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"News You Can Use" <> February 21, 2014



Save the Date: San Diego-wide Physician Networking Opportunity & Mixer on April 3Click Here for Details

Executive Director Comment on ICD-10: ICD-10 implementation will be painful. The “day of pain” is October 1, 2014. What are you doing TODAY to get ready? Click Here to Learn How SDCMS Can Help With Your ICD-10 Implementation

Executive Director Comment on Covered California: Got implementation problems with Covered California — either for you, your practice, or your patients? SDCMS members may email Marisol Gonzalez at MGonzalez@SDCMS.org or me at Gehring@SDCMS.org for help.


14 Measles Cases in California in 2014 (None in San Diego Yet): Click here for further information, including how to look for signs of this highly contagious disease.

All Physicians: Please take a survey on the “Knowledge, Practice, and Attitudes of Non-HIV Specialists With Regard to HIV and HIV Screening in the San Diego-Tijuana Border Region.” Click here for further details and to take this confidential, de-identified survey. The survey will identify areas where further training and intervention can help increase the identification and engagement in care of HIV-infected individuals.

Legislation Calls for Safety Warning Labels to Highlight Health Risks of Sugary Drinks: Click Here

County of San Diego Influenza Update (Feb. 19): Click Here


SGR Payment Reform Bill Moves From Committee to the Full Congress: A bipartisan, bicameral agreement to repeal the flawed SGR payment formula and establish a new, more stable Medicare payment system was announced on February 7. The bill …

  • gives small practices more time and funding assistance to transition to the new payment models;
  • ensures that physicians are involved in the development of the quality measures, clinical projects, and alternative payment models;
  • and includes California-specific language that will update GPCI, our state’s outdated Medicare payment localities, while holding the rural localities harmless from cuts.

Congress must now marry the bill to up to $150 billion in funding sources by March 31. Click here for a fact sheet on the legislation. Click here for further details from CMA.

U.S. Dept. of Health and Human Services Announces New Rule That Gives Patients Direct Access to Lab Test Results: Click Here

CMS Warns of Fraudulent Durable Medical Equipment (DME) Suppliers: Click Here for Details


Another Delay for the Cal MediConnect Project for Dual Eligibles: As of February 7, passive enrollment has been delayed by one month to May 1, 2014 (the voluntary enrollment period begins no sooner than April 1, 2014). Participating health plans in San Diego County include Care 1st, Community Health Group, HealthNet, and Molina. Click here for further details.


Save the Date: 2nd Annual Aces for Health Golf Tournament on March 13: This year’s SDCMS Foundation Aces for Health Golf Tournament, which benefits Project Access and provides healthcare to those who need our help the most, will be held on Thursday, March 13 at the Del Mar Country Club. Foursome: $1,000. Individual players: $300. Sponsorship opportunities available. Contact (858) 565-7930.

Save the Date: 17th Annual Western Health Care Leadership Academy on April 11–13: This year the Academy is thrilled to welcome keynote speaker Hillary Rodham Clinton, former secretary of state and former U.S. senator from New York. The conference will examine the most significant challenges facing healthcare today and present proven models and innovative approaches to transform your organization’s care delivery and business practices, with topics including leadership development, ACA implementation, and practice management. $100 discount if registration received on or before March 14. Visit www.westernleadershipacademy.com for more details.

Save the Date: SDCMS’s 2014 White Coat Gala Will Be Held on Saturday, June 14, 2014: At the Hyatt La Jolla at Aventine from 6:00pm to 11:00pm. J. Steven Poceta, MD, will be installed as SDCMS’s president for 2014-15, and Robert E. Peters, MD, PhD, SDCMS’s current president, will be recognized. Contact Jen with any questions at (858) 300-2781 or at JOhmstede@SDCMS.org.


Ask Your SDCMS Physician Advocate, Marisol Gonzalez: 

Member Question: For Covered California patients, is there any way physicians will know before the second month of the patient’s delinquency that they will not be paid, and that the patient is delinquent?

Answer: Just as a reminder, the grace period issue only applies to subsidized Covered California enrollees. Unfortunately, there is no way to identify which patients are subsidized versus those that are not. That’s why it’s imperative that physicians verify eligibility on their exchange patients each time they are seen (identified by the Covered California logo on their cards). This is the key to knowing whether the patient is in their grace period. If the patient is more than 30 days delinquent with their premium, the eligibility verification should indicate that the patient’s coverage is suspended.

Contact Marisol: SDCMS members who are interested in obtaining CMA’s Physician’s Guide to Covered California should contact Marisol Gonzalez, your SDCMS physician advocate, at MGonzalez@SDCMS.org or at (858) 300-2783.

Click Here to Read the February 2014 Issue of San Diego Physician Magazine: If you would like to be notified via email when future issues of San Diego Physician are ready to be read online, email Editor@SDCMS.org and include your complete name.

SDMCS’s Discounted Disability Insurance Premium May Be Raised: If you submit prior to April 1, you can lock in the older/cheaper rates. Contact Brian Gerwe at SDCMS at (858) 300-2782 or at Brian.Gerwe@SDCMS.org for additional information. Click here to request an illustration.

Microsoft to End Windows XP SP3 and Office 2003 Support on April 8, 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


Covered California Removes Provider Directory, Again: Following numerous complaints from both enrollees and providers, Covered California has removed its provider directory from the exchange website until further notice. California physicians are able to identify which exchange plans are listing them as a participating provider using CMA’s members-only physician participation lookup tool. Practices, however, should also take the extra step of verifying participation status with the health plans themselves, as they will have the most updated information. For further information on verifying participation status with the health plans, please refer to CMA’s “Surviving the Second Month of Covered California." Click here for further details.

Physicians: Do You Know if You’re Contracted to See Covered California Patients? You could have been opted in without your knowledge, depending on your contracts. For more information on which health plans are participating in Covered California, and for information on how to check your participation status with these plans, SDCMS members are invited to CLICK HERE to download a matrix that will help you answer these questions. For assistance with logging in to SDCMS’s website, call SDCMS at (858) 565-8888 or email Membership@SDCMS.org.

Exchange Enrollees Grace Period Can Affect Collections: When verifying eligibility at your practice for patients enrolled in subsidized Covered California plans, check for an inactive status; during months two and three of nonpayment, the health plan may suspend payment to your practice for any services provided and deny the claims if the enrollee’s coverage is terminated for non-payment of premiums at the end of the third month. Practices should have policies to deal with the grace period in place before March, and may require a patient to sign an agreement that they will be responsible for unpaid charges, or request payment up front. Practices may consider applying their current policies on treating uninsured or self-pay patients to those in a grace period. SDCMS-CMA members can click here to access a CMA document that answers frequently asked questions about the Covered California grace period.

Covered California Resources for SDCMS-CMA Members:

SDCMS and SDCMS Foundation Seminars and Webinars for Physicians and Office Staff:

  • Thursday, March 6: “What You Need to Know About Covered California to Inform Your Patients” • Seminar (at SDCMS) / Webinar for Physicians & Staff • 12:00pm–1:00pm • Click Here to RSVP
  • Wednesday, March 12: “Update on Covered California in San Diego County” • Seminar (at SDCMS) for Physicians & Office Staff • 6:00pm–7:30pm (Dinner Provided) • Click Here to RSVP
  • Friday, March 14: “How to S.H.O.P. (Small Business Options Program) for Health Insurance for Your Practice” • Webinar for Physicians & Staff • 12:00pm–12:30pm • Click Here to RSVP
  • Thursday, March 27: “Get in the Know: How Your Uninsured Patients Can Get Insured” • Seminar (at SDCMS) for Physicians & Staff • 5:30pm–7:30pm (Dinner Provided) • Email Victor at Victor.Bloomberg@SDCMS.org for Further Details and to RSVP

Blue Shield Exchange / Off-exchange Plans Confusing Physicians: Click Here for Details

“I can’t go on, I’ll go on.” The Ending of The Unnamable by Samuel Beckett, Irish Author (1906–1989)

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