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"News You Can Use" <> July 16, 2014



Do You Have a Love / Hate Relationship With Outlook? Maybe more hate than love? Join me at a Taming Microsoft Outlook workshop on Saturday morning, September 13, from 8:00am to noon. Click Here for Details and to Register

NO ON PROPOSITION 46 — MICRA Lawsuit Measure Assigned Proposition #46: If approved by voters on November 4, 2014, Proposition 46 would increase health costs, reduce access to care, and threaten patient privacy, all to make it easier and more profitable for lawyers to sue doctors and hospitals. In addition, Proposition 46 contains a number of unrelated provisions designed to mislead and deceive voters, including a little-discussed mandate relying on a massive expansion of a government-run prescription drug database, which third-party analysts say cannot be implemented as written and will leave personal medical information vulnerable to privacy breach. For these reasons, health providers, education groups, labor unions, business organizations, working men and women, and community clinics have all announced their opposition to Proposition 46. For information on how you can help stop this healthcare lawsuit measure, visit www.NoOn46.com.

California Democratic Party to Remain Neutral on Proposition 46: Backers of Proposition 46 were dealt another severe blow this past weekend when, despite their intense lobbying, the Executive Board of the California Democratic Party rejected their efforts to gain an endorsement, instead voting to remain neutral. Click Here


Chikungunya Case Confirmed in San Diego County Resident: Click Here for Details

DEA Makes Tramadol a Schedule IV Drug — Effective August 18, 2014: Click Here for Details


CMS Issues 2015 Medicare Physician Payment Proposed Rule: Click Here

HIPAA Audits to Resume Shortly; Physicians Need to Be Compliant: Click Here


Lawsuit Filed to Stop Cal MediConnect Dual Eligible Demonstration Project: Click Here for Details

Executive Director Comment: The MICRA fight is multi-dimensional — we have to be ever vigilant to address all the threats!

CMA Files Brief With California Supreme Court in MICRA Constitutionality Case: Click Here for Details

Error on Anthem ID Cards — Listing Patients as PPO When They Are Actually EPO — Results in Claim Denials: At CMA’s urging, Anthem corrected the affected patient ID cards and reissued new cards to EPO patients whose old cards indicated they had purchased PPO products. Anthem also confirmed they have updated the information that displays when physicians verify eligibility to accurately reflect the correct product type. Anthem was unwilling to automatically reprocess affected claims at the PPO rates; they are requiring patients to appeal each individual claim to Anthem. Patients who are unsuccessful in their appeal to Anthem can contact the Department of Managed Care’s Help Center at (888) 466-2219. Click Here for Details

DHCS Continues Fixes to Computer Systems for ACA Primary Care Rate Increases in order to process individual fee-for-service (FFS) claims at the new higher rates under the ACA primary care provider rate increase. Click Here for Details

Primary Care Physicians: There’s Still Time to Attest! Eligible physicians who have already attested have received over $200 million in ACA primary care rate increases — don’t miss out! To qualify for enhanced payments for fee-for-service Medi-Cal and Medi-Cal managed care plans, you must first self-attest to your eligibility. The deadline to attest, if you haven’t already done so, is December 31, 2014. If you have attested and not received your additional funds, you should confirm the accuracy of the information submitted through the attestation process. If you have questions, call Medi-Cal’s Telephone Service Cente r at (800) 541-5555. For more information, see CMA’s “Medi-Cal Primary Care Physician Rate Increase FAQs." Click Here for Details

State Budget Includes $7 Million for Primary Care Residency Slots: Click Here


September 20 CPPPH Workshop for Physician Health Committees: The California Public Protection & Physician Health, Inc. (CPPPH) is holding a workshop for members of medical staff and medical group physician health committees on Saturday, September 20, 9:00am to 12 noon, at the SDCMS Foundation, 5575 Ruffin Road, Suite 250, San Diego, CA 92123. Advance registration is required — click here.

Sign up for SDCMS Foundation’s Solana Beach Sunset 5K Run / Walk on Saturday, September 27, Promoting Healthier Lifestyles and Diabetes Prevention: Be a role model for your office staff and patients by organizing a team and inviting them to join you on the beach at low-tide at sunset for a late afternoon of fun. Any physician-led team of 20 or more will also receive team T-shirts customized with your own team name and identification. Click Here for Details

SDCMS Leader’s Toolkit Workshop on September 27–28: Participants will learn real world skills and will leave with actionable behaviors, tools, and concepts to help them be effective leaders in organized medicine. Some of the issues covered include change management, leading a team, responsibilities of a leader, setting boundaries and priorities, time management, parliamentary procedure, and understanding and leveraging critical relationships. To reserve your spot, email me at Gehring@SDCMS.org.

Free Work-Life Balance Workshop on Saturday, October 11: Take an honest look at your life, reacquaint yourself with what you find most meaningful, and then make the changes that will bring your life into greater balance! Join your colleagues and Helane Fronek, MD, certified physician development coach, on Saturday, October 11, from 9:00am to noon to begin to see your life, and your choices in it, in a new light! Workshop limited to 12 physicians. Email Dr. Fronek at hsfronek@aol.com for details or to reserve your spot today!

Thank You to the 1,600+ Physicians Who Participated in This Year’s “Physicians of Exceptional Excellence” Selection of San Diego’s Top Docs: Selectee notification letters will be mailed out on July 18, 2014, and the gala honoring selectees will be held on Saturday, November 1 at the Birch Aquarium — mark your calendars!


Ask Your SDCMS Physician Advocate, Marisol Gonzalez:

  • Member Question: One of the IPAs we are contracted with is asking for a refund. The date of service for the claim is over a year ago. Are they allowed to ask for a refund for a service done so long ago?
  • Answer: Knox-Keene plans may not request reimbursement for the overpayment of a claim unless the payor sends a written request for reimbursement to the physician within 365 days of the “Date of Payment” on the overpaid claim. This limit applies to all Knox-Keene plans (HMOs, and most Blue Shield and Blue Cross plans) and their contracting medical groups / IPAs (payors). This 365-day limit does not apply if the overpayment was caused in whole or in part by provider fraud or misrepresentation. For more information, see CMA’s ON-CALL document #7512, “Plan Requests for Refunds from Physicians.” SDCMS-CMA members can obtain this document by contacting Marisol Gonzalez, your SDCMS physician advocate, at MGonzalez@SDCMS.org or at (858) 300-2783.ext.

In Case You Missed SDCMS’s July 10 OSHA Seminar: Click Here — Email Membership@SDCMS.org for Login Assistance

Receive Specialty-specific Physician Compensation Data! SDCMS member physicians who would like to receive specialty-specific compensation data from SDCMS’s 2013 Physician Workforce and Compensation Survey can email Gehring@SDCMS.org.

CMA Practice Resources for July 2014:

  • Three Things Physicians Can Do to Avoid High Virtual Credit Card Fees: Click Here
  • Renew Early! Physicians Renewing Licenses Experiencing Delays: Click Here
  • Change in Mailing Address for Medi-Cal TAR Submissions: Click Here
  • The Coding Corner: Modifier 22 — Reporting and Reimbursement: 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


Health Net Requesting Amendment to Physician Contracts: Health Net has notified physicians who are currently participating in its Covered California individual / exchange and/or SHOP HMO and PPO products of a request to amend the Health Net Provider Participation Agreement after Covered California imposed a requirement that qualified health plans (QHPs) make reasonable efforts to obtain agreement from participating physicians to allow plans to share physicians’ reimbursement rates with the exchange. Click Here

Provider Access Issues Plague Anthem and Blue Shield as DMHC Begins Investigation: CMA has urged Covered California to address this and other issues before the next open enrollment period: November 15, 2014 – February 15, 2015. As part of the audit, DMHC has hired pmpm Consulting to contact physicians to ask about your participation status with the two plans. If you are contacted by pmpm Consulting, CMA strongly encourages you to respond to their questions. As well, if you are experiencing difficulties finding in-network providers you can refer patients to, please notify CMA so that CMA can raise the issue with the plan, with Covered California, and with the appropriate regulator. Click Here for Details

Resources for SDCMS-CMA Member Physician Practices Only:

Resources for All Physician Practices:


Physicians Return to Practice With Help of Online Retraining Program: Click Here

“We cannot seek or attain health, wealth, learning, justice or kindness in general. Action is always specific, concrete, individualized, unique.”
— John Dewey, American Philosopher, Psychologist, and Educational Reformer (1859–1952)

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