Send us an email at NYCU@SDCMS.org to sign up for our bi-weekly e-newsletter!

"News You Can Use" <> December 10, 2013



Executive Director Comment: You run a real risk of not getting paid for your services if you don’t religiously and systematically check eligibility.

Starting on January 1, Verifying Eligibility for Patients — New and Current — Becomes Mission Critical: Please carefully review the details — click here — with your front office staff.

Want to Know if You Are Listed as a Covered California Provider? Click Here

Practice Managers / Office Managers: Please Take the 2013 SDCMS Medical Office Salary Survey! Takes 5 minutes, it’s anonymous, and anyone who completes the survey may receive a copy of the results. Click Here to Take the Survey Now

Executive Director Comment: It’s déjà vu all over again …

CMS Releases Physician Fee Schedule Final Rule — 24% Pay Cut Scheduled for January 1, 2014: CMS also issued two factsheets (Final Policy and Payment Changes to the Medicare Physician Fee Schedule for Calendar Year 2014 and Changes for Calendar Year 2014 Physician Quality Programs and the Value-Based Payment Modifier). Although the rule was issued nearly a month late, it is still scheduled for imp lementation January 1, 2014 (though CMS has agreed to extend the period in which doctors can change their Medicare participation status to the end of January 2014). Unless Congress acts this month, physicians face a net reduction in payment rates of about 24%. Contact Congress and tell lawmakers to Fix Medicare Now!

Free SDCMS “Preparing to Launch” Workshop for Residents and Young Physicians on February 1: Figuring out life after residency? Attend SDCMS’ “Preparing to Launch” workshop on Saturday, February 1, 2014. Click here for details. Contact Jen to register at (858) 300-2781 or at JOhmstede@SDCMS.org.


Tick-borne Disease in San Diego County: Click Here

Chickenpox Exposure at County North Region Family Resource Center: Click Here

Executive Director Note: The holidays are the best of times, and the worst of times. If you need help — members and non-members — call CMA’s Physician Confidential Line, a peer-to-peer referral service for physicians in need of assistance with substance abuse, stress, anger management, and other similar health issues, at (213) 383-2691. Click Here for Details


Trial Lawyers Begin Collecting Signatures for Anti-MICRA Ballot Initiative: From Redding to San Diego, canvassers are gathering signatures to qualify an initiative for the November 2014 ballot to gut MICRA.

The initiative is framed as an effort to ensure patient safety through mandatory random and situational drug testing of physicians, with provisions (in the fine print) that would gut the MICRA reforms and patient protections. The CMA-led collation working to protect MICRA has published a patient education brochure. To learn what you can do to help, visit www.cmanet.org/micra. Click Here for Further Information

Executive Director Comment: The best thing you can do is pay your dues or join SDCMS — it’s truly “all hands on deck.”


Six Large State Medical Societies Support CMA’s Medicare Geographic Payment Locality Update: Six of the largest medical associations in the United States have signed a letter to the chairman of the Senate Finance Committee and the House Ways and Means Committee asking them to incorporate the California locality update into the legislation to repeal the flawed Medicare Sustainable Growth Rate (SGR) formula. In July, the House Energy and Commerce Committee unanimously approved another bipartisan bill — which does include a CMA-sponsored “GCPI fix” — to overhaul the SGR. The bill would also hold the physicians in rural counties harmless from the corresponding cuts that would otherwise occur. Click Here for Details

Would You Like Covered California Consumer Materials for Your Office Waiting Room? Call (858) 300-2789. SDCMS Foundation staff can provide training for your office staff to assist patients in understanding their healthcare insurance options. Call Barbara Mandel, SDCMS Foundation Executive Director, at (858) 300-2777.

Covered California Deadline Extended, Resources Added: In order to have coverage go into effect on January 1, 2014, patients must now complete their enrollment by December 23, 2013. Physicians interested in purchasing health insurance for employees through SHOP can use the new self-service website (http://www.coveredca.com and click on “small business”) for coverage effective January 1, 2014. Covered California’s SHOP plans were negotiated to bring a standardized set of benefits, a robust provider network, and a broad choice of health insurance plans with competitive pricing to employers and their employees. For more information visit http://www.coveredca.com, or for in-office presentation s for you and your staff contact Victor.Bloomberg@SDCMS.org.

Covered California Webinar for Physicians on Thursday, December 19, 12:00pm–1:00pm: Need clarification on Covered California, and how to inform your patients of their options? Join the webinar, presented by Kena Burke, CMA Foundation Covered California project manager, on Thursday, December 19 at noon. This will be a real-time webinar, with opportunities to get answers to your questions. Click here to register. For more information, email Barbara.Mandel@SDCMS.org.

Executive Director Comment: If you got a letter from the Medical Board ordering you to “cease & desist” from conducting any daily deal marketing arrangements with sites such as Groupon, Living Social, and Amazon, it’s a fraud!

Medical Board Not Behind ‘Daily Deal’ Cease and Desist Letters: The Medical Board of California issued a statement that it did not author a letter apparently coming from its Discipline Coordination Unit warning physicians to immediately “cease and desist “ from conducting any daily deal marketing arrangements with sites such as Groupon, Living Social, and Amazon. Physicians should, however, use caution when using such sites. Click Here for Further Information

Anthem Blue Cross Posts Social Security, Tax Numbers of 24,500 Doctors: Click Here


PQRS Deadline Looming! If you have not yet started reporting, the deadline to avoid a 1.5% fee schedule penalty in 2015 is fast approaching. There is still time to report at least one valid individual measure via claims for dates of service in 2013. There are many measures that only need to be reported once per reporting period (January 1 through December 31, 2013) that meet the requirement. The 2013 Physician Quality Reporting System (PQRS) Implementation Guide is a good place to start to identify any measure that might pertain to the physician’s practice. The 2013 PQRS Individual Claims Registry Measure Specification Supporting Documents provides the specifications that must be met in order to report the measure (frequency of reporting, procedure codes, diagnosis codes, and reporting measure code(s)). Remember, you cannot go back and add a measure code to claims already submitted. CMA has also developed a guide, Getting Started with the Physician Quality Measure System, which is available free to members. If you have any questions, please contact Marisol at (858) 300-2783 or at MGonzalez@SDCMS.org.

CMS to Implement Ordering and Referring Denial Edits Beginning in January 2014: Click Here

Meaningful-use Deadline Pushed Back One Year: Click Here

Congress Approves Final Version of Compounding Legislation: Click Here for Details

Medicare E-prescribing 2012 Feedback Reports Available: Physicians and group practices that submitted data for the 2012 Electronic Prescribing (eRx) Incentive Program can now access their 2012 eRx Incentive Program Feedback Reports in one of two ways:

  1. Taxpayer Identification Number (TIN)-level reports are available for download on the Physician and Other Health Care Professionals Quality Reporting Portal (Portal) via QualityNet. TIN-level reports on the Portal require an Individuals Authorized Access to CMS Computer Services (IACS) account. IACS Quick Reference Guides are available on the Portal and these guides provide step-by-step instructions on how to request an IACS account and access the Portal.
  2. NPI-level reports can be requested through the Communication Support Page by creating a NPI-level feedback report request. The report will be sent electronically within 2 to 4 weeks to the email address provided in the request.

For more information about how to request an informal review, please read the 2012 eRx Incentive Program Informal Review Made Simple fact sheet. For other questions related to the eRx Incentive Program, physicians should contact the QualityNet Help Desk at (866) 288-8912 or qnetsupport@sdps.org.

Update on Incarcerated Beneficiaries Issue: This summer, CMS initiated recoveries from providers and suppliers based on data that incorrectly identified some Medicare beneficiaries as incarcerated or in custody. AMA and state medical societies sent a letter on Aug. 23, urging the agency to halt recoupments based on these data. CMS has now published a Frequently Asked Questions (FAQ) document outlining the resolution timeframe and process for these claims. CMS also posted a special factsheet that restates CMS’ policy regarding Medicare coverage for incarcerated beneficiaries.


Ask Your SDCMS Physician Advocate, Marisol Gonzalez: 

Member Question: I renewed my medical license online, paid the fee and it was approved. My employer notified me that I cannot start working because my license is still being listed on the Medical Board of California’s website as expiring at the end of the month. I looked over my application again, and I think it’s because I answered one of the questions incorrectly. I have to remedy this ASAP so that I can begin working, and I am getting absolutely nowhere on my own. Is there any way SDCMS-CMA can help?

Answer: There are times when CMA can assist with urgent situations such as these on behalf of SDCMS members. In this particular instance, CMA was able to work with its contacts at the Medical Board of California to facilitate the renewal of this physician's medical license within the day. The issue resolved, this very grateful (and relieved) SDCMS-CMA member physician was able to start working immediately.

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

CMA Updates Its Exchange Toolkit — "A Physician's Guide to Covered California" — to Reflect Key Developments: Click Here

Young Physicians: Win $5,000! The Doctors Company Foundation’s Patient Safety Award — Share your personal essay on how a patient safety event impacted your learning and growth. $5,000 awards. Deadline February 3, 2014. 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


Will You Let a Pre-med Student Shadow You? The Student-Physician Shadowing Program at SDSU is looking for physicians who will allow pre-medical students the opportunity to shadow them. For more information, contact Dunia Anwar at sdsu.peeradvisors@gmail.com.

“The ideas that have lighted my way and, time after time, have given me new courage to face life cheerfully have been Kindness, Beauty, and Truth.” — Albert Einstein (1879–1955)

Comments are closed.