"News You Can Use" <> October 4, 2013 October 4, 2013 Covered California, Medi-Cal, Medicare, MICRA, Noridian, PPACA Covered California, MBC, Medi-Cal, Medical License, MICRA 0 CONTENTS: The MBC Is Currently Transitioning to a New Database — Online License Renewals Affected! Primary Care Physicians: Before Receiving Increased Medi-Cal, You Must First Attest to Your Eligibility! SDCMS’s 2013 San Diego County Physician Workforce and Compensation Survey MICRA Fight Contribution Update — Hospital Medical Staffs MICRA Fight Contribution Update — Specialty Groups CMA House of Delegates Participation CDC Releases Prevention and Control of Seasonal Influenza With Vaccines, 2013–14 MICRA Sustained by Judiciary AGAIN! CMA Files a Petition With the Supreme Court to Block the 10% Medi-Cal Physician Reimbursement Cut Legislation Signed by the Governor Sponsored or Supported / Modified by CMA Bad Bills Killed in the Legislature California's Health Insurance Exchange Toolkit Blue Shield Announces Fee Schedule Changes Effective December 1 Health Net to Allow Physicians to Obtain a Retroactive Authorization Changes to Anthem Blue Cross Reimbursement Policies and Claims Software Become Effective November 1 Cigna Recontracting With Thousands of Physicians in Southern California DHCS Webinars on What Physicians Need to Know About the Coordinated Care Initiative What Will Medicare Reimburse for Flu Vaccine? PQRS Payment Penalties Starting in 2015 Medicare Transition Update Ask Your SDCMS Physician Advocate HIPAA Resources CMA Practice Resources October 2013 Follow SDCMS’ Twitter Feed Is Your Office Manager / Practice Administrator Using SDCMS’ Online Forum? Welcome to Our New and Rejoining SDCMS-CMA Members! Nominate Your Office Manager for SDCMS' 5th Annual "Outstanding Medical Office Manager" Contest Today! ABOVE THE FOLD Executive Director Comment: If you need to renew your medical license in the next 30 days, READ THIS (directly below)!!! The Medical Board of California (MBC) Is Currently Transitioning to a New Database — Online License Renewals Affected! The MBC sends out renewal applications by U.S. mail to the physician’s address of record approximately 90 days prior to the license expiration date. At this time, if you need to renew your license, the online renewal option will not be available during the month of October 2013. Online renewals are usually processed within 48–72 hours, but, because this option is down, the MBC is recommending that renewals be mailed in. Depending on when the renewal paperwork is received, it will typically take 7 to 8 weeks to process. Click here for the FAQ section of the MBC website regarding license renewals. SDCMS Members: If you have any questions, please contact your SDCMS physician advocate, Marisol Gonzalez, at MGonzalez@SDCMS.org or at (858) 300-2783. Primary Care Physicians: Before Receiving Increased Medi-Cal, You Must First Attest to Your Eligibility (and time is running out!): Click Here Members & Nonmembers: Click Here to Complete SDCMS’s 2013 San Diego County Physician Workforce and Compensation Survey — 5 Minutes Tops! MICRA Fight Contribution Update — Hospital Medical Staffs: Scripps Mercy: $33,000 Rady Children’s: $33,000 Sharp Memorial: $33,000 Scripps La Jolla: $33,000 Scripps Encinitas: $10,000 Alvarado: $10,000 Tri-City: $5,000 Important Note: The California Hospital Association matches hospital medical staff contributions 2:1, in other words, medical staffs have raised $475,000, plus the $22,000 below, or almost $500,000 for San Diego! MICRA Fight Contribution Update — Specialty Groups: San Diego Pathology: $10,000 San Diego Imaging: $12,000 CMA House of Delegates Participation: If you are interested in participating in the annual House of Delegates for SDCMS-CMA — a great opportunity to help shape the future of medicine in California — and you're able to commit to being in Anaheim from 8:00am on Friday, October 11, to noon on Sunday, October 13, please call me (Tom) on my cellphone at (619) 206-8282. MEDICAL CDC Releases Prevention and Control of Seasonal Influenza With Vaccines, 2013–14: Click Here STATE MICRA Sustained by Judiciary AGAIN! On Sept. 23, the Second Appellate District Court issued its opinion upholding the constitutionality of MICRA’s non-economic damages cap. Executive Director Comment: So, while the judiciary keeps reaffirming MICRA, and the Legislature refuses to change it, the trial lawyers are bypassing both by going to the ballot box — that’s why we need your help! A!! hands on deck! CMA Files a Petition With the Supreme Court to Block the 10% Medi-Cal Physician Reimbursement Cut: Click Here Legislation Signed by the Governor Sponsored or Supported / Modified by CMA: AB 565: Expands the ability of residents to work in underserved areas and reduces their medical school debt. SB 809: Creates a funding source for the Controlled Substance Utilization Review and Evaluation System (CURES) database, reduces the fee impact on physicians, and simplifies and streamlines the enrollment process. Bad Bills Killed in the Legislature: CMA defeated the attempt by nurse practitioners to gain independent practice in California (SB 491: Nurse Practitioners). CMA defeated efforts by optometrists seeking to diagnose and treat diseases in patients (SB 492: Optometric Corporations). CMA defeated efforts by pharmacists to provide some primary care (SB 493: Pharmacy Practice). CMA defeated a proposal that would have given the Medical Board of California (MBC) overly broad powers (SB 670). CMA defeated an effort to shift investigative authority from the MBC to the Department of Justice. CMA ensured no action was taken in the Legislature to eviscerate MICRA. California's Health Insurance Exchange (aka, Covered California) Toolkit: Got Questions? SDCMS Members Only Click Here Blue Shield Announces Fee Schedule Changes Effective December 1: Increasing payment for evaluation and management services for preventive care. SDCMS Members Only Click Here Health Net to Allow Physicians to Obtain a Retroactive Authorization: Effective October 1, 2013, Health Net is implementing a new “retroactive review and authorization program,” allowing contracted physicians the ability to request a retroactive authorization for up to three business days beyond the date of service if an authorization was required and not obtained prior to the rendering of care. Click Here Changes to Anthem Blue Cross Reimbursement Policies and Claims Software Become Effective November 1: Physicians may notice a difference in how certain codes and code pairs are adjudicated. Click Here Cigna Recontracting With Thousands of Physicians in Southern California: By migrating physicians currently tied to its 2003 fee schedule to its updated 2012 standard fee schedule. The notice provides 90 days’ advance notice of the change and instructs physicians who do not agree to the changes to send written notice of their objection within 20 business days of receipt to Cigna. Affected physicians are encouraged to carefully review all proposed amendments to payor contracts. Click Here DHCS Webinars on What Physicians Need to Know About the Coordinated Care Initiative: October 8, 1:00pm–2:00pm: Click Here November 18, 1:00pm–2:00pm: Click Here December 10, 1:00pm–2:00pm: Click Here FEDERAL What Will Medicare Reimburse for Flu Vaccine? Click Here Physicians Who Do Not Successfully Participate in the Medicare Physician Quality Reporting System (PQRS) This Year Will Be Subject to PQRS Payment Penalties Starting in 2015: Click Here Medicare Transition Update: September 16 marked the transition to the new Medicare Administrative Contractor, Noridian. Got problems? SDCMS members can call SDCMS at (858) 565-8888 and we'll help. We will work with Noridian to resolve member issues as needed. For additional information about the transition, see CMA’s “Medicare Transition Guide: What physicians Need to Know." Click Here for Further Details BENEFITS / PRACTICE MANAGEMENT Ask Your SDCMS Physician Advocate, Marisol Gonzalez: Question: When a Medicare beneficiary has Blue Cross as their secondary, Medicare pays at their rate and puts 20% to the coinsurance. Blue Cross’s rates are sometimes lower than the 80% that Medicare pays, so they in turn pay nothing. This means for these patients we are only being paid 80% of Medicare! Is this legal? Click Here for the Answer Answer: Unfortunately, this practice is purportedly justified by the plans based on coordination of benefits provisions, which typically purport to allow the managed care organization to pay physicians “only those amounts when added to the amounts received by other payors equals the [managed care organization’s] maximum allowable payment under the agreement.” Blue Cross (BC) added a provision to their contracts that basically say when Blue Cross is secondary to another payor, they will only pay if you have received less than your Blue Cross contracted amount from the primary carrier. In the case you outline in your question, Medicare is the primary payor and it sounds like your contracted rate for this procedure(s) is below the Medicare rate. So in Blue Cross’ eyes, you have received the full amount expected to receive under your Blue Cross contract, therefore no additional money is du e. For more information on this discussion, please see CMA ON-CALL document #7503, “Coordination of Benefits: Payment Below Medicare Allowable.” HIPAA Resources: FAQ Document for SDCMS Members: Please email Membership@SDCMS.org. Recording of Our Sept. 5 “New HIPAA Rules Take Effect September 23: Are You Ready?” Webinar: Click Here CMA HIPAA Resources CMA Practice Resources (CPR) October 2013: Medicare Transition Update Don’t Forget! PQRS Payment Adjustment Exemption Deadline Oct. 15 Don’t Miss out on Increased Medi-Cal Payments Blue Shield Announces Fee Schedule Changes Effective December 1 CMA Updates Exchange Toolkit Cigna Recontracting With Thousands of Providers in Southern California Exchange’s Provider Directories Yet to Be Published, Staff Targeting Oct. 1 Release Health Net to Allow Physicians to Obtain a Retroactive Authorization Medicare Reconsiders Overpayments Associated With Incarcerated Beneficiaries Reminder: Changes to Anthem Blue Cross Reimbursement Policies and Claims Software Become Effective November 1 What Will Medicare Reimburse for Flu Vaccine? FYI: Anthem Blue Cross Moving Inquiry Functions to Availity Web Portal Anthem Blue Cross Sends “Exchange 101” Mailer to Physicians in Its Exchange Networks CMS Launches New Online ICD-10 Implementation Guide The Coding Corner: Document Carefully for Same-day Preventive, Complaint-driven Services 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 LOCAL Welcome to Our New and Rejoining SDCMS-CMA Members! Click Here Nominate Your Office Manager for SDCMS' 5th Annual "Outstanding Medical Office Manager" Contest Today! SDCMS member physicians can nominate their office manager by explaining in writing (up to 600 words) why their office manager is the best in San Diego County. Send nominations (and questions) to Kyle Lewis at SDCMS at KLewis@SDCMS.org. Nominations deadline is November 1, 2013. “He presents me with what is always an acceptable gift who brings me news of a great thought before unknown. He enriches me without impoverishing himself.” — Ralph Waldo Emerson Comments are closed.