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SDCMS "News You Can Use" (2009.12.08)

by: San Diego County Medical Society
Published December 8, 2009

SDCMS "News You Can Use"
— December 8, 2009

Executive Director Comment: If you've not taken the survey (see directly below), please do so. Last chance to influence the outcome!!!

SDCMS' 2009 Workforce and Compensation Survey
If you have not yet taken SDCMS' 2009 Workforce and Compensation Survey, please do so now. It'll take only five (5) minutes, and it is critical to our advocacy efforts. And thanks to the 400+ who have already taken the survey. Click here.

Executive Director Comment: The following (see directly below) is time critical AND money critical. You only have one more day to get your billing in before Medicare stops paying for 21 days!!!!!

Disruption in Medicare Cash Flow this Month
Palmetto, California's Medicare contractor, announced a temporary operational change that will result in a "front loading" of payments in December. On Wednesday, December 9, 2009, the waiting period for claims payment will be reduced to zero days (normally 14 days for electronic claims and 30 days for paper claims). All claims that have been cleared will be paid immediately. The temporary elimination of the claims payment floor is part of Palmetto's transition to a new financial accounting system. This may give the appearance that your cash revenues have increased, when in fact payments for some of your claims may have simply been made earlier than normal. Physicians are encouraged to monitor their payments and make adjustments as necessary to prevent cash-flow problems later in the month. No payments will be issued from December 10 through December 15 while the accounting systems are being switched. Normal payment cycles will resume on December 16. Physicians should continue submitting claims as normal during this transition. Although no payments will go out December 10-15, the payment floor clock WILL tick for claims received during that time period. Physicians should also be aware that access to claims data (both online and from Palmetto customer service) will be extremely limited during the five-day transition. Click here for the gory details. Contact Marisol Gonzalez, your SDCMS physician advocate, at (858) 300-2783 or at MGonzalez@SDCMS.org for help.

Executive Director Comment: This "rob Peter to pay Paul" mentality (see directly below - the money "saved" would allegedly be used to increase reimbursements to primary care physicians) is what we object to. There is almost no opposition to increasing reimbursements for primary care, but simply taking it away from other physicians is the wrong answer. Please provide your input to CMS!!!!

Need Your Input to Restore Payments for Consultation Codes
The 2010 Medicare payment rule contains a controversial change that would eliminate payments for inpatient and outpatient consultation codes and require physicians to instead bill for either new or established office visits or for initial hospital stays. Click here to see the SDCMS letter (co-signed by UCSD) and click here to see the CMA letter, both in opposition to abolishing the consult codes. Click here to provide input to CMS on the elimination of consultation code issue until December 31, 2009. Click here for more information.

CONTENTS

  • State Extends H1N1 Vaccine Thimerosal Exemption
  • New Email Scam Preys on Patients' H1N1 Fears
  • CMA Publishes H1N1 Billing Guide
  • Medical Board of California Website Changes
  • DOI Lawsuit Against PacifiCare Begins Today
  • AMA Interim Meeting Highlights
  • CMA Clarifies Medical Liability Provisions in Health Reform Bills
  • CMS Delays Implementation of PECOS Enrollment Policy
  • SDCMS Young and Resident Physicians Social • February 11
  • SDCMS New Member Social • April 2
  • SDCMS SEMINARS / WEBINARS / EVENTS
  • SAN DIEGO COUNTY HEALTHCARE EVENTS

H1N1 AND SEASONAL INFLUENZA UPDATES

State Extends H1N1 Vaccine Thimerosal Exemption
California's Department of Public Health (DPH) announced it would continue to exempt the H1N1 vaccine from state law banning the use of mercury-containing vaccines for pregnant women and small children. See CMA's H1N1 page for the latest information.

New Email Scam Preys on Patients' H1N1 Fears
CDC has received reports of fraudulent phishing emails promoting a fake CDC-sponsored State Vaccination Program. The fraudulent email insists that anyone over the age of 18 (regardless of having been vaccinated or not) must create a personal H1N1 vaccination profile on the CDC website. It provides a link to a fake CDC webpage where patients are prompted to enter their personal information.

CMA Publishes H1N1 Billing Guide
AMA has created a new CPT code specific to H1N1 vaccine administration (90470) and revised existing code 90663 to include the H1N1 vaccine. The Centers for Medicare and Medicaid Services (CMS) has also created unique HCPCS codes for administration of the H1N1 vaccine (G9141) and for the vaccine itself (G9142). Because the vaccine is provided free of charge by the federal government, physicians will not be reimbursed for the vaccine itself. Practices have been instructed to submit claims for the vaccine, but for zero dollars. This will allow for proper vaccine tracking. Physicians will be reimbursed for administration of the vaccine. To help physicians understand how to bill for H1N1 vaccine, CMA has reached out to all the major payors in California for clarification on their H1N1 billing policies. CMA has compiled this information into an easy-to-read chart available to members. For more details, visit CMA's H1N1 page.

STATE

Executive Director Comment: Check out your entry (see directly below). Strongly suggest you not use your home address as your address of record, since when you click on the address of record, you get a map with a satellite view.

Medical Board of California Website Changes
The Medical Board has enhanced its information listing on all physicians.

DOI Lawsuit Against PacifiCare Begins Today
Opening arguments have begun in a lawsuit filed by the California Department of Insurance against PacifiCare for widespread unfair payment processes in the wake of United Healthcare's takeover of PacifiCare in 2005. The California Department of Insurance (DOI) and the California Department of Managed Health Care (DMHC) in 2007 launched a joint investigation into the healthcare giant's unfair payment practices. The investigation was prompted by complaints filed by CMA's Center for Economic Services on behalf of CMA member physicians. The DOI alone uncovered 133,000 violations of state laws and regulations regarding payments for medical care. Each violation carries a maximum penalty of $10,000 for a possible total of $1.33 billion. CMA publicly opposed the United/PacifiCare merger from the beginning, saying it would be a detriment to patient care. Although not a named plaintiff, CMA is working with DOI lawyers on this case and will testify to substantiate the DOI's case at trial. Click here for more information.

FEDERAL

Executive Director Comment: Click here for an excellent summary by one of our two AMA delegates on what really happened (and why) (see directly below).

AMA Interim Meeting Highlights
The AMA Interim meeting was held in Houston November 6-10, 2009. Over a thousand delegates and alternate delegates debated 66 resolutions and 25 reports and heard many informational presentations. It was one of the most important meetings in more than a generation, because of the simultaneous discussion in Congress about health system reform. Clearly that reform effort and the House and Senate bills that will make it happen were the major items of business at this meeting. Highlights of the meeting written by CMA's extraordinary staff, Ginnie Yee, can be accessed by clicking here. This report will attempt to address the subject most on everyone's mind, reform, and only a few others.

CMA Clarifies Medical Liability Provisions in Health Reform Bills
Neither Senate or House proposal would pre-empt or otherwise directly impact MICRA and other similar state laws, although the U.S. House bill does incentivize states to adopt pilot programs using early offer and certificates of merit while explicitly excluding MICRA-like caps from such incentives. CMA also was instrumental in getting language into the House bill to ensure that any practice guidelines or payment policies established in the bill do not increase the liability exposure for physicians. To help physicians understand this issue, and clarify what the health reform bills do and don't do with regards to medical liability, CMA has published a medical liability issue brief on its health reform page. There you will also find briefs on other health reform issues, including the SGR and other Medicare payment issues, and Medicaid/Medi-Cal. Additional issue briefs will be published in the coming weeks. Click here for more information.

CMS Delays Implementation of PECOS Enrollment Policy
CMA has been receiving calls regarding a change in Medicare rules that requires physicians to enroll in PECOS (Provider Enrollment, Chain, and Organization System) - the national database of all Medicare physicians and providers - or risk having their claims denied as of January 1, 2010. Because of CMA's advocacy, the implementation of this new rule has been delayed indefinitely. Physicians and nonphysician practitioners must be enrolled in PECOS to be eligible to order or refer Medicare services. Enrollment in PECOS is done through the standard Provider Enrollment process. CMA engaged in successful discussions with CMS and Palmetto GBA regarding the PECOS enrollment requirement. CMA fought to move the implementation date out because CMS needed to establish an orderly revalidation process with Palmetto and not disrupt the standard enrollment processes. We do not want to have the chaos that ensued in enrollment following transition to Palmetto. Notably, Palmetto agreed with CMA and helped us convince CMS to delay the implementation date. CMA will continue its discussions with CMS and Palmetto GBA to establish an orderly process for implementation of the PECOS enrollment rule. You will receive details of the process as it becomes finalized. In the meantime, physicians can verify whether they are PECOS by using the PECOS Internet tool at or by calling Palmetto GBA at (866) 931-3901.

LOCAL

SDCMS Young and Resident Physicians Social • February 11
Mark your calendars to attend SDCMS' upcoming Young and Resident Physicians Social on Thursday, February 11, 2010, from 6:00pm to 9:00pm. Member and nonmember physicians and their guests are welcome. RSVP required. For location and additional information, please contact Jen Ohmstede at (858) 300-2781 or at JOhmstede@SDCMS.org.

SDCMS New Member Social • April 2
Mark your calendars to attend SDCMS' New Member Social on April 2, 2010. All new SDCMS member physicians and guest are invited to attend. RSVP required. For location and additional information, please contact Jen Ohmstede at (858) 300-2781 or at JOhmstede@SDCMS.org.

SDCMS SEMINARS / WEBINARS / EVENTS

  • JAN 7 (THU 11:30am–1:00pm) • Collections Seminar/Webinar • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
  • JAN 9 (SAT 8:00am–11:00am) • Legislative Advocacy Training • Contact Tom Gehring at (858) 565-8888 or at Gehring@SDCMS.org
  • JAN 20 (WED 6:30pm–7:30pm) • Risk Management Webinar ("Scope of Practice of Allied Health Professionals") • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
  • JAN 21 (THU 11:30am–12:30pm) • Risk Management Webinar ("Scope of Practice of Allied Health Professionals") • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
  • JAN 27 (WED 11:30am–1:00pm) • Human Resources Law Seminar/Webinar • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
  • FEB 4 (THU 11:00am–1:00pm) • Practice Management Seminar/Webinar ("Treating Patients Right") • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
  • FEB 11 (THU 6:00pm–9:00pm) • Young and Resident Physicians Winter Social • Contact Jennipher Ohmstede at (858) 300-2781 or at JOhmstede@SDCMS.org
  • FEB 18 (THU 11:30am–11:00pm) • Palmetto/Medicare Seminar/Webinar • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
  • FEB 25 (THU 9:00am–7:00pm) • EMR/EHR Trunk Show • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
  • FEB 27 (SAT 9:00am–1:00pm) • Retirement Workshop ("End-game Planning") • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
  • MAR 5–26 (4 FRIDAYS 9:00am–4:00pm) • Certified Medical Office Manager Course • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
  • MAR 18 (THU 11:30am–1:00pm) • Contract Management Seminar/Webinar • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
  • MAR 24 (WED 9:00am–12:00pm) • Billing and Collections Procedures Seminar/Webinar ("Back to Basics") • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
  • APR 2 (FRI 6:00pm–9:00pm) • SDCMS New Member Social • Contact Jennipher Ohmstede at (858) 300-2781 or at JOhmstede@SDCMS.org
  • APR 17 (SAT 8:30am–3:30pm) • Resident Physician Workshop ("Preparing to Practice") • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
  • APR 21 (WED 6:30pm–7:30pm) • Risk Management Seminar/Webinar ("eHealth: Telemedicine and Telehealth") • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
  • APR 22 (THU 11:30am–12:30pm) • Risk Management Seminar/Webinar ("eHealth: Telemedicine and Telehealth") • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
  • APR 28 (WED 11:30am–1:00pm) • Medi-Cal Seminar/Webinar • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
  • MAY 6 (THU 11:30am–1:00pm) • IT Seminar/Webinar • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
  • MAY 12 (WED 11:30am–12:30pm) • e-Town Hall • Contact Tom Gehring at (858) 565-8888 or at Gehring@SDCMS.org
  • MAY 20 (THU 11:30am–1:00pm) • Workers' Compensation Billing Seminar/Webinar • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
  • MAY 21 (FRI 6:00pm–9:00pm) • Young and Resident Physicians Spring Social • Contact Jennipher Ohmstede at (858) 300-2781 or at JOhmstede@SDCMS.org
  • JUN 5 (SAT 6:00pm–11:00pm) • SDCMS Inaugural SDCMS • Contact Jennipher Ohmstede at (858) 300-2781 or at JOhmstede@SDCMS.org
  • JUN 18–19 (FRI-SAT 8:00am–4:00pm) • Leader's Toolbox Workshop • Contact Tom Gehring at (858) 565-8888 or at Gehring@SDCMS.org
  • JUN 24 (THU 11:30am–1:00pm) • Sexual Harassment Seminar/Webinar • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org

SAN DIEGO COUNTY HEALTHCARE EVENTS

"A violent wind does not outlast the morning; a squall of rain does not outlast the day. Such is the course of Nature. And if Nature herself cannot sustain her efforts long, how much less can man!" — Lao-Tzu

Read more about: consultation codes, H1N1, Healthcare News and Updates, News You Can Use,, NYCU, SDCMS News and Updates, News You Can Use

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