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SDCMS "News You Can Use" (2010.07.09)

by: San Diego County Medical Society
Published July 8, 2010

SDCMS "News You Can Use"
— July 9, 2010

Executive Director Comment on Pertussis: Please check out the details of the California epidemic of pertussis below. This is a serious issue that every clinician should be thinking about and acting on!

CMS Delays PECOS Enforcement
CMS announced on June 30, 2010, that it would not begin rejecting claims on July 6, 2010, if an ordering or referring physician is not identified in Medicare’s internet-based PECOS enrollment system. Although the PECOS enrollment rules still take effect July 6, CMS is allowing some additional time so that providers making good-faith efforts to comply are not penalized. CMS, however, did not provide a new enforcement date. Physicians are encouraged to complete the application process as soon as possible to avoid future cashflow disruptions. CMA has also developed a step-by-step guide to walk physicians through the process, from determining if they are already in PECOS to helping them navigate the internet-based PECOS enrollment system. Physicians who need help with the enrollment process can contact SDCMS’ Physician Advocate, Marisol Gonzalez, at (858) 300-2783 or at MGonzalez@SDCMS.org.

Additional PECOS Enrollment Verification Tool
Click here to access oandp.com's PECOS enrollment tool (oandp.com is an online resource for orthotics and prosthetics information) (hint: enter last name, first name, and "CA").

CONTENTS

  • EHR Certification Process
  • United Healthcare Settlement
  • Medicare Fee Schedule: Palmetto GBA Update
  • Proposed Medicare Physician Payment Regulation
  • Mark Your Calendars to Attend SDCMS’ July 22, 2010, Membership Social
  • “Microsoft Outlook for Busy Docs” SDCMS Seminar • Saturday, August 7, 2010 • 8:00am–11:30am
  • Project Access San Diego (PASD) Success Story
  • State Facing Pertussis Epidemic • CDPH Urges Physicians to Vaccinate Patients Against Whooping Cough
  • CMA Foundation Publishes Diabetes and Cardiovascular Disease Provider Reference Guide
  • Flyers Promoting Healthy Eating, Recreation
  • CMA Publishes Payor Contract Amendment Action Guide
  • Cal-Net Physicians IPA: Important Information for Physicians
  • Physicians Must Now Comply With MBC Signage Regulations
  • The 2010 California Physician’s Legal Handbook Is Here
  • CMA Practice Resources E-newsletter
  • SDCMS SEMINARS / WEBINARS / EVENTS
  • SAN DIEGO COUNTY HEALTHCARE EVENTS

FEDERAL

EHR Certification Process
Executive Director Comment: Click here to access a terrific document from CMA — worth reading cover-to-cover (it’s only two pages!) if you are in the decision loop for an EHR purchase. Here are my critical issues:

  • No one should be purchasing an EHR in advance of temporary certification. Quoting from the document: For physicians, now is a good time to prepare for the transition to EHR. Until the first list of certified EHR systems is published, physicians can spend time assessing practice EHR needs, mapping office workflow, and researching potential vendors. This will allow practices to move quickly once vendors are certified.
  • There is a potential gotcha in the document (hey, it is the Feds after all): Once an EHR is certified, it will not need to be recertified if the vendor makes minor upgrades to it. It will need to be recertified, however, when the transition to the permanent program occurs in 2012. So what would happen if your temporarily certified EHR did not (for some reason) get permanently certified? I’d want to make sure there is a cast-iron money-back clause in the contract that obviates this issue.

Executive Director Comment: This is worth paying attention to (directly below). Ask your office manager to explain to you how your office will get some of this money!

United Healthcare Settlement
Physicians will soon be able to get their share of a $350 million settlement with UnitedHealth Group. The settlement is the result of a class-action lawsuit, initially filed in 2000 by AMA and other healthcare provider and patient groups, alleging that United conspired to defraud consumers by manipulating out-of-network reimbursement rates and shortchanging physicians and patients by hundreds of millions of dollars over the past 15 years. Physicians will be paid based on their total “recognized loss” between 1994 and 2009, which is calculated based on the difference between a physician’s billed amount and the “allowed amount” that United actually paid for covered out-of-network services. If the total amount of submitted claims exceeds the settlement fund, physicians will receive a pro rata share based on their total recognized loss. The deadline to submit claims for payment from the settlement fund is October 5, 2010. To help physicians understand the settlement and what they need to do to claim their share, CMA has published a detailed settlement guide and other useful resources.

Medicare Fee Schedule: Palmetto GBA Update
Palmetto has provided CMA with the following additional information on previously held June claims:

  • Palmetto began processing June 2010 claims with the 2.2% increase on Thursday, July 1, 2010.
  • Claims with June 2010 dates of service received on June 1 and June 2 that were subjected to the 21% reduction are being adjusted up to the new fee schedule (or submitted charge, whichever is less), and physicians can expect to start seeing those corrected claim payments next week.
  • Claims submitted at the previous fee schedule amount will not be automatically adjusted. Once physicians receive payment for these claims, they will have to submit corrections to the submitted charge to the written reopening post office box (see last bullet). Palmetto also asks that physicians who received payment at the 21% reduction amount wait until the corrected claims are received before they request a reopening to increase the submitted charge.
  • Palmetto is releasing held claims a day or two at a time, with the oldest claims being processed first. The volume released is dependent on incoming claim volume and national system capacity for processing claims. Daily calls are being held with CMS to determine how much can be released. As of July 7, 2010, Palmetto has processed claims received up through June 8 or 9. It takes approximately 2–3 days from release into the processing system before a check or electronic payment is generated. Palmetto is hopeful that all the held claims will be released within the next two weeks.
  • Palmetto is still working on formatting the new fee schedule with the 2.2% increase for posting to their website. They expect to have it posted by July 15, 2010, or sooner.
  • Some physicians continued to submit claims at the fee schedule amounts that were in effect from January through May. Palmetto GBA cannot automatically adjust these claims. Physicians will have to submit corrections to the written reopening post office box (see address following). Physicians may request an adjustment to the billed charge by submitting a spread sheet indicating the procedure code, the corrected submitted charge, the ICN (claim number) of the claim, and the paid date. They can also submit the EOBs and include a list of the procedure codes with the corrected billed charge. Physicians should use the reopening form from Palmetto's website. Requests for reopening should be sent to: Palmetto GBA, Part B J1 MAC, P.O. Box 1252 Augusta, GA 30903-1252

Proposed Medicare Physician Payment Regulation
A proposed rule governing Medicare payments to physicians in 2011 went on display on June 25, 2010, and will be published in the Federal Register on July 13, 2010. The rule proposes several potentially helpful provisions, particularly an AMA-advocated plan to examine whether the Medicare Economic Index (MEI) accurately reflects all the costs of a current medical practice. The rule projects a 6.1% cut in the conversion factor. This would come on top of a budget neutrality adjustment tied to rebasing the MEI and the expiration of legislation averting a 21.3% cut, leading to a conversion factor of $26.76 in 2011. The 1,250-page rule also implements provisions of the Patient Protection and Affordable Health Care Act of 2010, including reduced out-of-pocket costs for preventive services, bonus payments to some general surgeons and primary care physicians, changes in the geographic practice cost indexes, and cuts in payments for advanced imaging services. In addition, CMS is proposing to expand its current 50% reduction in advanced imaging services performed on contiguous body parts in the same session to include therapy services performed on the same day and imaging of the same modality in the same session. The rule also would make a number of significant changes in the Physician Quality Reporting Initiative (PQRI), including reducing the reporting sample for claims-based reporting of individual measures from 80% to 50% as had also been advocated by AMA. Click here to view the proposed rule, entitled “Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2011.”

LOCAL

Mark Your Calendars to Attend SDCMS’ July 22, 2010, Membership Social
To be held Thursday, July 22, 2010, from 6pm to 9pm at the Rock Bottom Restaurant and Brewery in La Jolla, 8980 Villa La Jolla Drive, La Jolla. Space is limited to 100 people, so please RSVP as soon as possible to Jen Ohmstede at (858) 300-2781 or at JOhmstede@SDCMS.org.

“Microsoft Outlook for Busy Docs” SDCMS Seminar • Saturday, August 7, 2010 • 8:00am–11:30am
This three-and-a-half hour SDCMS members-only course on how to make Microsoft Outlook your servant and not your master. This will be a very, very practical and user-focused seminar taught by the CEO of SDCMS. Please mark it down on your calendar and email me (Gehring@SDCMS.org) if you’re interested.

Project Access San Diego (PASD) Success Story
On July 1, 2010, Project Access San Diego celebrated its one-year anniversary, with first-year accomplishments including over $1.4 million in donated services provided to 400 patients served by over 350 physician volunteers. Claudia is one of these patients. She was originally referred to PASD for a pelvic ultrasound but soon needed to be seen by a gynecologist. Volunteer Dr. Lawrence Eisenhower determined a hysterectomy was needed and provided this procedure to the patient on June 21. Claudia is recovering well and looks forward to returning to caring for her family after she recovers. To learn more about Project Access San Diego, contact Lauren Radano at LRadano@SDCMS.org.

MEDICAL

State Facing Pertussis Epidemic • CDPH Urges Physicians to Vaccinate Patients Against Whooping Cough
According to the California Department of Public Health (CDPH), the state is in the midst of a pertussis (whooping cough) epidemic. Infection rates have risen this year, with a four-fold increase in the number of reported pertussis cases in California, compared to the same time period in 2009. If current trends continue, California could experience a 50-year high in pertussis cases, despite wide availability of a vaccine to protect both adolescents and adults. In order to protect infants who are too young to be vaccinated, it is important to vaccinate anyone with potential infant contact. CDPH is making additional Tdap (tetanus, reduced diphtheria, and acellular pertussis) vaccine available at no charge to eligible hospitals, so that they can immunize post-partum women and their close household contacts. For more information, visit the CDPH website. Healthcare providers are also urged to receive the Tdap vaccine, to protect themselves and their patients. Effective September 1, 2010, the Cal/OSHA Aerosol Transmissible Disease Standard requires all hospitals, outpatient medical facilities, and other employers covered by the standard to offer Tdap immunization to their employees who may be exposed to pertussis. Employees who choose not to be vaccinated will be required to sign a declination form. Physicians are also reminded that pertussis immunity from previous infection or vaccination wanes over time. Even fully immunized children become susceptible to pertussis by adolescence. Additionally, because pertussis vaccine for adolescents and adults was not available until 2005, immunization rates in these populations remains low. The American Academy of Pediatrics has released clinical guidelines for clinicians providing care for infants with pertussis. The AAP guidelines are available at the AAP website. Additional resources may be found on the CDPH website.

CMA Foundation Publishes Diabetes and Cardiovascular Disease Provider Reference Guide
The CMA Foundation’s Advancing Practice Excellence in Diabetes Program recently published its “Diabetes and Cardiovascular Disease Provider Reference Guide” to help physicians understand the most effective ways to prevent, assess, and treat diabetes and related cardiovascular disease. The was developed in cooperation with an expert panel of physicians to address these issues and improve patient care and outcomes. Included in the reference guide:

  • Guidelines supporting the screening and diagnosis of type 2 diabetes, dyslipidemia and hypertension
  • Approaches to the clinical management of type 2 diabetes and related cardiovascular complications
  • Effective communication techniques
  • Healthcare provider and patient education resources
  • Billing and procedure codes

The guide is available free at the CMA Foundation website.

Flyers Promoting Healthy Eating, Recreation
The following flyers/fact sheets are made available for physicians who serve low-income communities with information and tips to help patients increase their healthy food choices and opportunities for physical activity and promote the value of food stamps and food stamp education for their patients:

STATE

Executive Director Comment: This members-only document (directly below) lays it all out for you if the insurance companies try to change a contract in midstream!

CMA Publishes Payor Contract Amendment Action Guide
To help physicians understand their rights when it comes to health plan contract amendments, CMA has published “Payor Contract Amendments: An Action Guide for Physicians” (available to members by clicking here). California law prohibits health plans from unilaterally amending both HMO and PPO contracts unless the amendment is necessary to comply with state or federal law, regulations, or accreditation requirements. California law also requires plans to provide contracted physicians with prior notice of any material contract change and the opportunity to terminate the agreement prior to the effective date of the change. Physicians are encouraged to carefully review all proposed amendments to health plan or medical group/IPA contracts. You do not have to accept substandard contracts that are not beneficial to your practice.

Cal-Net Physicians IPA: Important Information for Physicians
Cal-Net Physicians IPA served approximately 5,500 enrollees in San Diego County. Cal-Net contracts with Molina Health Plan, Community Health Group, and Care 1st to provide services to Medi-Cal and Healthy Families enrollees. CMA recently learned that these health plans have terminated their contracts with Cal-Net effective June 1, 2010, due to financial solvency concerns. For more details, including information on transition plans, continuity of care protocols, and claims payment, click here to access CMA's members-only Cal-Net Physicians IPA information guide.

Physicians Must Now Comply With MBC Signage Regulations
Effective June 27, California physicians are required to inform their patients that they are licensed by the Medical Board of California, and to provide patients with the Medical Board’s contact information. CMA has prepared a number of resources to help physicians comply with these new regulations, including downloadable posters and customizable patient notices. These resources are available to SDCMS-CMA members only by clicking here. Click here for further information.

The 2010 California Physician’s Legal Handbook Is Here
The 2010 California Physician’s Legal Handbook (CPLH) is now available. CPLH — an annual publication of CMA’s Center for Legal Affairs ON-CALL documents — answers medical-legal questions most frequently asked by physicians. The handbook is available in a seven-volume print format (a copy is available at SDCMS’ offices) and on CD-ROM. Click here for further information. Don’t forget that SDCMS-CMA members can access most of the CPLH content free of charge via CMA ON-CALL, CMA’s online library of medical-legal information.

CMA Practice Resources E-newsletter
CMA Practice Resources is a free monthly email bulletin from CMA’s Center for Economic Services, full of tips and tools to help physicians and their office staff improve practice efficiency and viability. In the July 2010 issue, you will find information on the following topics and more:

  • Identify and Fight Unfair Payment Practices
  • Blue Cross Announces Changes to Prudent Buyer Contract
  • Federal Medi-Cal Audits to Begin in August
  • Palmetto Releases E/M Peer Code Comparison Reports
  • Coding Corner: Use of Modifier -25
  • Cal-Net Physicians IPA: Important Information for Physicians

SDCMS SEMINARS / WEBINARS / EVENTS
For further information on or to register for any of the following SDCMS seminars, webinars, and events, contact Sonia Gonzales at (858) 300-2782 or at SGonzales@SDCMS.org.

SAN DIEGO COUNTY HEALTHCARE EVENTS
To submit a community healthcare event for possible publication, email KLewis@SDCMS.org. Events should be physician-focused and should take place in San Diego County.

“The friend in my adversity I shall always cherish most. I can better trust those who helped to relieve the gloom of my dark hours than those who are so ready to enjoy with me the sunshine of my prosperity.”
— Ulysses S. Grant

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

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