NYCU June 6, 2023 June 9, 2023 CMA, CMA Benefits, COVID-19 Vaccinations, DEA, Infectious Disease, Public Health, Regulations, SDCMS 0 TUESDAY, JUNE 6, 2023 PHYSICIANS: I wanted to update you on two policies that the California Medical Association’s Center for Economic Services have been advocating on: Cigna Modifier 25 Policy–Delayed We are pleased to report that Cigna has announced that it will delay implementation and re–evaluate the policy that would require the submission of medical records for all Evaluation and Management (E/M) claims billed with CPT 99212–99215 and modifier 25 when a minor procedure is billed. CMA and others in organized medicine have been urging the payor to again rescind their modifier 25 policy (that was first announced and delayed in 2022) and reintroduced nationally with an effective date of May 25, 2023. In CMA’s April letter to Cigna, we outlined serious concerns regarding the significant, unnecessary administrative burden and compliance costs for physician practices of implementation of the policy as well as the penalization of physicians for providing efficient, unscheduled care. Due to CMA’s ongoing advocacy on this issue with Cigna and the California Department of Managed Health Care, Cigna chose to delay implementation of the policy until June 11 and to not apply the modifier 25 policy to fully–insured products regulated by the California Department of Managed Health Care or the California Department of Insurance. Unfortunately, Cigna’s large population of self–funded, Administrative Service Only business in California — representing over 70% of the total lives in the state — would have remained subject to the modifier 25 policy. With the announcement of delay of the policy entirely, Cigna has also said it will work with key national medical associations to educate providers to ensure modifier 25 is used appropriately and in alignment with national guidelines and industry standards. CMA will continue to advocate for a more collaborative approach to identify alternative methodologies for cost containment that do not bluntly penalize physicians using the modifier appropriately. UnitedHealthcare GI Prior Authorization Policy CMA and others in organized medicine continue to advocate against UnitedHealthcare’s recently announced policy requiring prior authorization for certain gastroenterology endoscopy services for commercial plan members effective June 1, 2023. In a letter to UHC’s Senior Market Medical Director, CMA highlighted our strong opposition to this new policy citing it as yet another unnecessary, administrative burden that will simply delay patient access to medically necessary diagnostic services. During our recent annual meeting with senior representatives of UnitedHealthcare’s California operation including their Chief Medical Officer, CMA pressed UnitedHealthcare to clarify language in their FAQ document outlining the applicability of prior authorization for screening colonoscopies and challenged the payor to utilize more effective and less costly, targeted provider education to control costs and overutilization. UHC had committed to taking both of these items back for review and CMA awaits their reply. More to come on this issue as we move past implementation day. Please don’t hesitate to contact CMA’s Center for Economic Services if you have concerns regarding these policies. A reminder that Champions for Health has developed an innovative, evidence–based, free CME course, which will satisfy three of the eight hours of required training on opioid and substance use disorder. Tailored for the busy schedule of today’s primary care providers, this course entitled ‘Innovations and Smart Approaches in Safe Prescribing’ is readily available on–demand, online via The Doctors Company Medical Malpractice Site. Following the presentation, participants will be able to: Utilize tools for prescribing and tapering opioids and benzodiazepines to increase competency and comfortability when treating patients Implement strategies for recognizing Substance Use Disorder (SUD) and Opioid Use Disorder (OUD) Provide pharmacological and non–pharmacological resources to connect patients to treatment for addiction to better assist recovering patients and their families To access the free, online CME course visit The Doctors Company website HERE, or you can access any of the 5 modules directly by clicking below: Module One: Eliminating Stigma Through Clinical Understanding Module Two: Alternatives to Opioids for Pain Module Three: Safe Prescribing of Opioids and CNS Depressants Module Four: Recognition, Diagnosis, and Treatment of SUD Module Five: Eliminating Stigma Through Clinical Understanding of SUD As always, let me know if you have any questions! Paul Hegyi, CEO WHAT TO KNOW … With Few MDs in Rural Areas, A Different Type of Doctor is Filling the Gap CLICK HERE How Covid Made It Nearly Impossible to Pass New Vaccine Rules CLICK HERE California Digital Privacy Battle: It’s Police vs. Civil Libertarians with an Abortionist Twist CLICK HERE The Gun Violence Epidemic is ‘Locking Us Back in Our Room’ CLICK HERE Will a ‘National Patient Safety Board,’ Modeled After the NTSB, Actually Fly? CLICK HERE California Eye Docs Say They Can’t Afford Medi–Cal Rates. Patients Have Few Other Options CLICK HERE California Confronts the Threat of ‘Tranq’ as Overdose Crisis Rages CLICK HERE Retail Clinics Seeing Utilization Soar, Popularity Grow CLICK HERE As Medicaid Purge Begins, ‘Staggering Numbers’ of Americans Lose Coverage CLICK HERE Wildfires Threaten to Undo Decades of Progress in Fighting Air Pollution CLICK HERE WHAT TO DO … JUN 15, 2023: 12:15–1:15pm, FREE Webinar for Members and Non–Members, ‘CMA Data Exchange Explainer Series #3 — Deep Dive into the Data Exchange Framework and Data Sharing Agreement’. Starting January 31, 2023, California Health & Human Services Agency (CHHS) is launching the CHHS Data Exchange Framework. Over the next 3 years this Framework will require all CA physician practices to exchange data with other practices, health plans, hospitals, and others. To help physicians prepare CMA has partnered with CHHS and developed the ‘CMA Data Exchange Explainer Series’ to walk practices through various considerations in implementing robust data exchange. This webinar dives into the Data Exchange Framework; requirements, implementation, technical and funding resources. Also receive an update on the latest DxF developments and important dates practices will need to know CLICK HERE JUN 22, 2023: 9am–5pm, ‘Deep Dive CME Accreditation Workshop’. Kimpton Sawyer Hotel, Sacramento, sponsored by CMA. Dive deep into the Plan–Do–Study–Act Cycle as it relates to the Accreditation Criteria and Standards. An essential course for new CME staff with valuable insights for experienced CME staff as well. Collaborate with other CME professionals, share experiences and ideas. Up to 6.5 CME Credits available. Workshop is $500, Conference is $650 (see below), and for both it is $900. A room block has been reserved at $259/ea. Call (877) 678–6255 and ask for the "CMA CME Conference Room Block" to get this discounted rate CLICK HERE JUN 23, 2023: 9am–4pm, ‘Leveling Up CME Provider Conference’. Kimpton Sawyer Hotel, Sacramento, sponsored by CMA. Guaranteed to revitalize your CME team. In addition to CME updates from the Nation, State and Local level, ACCME’s Kate Regnier will present interactive case studies to help you navigate the nuances of the accreditation standards and criteria. Learn how to use health design thinking to create meaningful educational interventions. Up to 4.5 CME Credits available. Workshop is $500 (see above), Conference is $650, and for both it is $900. A room block has been reserved at $259/ea. Call (877) 678–6255 and ask for the "CMA CME Conference Room Block" to get this discounted rate CLICK HERE JUL 11, 2023: 12–1pm, ‘Virtual Grand Rounds Fentanyl and “Tranq” (Xyazine): Emerging Threats in Illicit Drug Use’, Sponsored by California Medical Association. Moderated by Kimberly Newell Green, MD, CMA Trustee and Associate Clinical Professor at UCSF. Adding to the fentanyl crisis, a deadly drug threat that has overwhelmed our country in the past years, the mixing of a powerful sedative used in veterinary medicine, xylazine, into fentanyl has increased the risk of fatal drug poisoning. In addition to our usual updates on COVID–19 and other emerging public health issues, we will feature experts discussing this rapidly evolving crisis on our streets. 1 CME Credit available. Free for CMA Members and Non–Members CLICK HERE JUL 14-16, 2023: Dr. Ni–Cheng Liang, one of our leaders in physician wellness, along with Dr. Jessie Mahoney, is leading a retreat ‘The Mindful Healers Connect in Nature Retreat’, Green Gulch Farm & Zen Center, Muir Woods/Muir Beach, California. All are welcome and CME credit is available for participating physicians. Practice mindfulness and play in the beautiful outdoors while you restore your energy, nourish and heal you nervous system, practice meditation, breathwork and stillness, and help rejuvenate your mind, body and spirit CLICK HERE JUL 18, 2023: 12:15–1:15pm, Webinar ‘Demystifying the Medical Staff’, Sponsored by California Medical Association. FREE for Members and their Staff [with Promo Code], $99 for Non–Members, This webinar covers the basic structure, role, and purpose of the medical staff, and the physicians’ membership in it. A brief Q&A session at the end. Intended for those wanting a better understanding of the medical staff functions, or who contemplate involvement in the medical staff but either don’t know how to get involved or are undecided if it’s worth the time. The Featured Presenter is Shari Covington, CMA Legal Counsel CLICK HERE AUG 15, 2023: 12:15–1:15pm, FREE Webinar for Members and Non–Members, ‘CMA Data Exchange Explainer Series #4 — How to Optimize Your Practice’s EMR for Data Exchange’. Starting January 31, 2023, California Health & Human Services Agency (CHHS) is launching the CHHS Data Exchange Framework. Over the next 3 years this Framework will require all CA physician practices to exchange data with other practices, health plans, hospitals, and others. To help physicians prepare CMA has partnered with CHHS and developed the ‘CMA Data Exchange Explainer Series’ to walk practices through various considerations in implementing robust data exchange. This webinar reviews an EMR data exchange inspection checklist to ensure your EMR is tuned–up and read for a successful DxF implementation journey. Also receive an update on the latest DxF developments and important dates practices will need to know CLICK HERE OCT 12, 2023: 12:15–1:15pm, FREE Webinar for Members and Non–Members, ‘CMA Data Exchange Explainer Series #5 — How to Optimize Your Practice’s Workflows for Data Exchange’. Starting January 31, 2023, California Health & Human Services Agency (CHHS) is launching the CHHS Data Exchange Framework. Over the next 3 years this Framework will require all CA physician practices to exchange data with other practices, health plans, hospitals, and others. To help physicians prepare CMA has partnered with CHHS and developed the ‘CMA Data Exchange Explainer Series’ to walk practices through various considerations in implementing robust data exchange. This webinar reviews best practices to ensure secure, timely, and accurate data exchange day–in and day–out. Also receive an update on the latest DxF developments and important dates practices will need to know CLICK HERE DEC 14, 2023: 12:15–1:15pm, FREE Webinar for Members and Non–Members, ‘CMA Data Exchange Explainer Series #6 — Incentives and Other Funding Opportunities for Data’. Starting January 31, 2023, California Health & Human Services Agency (CHHS) is launching the CHHS Data Exchange Framework. Over the next 3 years this Framework will require all CA physician practices to exchange data with other practices, health plans, hospitals, and others. To help physicians prepare CMA has partnered with CHHS and developed the ‘CMA Data Exchange Explainer Series’ to walk practices through various considerations in implementing robust data exchange. This webinar provides an overview of grant funding opportunities for technical assistance and connecting to a Qualified Health Information Organization to support practices meeting their DSA Requirements CLICK HERE WHAT TO READ, LISTEN & WATCH … CMA in the Courts READ HERE Podcast ‘What the Health?’ Our 300th Episode! LISTEN HERE CMA Webinar: Telehealth Reimbursement and Privacy Laws: COVID–19 Emergency WATCH HERE CMA Webinar: What is Value–Based Care and What Does it Mean for My Practice? WATCH HERE SDCMS Webinar: Physician Financial Wellness (Part 1) WATCH HERE SDCMS Webinar: Physician Financial Wellness (Part 2) WATCH HERE SDCMS Webinar: Best Practice: Documenting Disruptive Patient Behavior WATCH HERE SDCMS Webinar: Understanding Malpractice Risks for NPs, PAs, and Supervising Physicians WATCH HERE SDCMS Webinar: COVID–19 for the Long Haul: Post COVID Recovery and Care WATCH HERE SDCMS Webinar: How to Avoid Being Reported to the Medical Board WATCH HERE SDCMS Webinar: Understanding the Risks: How to Dismiss a Patient from Your Practice WATCH HERE SDCMS Webinar: Physician Wellness WATCH HERE SDCMS Webinar: Biosimilars Overview & Policy Landscape WATCH HERE Alzheimer’s Project Clinical Roundtable Free On–Demand CME Webinar Series on Dementia WATCH HERE Please Consider Supporting Our Advertisers … Thank You! Comments are closed.