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

"News You Can Use" <> December 18, 2015



Executive Director Final Message: After 14 years, this is my last NYCU as your CEO. If you wish to contact me in my dotage, my email will change to tom@tsgehring.net, but my cell phone remains the same at (619) 206-8282. Please don’t ever forget why you got into medicine in the first place; don’t let the mundane overwhelm the marvelous — the magic you work every day with and for your patients. Godspeed, fair winds, and following seas. Tom



Question: I was told by one of my colleagues that I would have to enroll in the Medi-Cal program because I order, refer, and prescribe for Medi-Cal patients. I do not currently participate in the Medi-Cal program. If I enroll, will I begin to get reimbursed by the Medi-Cal program? Click Here for the Answer



New POLST Forms Take Effect January 1: Click Here

Free Workshops to Help Raise Adult Immunization Rates: Click Here

Click Here to Read the County of San Diego’s Dec. 16 Influenza Watch



AMA Update on Federal Legislation: Congress has approved a $1.1 trillion spending package to fund federal agencies and programs through September 30, 2016, including a two-year delay of the “Cadillac tax” on benefit-rich health insurance plans (for 2018 and 2019), as well as a one-year delay of the health insurance tax (for 2017). Some of the other health-related provisions include the following:

  • IPAB operational funding was cut by $15 billion (although the panel has never actually been established)
  • Breast cancer screening recommendations issued by the USPTF were blocked for wo years
  • AHRQ funding was cut by $30 million (earlier House version had zeroed out agency funding)
  • Funding for NIH was increased by $2 billion
  • Funds for 9-1-1 emergency responder healthcare benefits were reauthorized and expanded
  • Additional funds were provided for opioid prescription drug overdose prevention
  • $20 million was provided for the National Diabetes Prevention Program
  • The annual ban on using CDC funding for gun violence epidemiological research was extended

A second $650 billion package extends a broad range of tax-related polices, including a two-year moratorium on the medical device tax. Click Here for Further Highlights

Interested in Becoming an AMA Alternate Delegate? Email Al Ray, MD, at Albert.X.Ray@kp.org.



Why Verify Your Patients’ Eligibility and Benefits for 2016?

  • calendar year deductibles and visit frequency limitations reset
  • open enrollment = possible changes to patients’ benefit plans
  • patients may be covered by a new payor
  • Medicare patients may have modified their enrollment choices Oct. 15 to Dec. 7
  • Covered CA open enrollment runs Nov. 1 through Jan. 31
  • existing Covered CA enrollees can change plans and/or products
  • two new plans are offering coverage on the exchange in 2016

CMA Resources:

  • Click here to access CMA’s “Covered California: Know Your Participation Status” toolkit (free to members).
  • Click here to visit CMA’s exchange resource center.
  • Click here for additional information.

United Healthcare to Delay Premium Designation Assessment Until Jan. 2017: Click Here

New Law Obliges Providers to Update Their Provider Directory Information: The law, SB 137, which takes effect July 1, 2016, underscores the importance of ensuring your demographic information, including whether or not you’re accepting new patients, is up-to-date with contracted payors and that any changes to your practice demographics are communicated to plans / insurers in a timely manner. See CMA’s members-only “Updating Provider Demographic Information with Payors.” Click Here for Further Details



CMA Practice Resources (CPR) for December 2015 / January 2016:

  • United Healthcare Issues Amendment to Physicians Participating in Core Network: Click Here
  • Physicians Urged to Preemptively File for Meaningful Use Hardship Exemptions: Click Here
  • Anthem Asking Physicians to Affirm Participation in Workers’ Comp MPNs by Dec. 31: Click Here
  • United Healthcare to Delay Implementation of Multiple Procedure Payment Reductions Until March 1: Click Here
  • DMHC Fines Blue Shield and Anthem for Provider Directory Inaccuracies: Click Here
  • DWC Reinstates Requirement to Pay Lien Activation Fees for Workers’ Compensation Claims: Click Here
  • CMS Changes Enrollment Requirements for Part D Prescribers: Click Here
  • The Coding Corner: “Initial” vs. “Subsequent” vs. “Sequela” in ICD-10-CM Coding: Click Here

Achieving Meaningful Use Woes? The SDCMS Foundation can provide FREE technical assistance for primary care physicians AND specialists working to attest for Medi-Cal incentive funds. Working to attest for Medicare incentive prior to year-end? Help is at hand as well. Providers can attest according to the old rules if their reporting period is prior to December 15, 2015. Get help with these difficult hurdles! For further information, email Victor.Bloomberg@SDCMS.org or call the SDCMS Foundation at (858) 300-2779.



Physicians Networking Opportunity and Mixer on Feb. 4 — Please Let Us Know if You Can Make It! You are encouraged to attend an upcoming SDCMS Physician Networking Opportunity and Mixer on February 4, 2016. Come learn more about your county medical society while you mingle, socialize, and network with your fellow San Diego County physicians. Complimentary hors d’oeuvres and drinks will be served! RSVPs are required as space is limited.

  • When: Thursday, February 4, 2016, 5–8pm
  • Where: Handlery Hotel in Mission Valley
  • Click here to Register for the Vendor Fair & Mixer
  • Grand Prize Giveaway: One Night Stay + Dinner for Two at A.R. Valentine!

If you have any questions, contact Jen Ohmstede at JOhmstede@SDCMS.org or at (858) 300-2781. Please help spread the word with your colleagues. Hope to see you there!

Physicians Needed to Mentor UCSD Undergraduates: UC San Diego’s Health and Medical Professions Preparation Program (HMP3) is catered to undergraduates in search of career guidance under the mentoring of clinical professionals. They are seeking physicians who can offer shadowing / advising opportunities for these students. For more information, click here.

Help Spread the Message of Health by Making a Brief Presentation in Your Community: Educate children, adults, seniors, and employees on how to improve their lives and take charge of their health through the Live Well San Diego Speakers Bureau. Email Andrew.Gonzalez@SDCMS.org at the SDCMS Foundation to say YES, you will volunteer just one or two times a year, quarterly, or however your schedule allows.


Happy Holidays From Your SDCMS and SDCMS Foundation Support Teams!

Comments are closed.