audit — 10% of all eligible professionals are audited! For more information, call PrivaPlan at (877) 218-7707.

Members: Click Here to Watch Previously Recorded SDCMS Seminars, Including:

  • How to Hire the Right Fit for Your Practice (2015.04.02)
  • HIPAA & EHRs: What Every Practice Must Know (2015.03.04)
  • Medicare Updates and Changes for 2015 (2015.01.29)
  • Covered California: What Your Healthcare Team Needs to Know (2014.11.13)
  • Payor Denials & Appeals: Effective Management and Best Outcomes (2014.10.09)

Email Membership@SDCMS.org for assistance in logging in.



Can You Help Spread the Message of Health by Making a Brief Presentation in Your Community? The SDCMS Foundation is partnering with the County of San Diego to educate community members on how to improve their lives and take charge of their health by launching a Live Well Physicians’ Speakers Bureau. Contact Barbara.Mandel@SDCMS.org to say YES, you will volunteer just one or two times a year, quarterly, or however your schedule allows.


“Controversy equalizes fools and wise men in the same way. And the fools know it.” — Oliver Wendell Holmes, Sr., American Physician, Poet, Professor, Lecturer, and Author (1809–1894)

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