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"News You Can Use" <> January 10, 2014



Executive Director Comment: Yesterday, we learned that the governor's 2014-15 budget will eliminate the retroactive 10% cuts in Medi-Cal reimbursements that would have dated back to June 2011. This is good news, but we will continue to advocate for a complete stop to the prospective 10% cuts in Medi-Cal reimbursements. CMA is reviewing the entire budget, and we will send updates as they become available.

SDCMS-CMA Members: Please Download CMA's "Surviving the First Month of Covered California" Tip Sheet: Click here to download CMA's tip sheet. For assistance with logging in, contact SDCMS at (858) 565-8888 or at Membership@SDCMS.org.

Trying to Figure Out Life After Residency? Clueless on lawyers and accountants and insurance and investing and job interviews and etc. …? Then Attend SDCMS’ free “Preparing to Launch” Workshop on Saturday, February 1. Click here for details. Contact Jen to register at (858) 300-2781 or at JOhmstede@SDCMS.org.

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 will receive a copy of the results. Click Here to Take the Survey Now

Meet Dr. Madara, the CEO of the American Medical Association (AMA), at a UCSD/AMA Evening Reception on “Professional Satisfaction, Practice Sustainability, and Innovations Shaping Delivery and Payment Models”: Pre-registration is required. Thursday, January 30, 2014, 5:30pm–7:30pm, at the UC San Diego School of Medicine. Click here to register (Note: You will be prompted to log in to the AMA website — use your existing AMA website account sign-in or create an account for yourself by following the instructions online). Email Catherine Dooley at cadooley@ucsd.edu or call (858) 534-9192 with questions. Hosted by the American Medical Association (AMA) and the UC San Diego School of Med icine.


Influenza Updates: From the California Department of Public Health and from the California Health Alert Network (CAHAN).


President Signed Law Providing 0.5% Raise for Medicare Through March 31, 2014: Thereby stopping a scheduled 25% cut on December 31, 2013. Negotiations for a long-term solution to the SGR are ongoing. Click Here for Details

There is no ADDITIONAL 2% Medicare sequestration cut in 2014, though the January 2013 2% sequestration cut stands.

Check the 2014 Medicare Fee Schedule for the Impact on Your Individual Practice: While there is a 3.7% increase in the Medicare fee schedule conversion factor, it was made to make the fee schedule budget-neutral due to the myriad Relative Value Unit (RVUs) changes. There are so many changes in the 2014 fee schedule impacting physicians differently by specialty, codes billed, and geographic region that it is better to consult the fee schedule for the impact on each individual physician or physician group. SDCMS-CMA members can download CMA’s Financial Impact Worksheet, which allows doctors to enter the CPT code, frequency billed, old rate, and new rate to automatically calculate the net impact to their practice.


Duals Demonstration Project Update: On April 1, 2014, notices will be mailed to those beneficiaries who will be enrolled in the Medicare / Medi-Cal Dual Eligible demonstration project. To download San Diego-specific sample letters physicians can send to patients, SDCMS-CMA members who are contracting physicians can click here, and SDCMS members who are noncontracting physicians can click here. Click here for further information on the state’s plan and other resources for physicians to help them through this transition.

Annual $6 Medical Board of California (MBC) Fee to Support CURES: Click Here


Ask Your SDCMS Physician Advocate, Marisol Gonzalez:

Member Question: With Covered California patients, there will be a 90-day grace period for subsidized enrollees. So, according to federal law and guidance thus far, what happens to claims incurred during that 90-day grace period?

Answer: According to CMA’s Physician’s Guide to Covered California (available free to members), federal regulations on qualified health plans require exchange plans to only pay for claims incurred during the first 30 days of the grace period as though the patient was eligible. The ACA allows exchange plans to “pend” or “deny” claims incurred during months two and three of the grace period. If the patient fails to settle up with the plan within the three-month grace period, the plan could terminate coverage and deny all “pended” claims incurred in those last two months. As a result, physicians could have been in a position of providing services for up to 60 days in good faith, only to be stuck absorbing a huge loss, which coul d be significant in terms of practice viability.

In California, health plans will be required to represent that a patient’s coverage is suspended in months two and three of the grace period for subsidized exchange enrollees, meaning that such patients are effectively uninsured in California when they reach the second month of the grace period. These patients, however, have the opportunity to have their coverage reinstated prior to the expiration of the three-month grace period.

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.

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


Would You Like Covered California Consumer Materials for Your Office Waiting Room? Call (858) 300-2789

Deadline for Consumers to Pay Their First Month’s Premium Extended: After a spike in enrollment last month, Covered California has extended the deadline for consumers to pay their first month’s premium to January 15. Approximately 200,000 households have signed up for coverage due to take effect January 1. Health insurance companies stress that this is a one-time payment deadline extension, and that payment for coverage is due at the beginning of each month.

SDCMS and SDCMS Foundation Seminars and Webinars for Physicians and Office Staff — Email Jen With Questions at JOhmstede@SDCMS.org or call (858) 300-2781:

  • Wednesday, January 22, 12:00pm–1:00pm: Covered California: What You Need to Know to Inform Your Patients (seminar at SDCMS’s offices, 5575 Ruffin Rd., Ste. 250, San Diego 92123, or webinar)
  • Wednesday, January 29, 12:00pm–12:30pm: Covered California: How to SHOP for Health Insurance for Your Practice (webinar)
  • Thursday, February 13, 12:00pm–1:00pm: Covered California: What You Need to Know to Inform Your Patients (seminar at SDCMS’s offices, 5575 Ruffin Rd., Ste. 250, San Diego 92123, or webinar)
  • Thursday, February 13, 5:30pm–7:00pm: Covered California for Physicians: What You Need to Know to Inform Your Patients and How to SHOP for Insurance for Your Practice (seminar at SDCMS’s offices, 5575 Ruffin Rd., Ste. 250, San Diego 92123, dinner served)
  • Wednesday, February 19, 12:00pm–12:30pm: How to SHOP for Health Insurance for Your Practice (webinar)

Covered California: Update and Preliminary Thoughts (Dec. 30) From Ted Steuer, Executive Director, Physician Partners: Click Here

“The changes in our life must come from the impossibility to live otherwise than according to the demands of our conscience … not from our mental resolution to try a new form of life.” — Leo Tolstoy, Russian Writer (1828–1910)

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