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"News You Can Use" — May 7, 2013



Click Here if You're at a Computer for a 7-minute Video Update Video Update From SDCMS President Sherry Franklin, MD, and SDCMS CEO Tom Gehring. Click here if you’re on a smartphone or tablet.

The Opening Shot in the 2013 MICRA Fight Was Fired last Thursday, May 2, at a press conference in Sacramento that called for fundamental changes to MICRA — backed by a well-funded trial lawyer consortium. Click Here

SB 640, Which Stops Prospective Medi-Cal 10% Rate Cuts and Prevents a Retrospective 10% Medi-Cal “Clawback” — if We Lose in Court — Moved out of Committee on a 19-0 Vote: Click Here

Defense Department Authorizes Temporary Waiver for CHAMPUS / TRICARE Authorizations and Referrals Until May 18, 2013: Click Here

Medi-Cal Duals Project Delayed for Three Additional Months, to January 1, 2014: Click Here

Watch Our April 17 “HIPAA Omnibus Rule” Webinar: Click here. Contact Kyle Lewis for website access assistance at (858) 300-2784 or at KLewis@SDCMS.org.

E-prescribing (E-Rx) Penalties / Incentives Explained:

  • To Avoid the 2014 2% Payment Penalty: Between January 1, 2013, and June 30, 2013, physicians need to submit a minimum of 10 unique E-Rx encounters associated with ANY billable allowed Medicare part B code. The G8553 codes can be reported with any billable service, and do not have to contain a code from the measure denominator.
  • To Earn the 2013 E-Rx Incentive: Between January 1, 2013, and December 31, 2013, physicians must report 25 valid E-Rx encounters that are associated with a valid denominator. Codes: 90791, 90792, 90832, 90834, 90837, 90839, 92002, 92004, 92012, 92014, 96150, 96151, 96152, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0101, G0108, G0109
  • If the 10 claims submitted before June 30, 2013, to avoid the penalty used any of the denominator codes, they can count towards the 25 needed for the incentive program. If the 10 submitted did not include any of these denominator codes, an additional 25 will need to be submitted using these denominator codes to earn the incentive.
  • After January 1, 2014, this type of reporting will no longer be penalized, nor will it qualify for any further incentives.


Avian Influenza A (H7N9) Virus Update: As of May 2, 128 human cases of influenza A (H7N9) virus infection have been laboratory-confirmed, including 26 fatalities. There is no evidence (yet) that the virus has become easily transmissible from person to person. Most cases have been reported in the eastern part of China, with the highest case counts in the provinces of Jiangsu, Shanghai, and Zhejiang. Click here for information for San Diego County healthcare providers, including information on reporting suspect cases, laboratory testing of suspect cases, infection control precautions, and treatment recommendations.

Nationwide Shortage of Tuberculin Skin Testing Antigen: Click Here


If You Are Having Problems With Walgreens’ Modifying Your Prescriptions or Asking for Inappropriate Information, Let Us Know! “Walgreens is requiring their pharmacists to take additional steps when verifying certain prescriptions for controlled substances.” An SDCMS rheumatologist, for example, prescribed Adderall to a patient, whereupon Walgreens told him he should not be prescribing the drug because he was not a psychiatrist. Another SDCMS physician fought Walgreens with their requests, with Walgreens’ acquiescing and filling the prescription without the information requested.

Anthem Blue Cross Agrees to Pay $3.2 Million Owed to Providers for Improper Claims Payments: Click Here


GPCI: Medicare classifies San Diego, the eight largest U.S. city, as rural, and therefore inappropriately reduces San Diego Medicare Part B (doctors only) by roughly 5%. We have been fighting in the courts and in Congress to repeal / replace this preposterous Geographic Practice Cost Index (GPCI). Click here to read the letter sent by San Diego’s congressional delegation at our urging. The GPCI battle continues!

Department of Defense (DoD) Authorizes Temporary Waiver for TRICARE Authorizations and Referrals: While the standard timeframe for processing authorization and referral requests is two business days for urgent requests and five business days for routine requests, United Health Military & Veterans (UHMV) has been weeks behind. CMA has been working closely with UMVS to seek a resolution to this issue as soon as possible. To address the delays, the DoD has waived authorization and referral request requirements for all TRICARE-covered services April 1 through May 18, 2013. Physicians will not be required to seek or wait for an approval from UMVS for any covered services; however, if a practice received a denial from UMVS for a previously submitted request for a referral or authorization, the previous denial will remain in effect. Click Here

Palmetto Medicare Contract Protest Denied by Federal Claims Court; Implementation to Begin Soon: Click Here

Doctors Strike Back at EHR Vendor With Class-action Suit: Click Here

Misreading HIPAA Privacy Law Blocks Mental Health Discussions: Click Here

The Doctor Will See You Now — Online: Click Here

Obama Budget Signals Quicker Trigger on Medicare Pay Cuts: Click Here Click Here

Immigration Bill Aims to Ease Doctor Shortage: Click Here

Physician Compensation Report 2013 (Medscape): Click Here


San Diego Psychiatric Society Will Present “DSM-5: What You Need to Know” on June 8-9, 2013 at the Hyatt Regency La Jolla: This exciting program, co-sponsored by the American Psychiatric Association, will feature several national psychiatric experts who helped develop the updated diagnostic criteria in the new DSM-5 manual. As a great deal of mental healthcare is delivered in the primary care setting, we invite and encourage primary care physicians to attend, along with psychiatrists and other mental health clinicians. Special breakout sessions will focus on updates to ADHD, autistic spectrum disorders, somatic symptom disorders, and mood disorders, all of which are commonly encountered in primary care practices. Click here to register before May 14 to secure the early registration discount! Discounts available for trainees and large groups. Contact SDPS Executive Director Janelle Kistler for more information at Janelle.Kistler@SDCMS.org.

UCSD Free Clinic Seeking Volunteer / Internship Opportunities for Bridge to Employment Program: Click Here Click Here

University of San Diego Needs NP Student Preceptors: USD is currently securing preceptors for summer semester (June 3 - August 23). If you would like more information about educating an NP student or if would like to volunteer, please contact rdevere@sandiego.edu or (619) 260-4718.


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“If there is no struggle, there is no progress. Those who profess to favor freedom and yet deprecate agitation are men who want crops without plowing up the ground, rain without thunder and lightning. They want the ocean without the awful roar of its many waters. This struggle may be a moral one, or it may be a physical one, and it may be both moral and physical, but it must be a struggle. Power concedes nothing without a demand. It never did and it never will.”
— Frederick Douglass, American Social Reformer, Orator, Writer and Statesman (1818–1895)


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