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"News You Can Use" — August 14, 2013



<> So How Are You Doing on Your Preparations for the ICD-9 to ICD-10 Transition Next Year? 10 questions physicians need to be asking themselves -- video by SDCMS CEO, Tom Gehring:

<> MICRA Watch: Trial Attorneys Have Submitted Ballot Language to Repeal Key Provisions of MICRA: SDCMS members must be well versed on California's landmark malpractice reforms and why they are crucial to the continued viability of physician practices in California. Click Here

<> Sunshine Law Now in Effect: Manufacturers of drugs, medical devices, and biologics that participate in federal healthcare programs must track and report certain payments and items of value. Click Here


<> Updated MERS-CoV Guidance From CDC: CDC recommends testing for MERS and other respiratory pathogens be done simultaneously in patients who meet the clinical and epidemiologic criteria for MERS testing, and that positive results for another respiratory pathogen not preclude testing for MERS. Click here for an updated case definition for a "probable case." CDC also clarifies which specimens should be obtained for MERS testing in the new guidance. 

<> 13 San Diego County Residents Diagnosed With Confirmed or Probable Invasive Meningococcal Disease In 2013: Click Here 

<> New Online Course for Clinicians Caring for Patients With Addiction: Click Here


<> CMA Negotiates Substantial Positive Changes to Bill to Fund and Upgrade the CURES System: Click Here

<> Physicians Urged to Call Gov. Brown and Ask Him to Sign the Maddy EMS Fund Bill: Without SB 191, cosponsored by CMA and the American College of Emergency Physicians (ACEP), providers of emergency medical care throughout the state will lose $50 million per year that is currently used to offset the costs incurred for care provided to uninsured patients in hospital ERs. Tell the governor to sign this critical bill by calling, emailing, and tweeting him. He has until August 28 to sign it into law. To contact the governor:

  • Phone: (916) 445-2841
  • Email: http://govnews.ca.gov/gov39mail/mail.php
  • Twitter: @JerryBrownGov (Tweets should include #SaveTheMaddyFund, #SignSB191, or #SB191 so that we can track if the hashtags are trending.)

For sample letter and talking points, click here. For further details, click here.

<> CMA Files Amicus Brief in Important Causation Case: The case looks at whether a third-party bears the burden of liability in a case of an accidental death caused by a criminal act. Click Here

<> Anthem Blue Cross Notifies Nearly 1,000 Practices of Intent to Terminate Medicare Advantage PPO Contracts: Click Here

<> San Francisco Appellate District Court Affirms MICRA's $250,000 Cap on Non-economic Damages: Click Here

<> Blue Shield Automatically Opts Some Practices Into Exchange Products: On June 27, Blue Shield of California notified 1,431 physician practices that they were being automatically included in either the Blue Shield Individual and Family Plan (IFP) EPO or PPO network, with both being offered within and outside of the California health benefits exchange, Effective January 1, 2014. Physicians who agree with the change are not required to take any action. For physicians who do not agree with the proposed change, Blue Shield has advised CMA that there is no ability for physicians to opt out of just this IFP product. Physicians do, however, have the ability to terminate the underlying Blue Shield PPO contract prior to the effective date. Click Here

<> Healthy Families August 1 Medi-Cal Transition May Cause Physicians to Lose Patients: For more information on the Healthy Families transition, see the DHCS FAQs. Click Here


<> Are You Prepared for the September 16 Medicare Part B Transition From Palmetto to Noridian?

  • CMA's Medicare Transition Webpage: Click Here
  • CMA's Medicare Transition Guide: What Physicians Need to Know (includes CMA's Medicare Transition Preparation Checklist): Click Here
  • SDCMS's Resources Webpage: Click Here
  • Noridian Ask-the-Contractor Teleconference on August 21, at 2:00pm (PST); call-in #: (800) 230-1059; no registration required. Click here for details (accept the "End User Agreement for Providers" and then click on "Schedule of Events")

<> IOM Concludes Geographically Based Value Index for Medicare Won't Save Money: Congress should not adopt a geographically based value index for Medicare because healthcare decisions are not made at the regional level, but rather at the physician or organizational level, an Institute of Medicine (IOM) committee has concluded. Click Here


<> SDCMS Survey on Mandated Reporting of Elder Abuse: If you see geriatric patients, please click here to take a (very short) survey.


<> CMA Creates Medicare Transition Checklist for Physicians: The transition from Medicare claims contractor Palmetto GBA to Noridian takes place on September 16, 2013 (Part B). Click Here

<> Free Help for Primary Care Practices to Complete Meaningful Use Attestation on Tuesday, September 17 at SDCMS's Offices: The SDCMS Foundation staff and technical assistors will be onsite from 6:00am to 9:00pm for hourly appointments. Practices must have registered for the CMS EHR incentive program and/or the Medi-Cal EHR incentive program by September 10, and have 2012 provider eligibility documentation and 90-day dashboard reports to attest. Contact Victor Bloomberg at Victor.Bloomberg@SDCMS.org or at (858) 300-2791 to make an appointment. Call now to assure you have all the required materials!

<> Don't Lose Your TDC Discount! SDCMS members who receive a professional liability insurance discount from The Doctors Company (TDC) must complete one approved risk management program once every two years. There are six simple options to accommodate your schedule, each of which only takes approximately one hour of your time. Click Here 

<> Q&A With Marisol Gonzalez, Your SDCMS Physician Advocate:

  • Question: With Covered California, the offered "in-network" rates have been less than Medicare for most physicians, so 100% Medicare would obviously be better. As to UCR, that would be determined by who or by what?
  • Answer: There are no federal requirements on UCR levels for the commercial health plans, which allows the plans to determine UCR on their own as they are allowed to do in the commercial market. Depending on the plan and their network, there may be some negotiating room for physicians as we get closer to the go-live for the exchange. Once the directory is posted (CMA expected July, but has been postponed by the exchange until at least August), CMA will be looking closely at potential network holes but would also encourage physicians to review the directories as well as it could help get a better sense of potential negotiating power.

SDCMS members are invited to contact Marisol with their practice management questions at (858) 300-2783 or at MGonzalez@SDCMS.org.

<> August 2013 CMA Practice Resources:

  • Aetna Unable to Locate Written Contracts for Some Southern California Providers: Click Here
  • Update to Healthy Families and Medi-Cal Rural Expansion Transitions: Click Here
  • Medicare Requests Refunds of Incorrect HPSA Bonus Payments: Click Here
  • Attestation Process for Medi-Cal Primary Care Rate Increase Now up and Running! Click Here
  • Anthem Blue Cross to Terminate 1,000 Medicare Advantage PPO Contracts: Click Here
  • Anthem Blue Cross Announces Changes to Reimbursement Policies and Claims Software: Click Here
  • Learn About Noridian's Provider Portal, Endeavor: Click Here
  • The Coding Corner: The Top Five Essential Tips for Successful Appeals: Click Here

<> Follow SDCMS' Twitter Feed and Get a Treasure Trove of Healthcare News Delivered Daily to Your Smartphone: Click Here

<> Is Your Office Manager / Practice Administrator Using SDCMS' Online Forum? Click Here to Join

A few can touch the magic string,
and noisy fame is proud to win them: —
Alas for those that never sing,
but die with all their music in them!

— Oliver Wendell Holmes, Sr., American Physician, Poet, Professor, Lecturer, and Author (1809-1894)

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