SDCMS "News You Can Use" (2010.01.13)

SDCMS "News You Can Use"
— January 13, 2010

Call Your Senators and House Representative!
If you have not called Senator Boxer's and Senator Feinstein’s offices, as well as your House representative's office, please do so — soon. The physician community needs every one of you to make two points:

1. Fix the Geographic Practice Cost Index (GPCI), which lumps San Diego County with a number of rural counties, thereby unfairly reducing Medicare reimbursements to San Diego County's physicians.
2. Raise Medicaid (Medi-Cal) rates concomitant with a proposed increase in Medicaid (Medi-Cal) patients — or access to care will suffer.

Click Here for Further Details and Legislator Telephone Numbers [1]

CONTENTS

• No More Medicare Consult Codes
• SDCMS-CMA Members-only Webinar on Billing for Consultations, Making a Decision on “Participation” • January 20, 2010, 12:15pm – 1:15pm
• Cautions/Advice on Dealing With the Consult Code Disestablishment
• References for Dealing With the Consult Code Disestablishment
• 21.2% Medicare SGR Cut Stopped for Two Months
• Medicare Participation Decision Deadline Extended to January 31, 2010
• CMS and ONC Issue Regulations Proposing a Definition of ‘Meaningful Use’ and Setting Standards for Electronic Health Record Incentive Program
• The Neverending State Budget Nightmare
  • Budget Solutions, Part 1: $8.5 Billion in Spending Reductions/Cuts
  • Budget Solutions, Part 2: $4.5 Billion in Fund Shifts/Alternative Revenues
  • Budget Solutions, Part 3: $6.9 Billion in Federal Funds
  • “Trigger” Reductions and Revenues
• Has Your IPA or Health Plan Stopped Paying Claims?
• The Medical Board of California Recruiting Expert Reviewers
• SDCMS Workshop — End-Game Planning: Charting a Course for Your Last Trimester of Practice • Sat., Feb. 27, 9:00am–1:00pm
• SDCMS Job Opening: Medical Office Manager Advocate
• SDCMS Young and Resident Physicians Social • February 11, 2010
• SDCMS New Member Social • April 2, 2010
• SDCMS SEMINARS / WEBINARS / EVENTS
• SAN DIEGO COUNTY HEALTHCARE EVENTS

FEDERAL

No More Medicare Consult Codes
Despite strong objections and intense AMA, CMA, SDCMS, and specialty association lobbying — click here [2] to read SDCMS’ joint letter with UCSD to our congressional delegation — the Centers for Medicare and Medicaid Services (CMS) eliminated payments for inpatient and outpatient consultation codes, requiring physicians instead to bill for either new or established office visits or for initial hospital stays.

SDCMS-CMA Members-only Webinar on Billing for Consultations, Making a Decision on “Participation” • January 20, 2010, 12:15pm – 1:15pm
This webinar will assist member physicians and their office staff on billing for consultations and guidance on making a participating/nonparticipating decision.

• Title: Consultation Code Crosswalk: How to Bill Medicare in 2010
• Presenter: Arthur Lurvey, MD, medical director for Palmetto GBA, will discuss what this means for physicians and how to bill for these services in 2010 and beyond.
• Date/Time: Wednesday, January 20, 2010, 12:15pm–1:15pm
• Registration: SDCMS-CMA members can click here [3] to register. After you register, you will receive a confirmation email containing information about joining the webinar. Please register at least one hour before the webinar. If you do not register within an hour, we cannot guarantee your attendance.

Cautions/Advice on Dealing With the Consult Code Disestablishment
The new policy will likely cause confusion as physicians and billing managers try to make sense of the new rules.

1. Physicians using electronic medical and health records (EMR/EHR) software and practice management and other coding systems should contact their vendors for any program updates.
2. Physicians need to inform the Department of Insurance and the Department of Managed Health Care about any insurance payer that cuts out consult codes but fails to shift monies to first visit codes, thus banking the money and failing to implement the full range of the change by following CMS only where it benefits them.

References for Dealing With the Consult Code Disestablishment

• SDCMS-CMA Members Click Here [3] to Access CMA’s Chart for Translating Consultation Codes for New and Established Patients
• Click Here [4] to Access Medicare Updates, Including Initial Guidance on Billing for Consultations
• Click Here [5] to Access Revisions to Consultation Services Payment Policy (CMS Manual System, Pub 100-04 Medicare Claims Processing, Transmittal #1875
• Click Here [6] to Access MLN Matters (MM6740): Revisions to Consultations Services Payment Policy

21.2% Medicare SGR Cut Stopped for Two Months
President Obama signed legislation preventing the scheduled 21.2% cut in Medicare payments from taking place on January 1, 2010. The cut is delayed until February 28, 2010. The fee schedule posted on December 17, 2009, by Medicare contractor Palmetto GBA — see Palmetto GBA's website [7] — is 21.2% lower than it will actually be on January 1, 2010.

Medicare Participation Decision Deadline Extended to January 31, 2010
In light of the uncertainty surrounding the SGR and health reform, CMS has extended the deadline for physicians to determine their Medicare participation status for 2010 until January 31, 2010. The effective date of the decision will be January 1, 2010. Participation decisions are binding for one year, unless physicians choose to opt out entirely. Once you opt out, you cannot opt back in for two years. Physicians, as always, have three choices regarding Medicare: 1) Be a participating provider; 2) Be a nonparticipating provider; 3) Opt out of Medicare entirely. Members may click here [8] to access CMA ON-CALL document #0151, “Medicare Participation (and Nonparticipation) Options.” You may also click here [9] for further information from AMA.

CMS and ONC Issue Regulations Proposing a Definition of ‘Meaningful Use’ and Setting Standards for Electronic Health Record Incentive Program
The Obama administration has put two health information technology regulations on display at the Federal Register. The Centers for Medicare and Medicaid (CMS) issued the first proposed rule, which outlines the provisions governing the electronic health record (EHR) incentive programs including the definition of “meaningful use.” The second rule is an interim final regulation issued by the Office of the National Coordinator for the Department of Health and Human Services (HHS), which describes the standards that must be met by certified EHR technology to exchange healthcare information. The administration reached out to AMA prior to the publication of the rules to emphasize that these are proposed rules and the administration is extremely interested in receiving comments. Both rules have a 60-day comment period which begins on the day both rules are published, which the administration anticipates will be January 16, 2010. Over the coming weeks, AMA will analyze the regulations and work with physicians to develop comments.

• Click here [10] to read the HHS press release.
• Click here [11] to view the CMS proposed rule and fact sheets.
• Click here [12] to view the ONC’s interim final rule. In early 2010 ONC intends to issue a notice of proposed rulemaking related to the certification of health information technology.

STATE

The Neverending State Budget Nightmare
On January 8, 2010, Governor Schwarzenegger released his 2010–11 budget proposal. Total General Fund (GF) spending is projected to be $83 billion. The plan proposes to close a projected $19.9 billion budget deficit over the next 18 months. The "solutions" are broken into three parts: $8.5 billion in spending reductions/cuts; $4.5b in fund shifts and alternative revenues; and $6.9 billion in federal funds. The 2010–11 budget projects that GF revenues will increase by $1.2 billion when compared to revised 2009–10 revenues. Stating that there are sufficient revenues to be found in both the prison system as well as in reigning in public employee pensions, the governor in his presentation flatly rejected any need for tax increases in order to pass the budget. He also appealed for mid-year budget cuts for the current 2009-10 budget and to not put the "solutions" off until the beginning of the 2010–2011 budget year, which begins on July 1, 2010.

Budget Solutions, Part 1: $8.5 Billion in Spending Reductions/Cuts
Of the $8.5 billion in proposed spending reductions, $2.4 billion is in the area of Health and Human Services (an 8% reduction from the revised 2009–10 amounts):

• Medi-Cal Cost Containment Strategies: Reduction of $750 million from the implementation of strategies, similar to other states, to reduce Medi-Ca l costs including limits on services, and utilization controls, and increased cost-sharing through co-payment requirements, premiums, or both.
• In Home Supportive Services (IHSS): Reduction of $77.9 million in 2009-10 and $872.6 million in 2010-11 for limiting the provision of services to consumers with the highest level of need and reducing state participation in IHSS workers’ wages.

Budget Solutions, Part 2: $4.5 Billion in Fund Shifts/Alternative Revenues
The governor proposes to place an initiative before the voters to allow the state to access Proposition 10 funds (tobacco tax for children’s healthcare) and Proposition 63 funds (mental health) for other health-related services.

Budget Solutions, Part 3: $6.9 Billion in Federal Funds
The budget assumes $6.9 billion in additional contributions from the federal government, including in part:

• Increase the federal matching fund rate for Medicaid to the national average from the current base Federal Medical Assistance Percentage (FMAP) rate for California from 50% to 57%. This increase would reflect the national average as well as the average of the 10 most populous states. $1.8 Billion
• Secure reimbursements for costs that should have been paid by Medicare and changes in the required level of state payment for Medicare prescription drug benefits. $1 Billion
• Assume continuation of a portion of the federal American Recovery and Reinvestment Act (ARRA) funding for various health and human services programs. $2.1 Billion

"Trigger" Reductions and Revenues
If the increased federal funding described above does not arrive, a series of additional cuts and revenue enhancements will be implemented, some of which affect healthcare. These cuts include reductions of up to $4.6 billion from the General Fund, including (partial list):

• Fund existing mental health services with Proposition 63 funds. $847 Million
• Reduce Medi-Cal eligibility to the minimum allowed under current federal law and eliminate most remaining optional benefits. $532 Million
• Eliminate the Healthy Families Program. $126 Million
• Eliminate various health services programs funded by Proposition 99. $115 Million

Additional revenues total up to $2.4 billion in General Fund, and include (partial list):

• Extend suspension of a business’s ability to reduce taxable income by applying net operating losses (NOL) from prior years to reduce current income. $1.2 Billion
• Extend reduction in the credit for each dependent on the personal income tax from $319 to $102. $504 Million

Has Your IPA or Health Plan Stopped Paying Claims?
Symptoms of an insolvent health plan, IPA, or other payor include a failure to pay claims in a timely manner or a payor that cuts checks within the statutory timeframes but does not release the checks in a timely manner. To help physicians monitor the financial health of their contracted payors, CMA has put together a checklist [3] available to members. SDCMS-CMA member physicians can also request a hard copy by contacting CMA’s reimbursement help line at (888) 401-5911 or at jwilliams2@cmanet.org [13].

The Medical Board of California Recruiting Expert Reviewers
The Medical Board of California has requested assistance in recruiting physicians in the following specialties to serve as expert reviewers: psychiatry, pain medicine, addiction, interventional cardiology, neurology, neurological surgery, endocrinology, gastroenterology, colon and rectal surgery, obstetrics and gynecology, surgery, diagnostic radiology. Click here [14] for further information, including how to apply.

LOCAL

SDCMS Workshop — End-Game Planning: Charting a Course for Your Last Trimester of Practice • Sat., Feb. 27, 9:00am–1:00pm
An intensive, half-day workshop conducted by SDCMS-endorsed Practice Performance Group (PPG) [15] for physicians who want to plan for an orderly and rewarding exit from active practice. Saturday, February 27, 2010, 9:00am–1:00pm. Click here [16] to download a registration form.

SDCMS Job Opening: Medical Office Manager Advocate
SDCMS is currently accepting applications for a “Medical Office Manager Advocate,” an independent thinker with a “can-do” attitude who will provide exceptional support to the staff of more than 1,000 small and medium-sized medical offices. Click here [17] for details.

SDCMS Young and Resident Physicians Social • February 11, 2010
Join us for a fun and relaxing evening. Unwind with your colleagues and make new friends! Thursday, February 11, 2010, 6:30pm–8:30pm. Rock Bottom Restaurant and Brewery at 401 “G” Street, San Diego, CA 92101 (downtown across from Horton Plaza). RSVP is a must as space is limited! To RSVP, please contact Jen Ohmstede at (858) 300-2781 or at JOhmstede@SDCMS.org [18].

SDCMS New Member Social • April 2, 2010
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 [18].

SDCMS SEMINARS / WEBINARS / EVENTS

For Further Information on or to Register for Any of the Below Seminars, Webinars, or Events, Contact Jen Ohmstede at (858) 300-2781 or at JOhmstede@SDCMS.org [18]

• JAN 20 (WED 6:30pm-7:30pm) • Risk Management Webinar [19] ("Scope of Practice of Allied Health Professionals")
• JAN 21 (THU 11:30am-12:30pm) • Risk Management Webinar [20] ("Scope of Practice of Allied Health Professionals")
• JAN 27 (WED 11:30am-1:00pm) • Human Resources Law Seminar/Webinar [21]
• FEB 4 (THU 11:00am-1:00pm) • Practice Management Seminar/Webinar [22] ("Treating Patients Right")
• FEB 11 (THU 6:00pm-9:00pm) • Young and Resident Physicians Winter Social [23]
• FEB 17 (WED 10:00am-12:00pm) • Palmetto/Medicare Seminar/Webinar [24]
• FEB 27 (SAT 9:00am-1:00pm) • Retirement Workshop [25] ("End-game Planning")
• MAR 5–26 (4 FRIDAYS 9:00am-4:00pm) • Certified Medical Office Manager Course [26]
• MAR 18 (THU 11:30am-1:00pm) • Contract Management Seminar/Webinar
• MAR 24 (WED 9:00am-12:00pm) • Billing and Collections Procedures Seminar/Webinar ("Back to Basics")
• APR 2 (FRI 6:00pm-9:00pm) • SDCMS New Member Social
• APR 17 (SAT 8:30am-3:30pm) • Resident Physician Workshop ("Preparing to Practice")
• APR 21 (WED 6:30pm-7:30pm) • Risk Management Seminar/Webinar ("eHealth: Telemedicine and Telehealth")
• APR 22 (THU 11:30am-12:30pm) • Risk Management Seminar/Webinar ("eHealth: Telemedicine and Telehealth")
• APR 28 (WED 11:30am-1:00pm) • Medi-Cal Seminar/Webinar
• LATE APRIL / EARLY MAY • EMR/EHR Trunk Show
• MAY 6 (THU 11:30am-1:00pm) • IT Seminar/Webinar
• MAY 12 (WED 11:30am-12:30pm) • e-Town Hall
• MAY 20 (THU 11:30am-1:00pm) • Workers' Compensation Billing Seminar/Webinar
• MAY 21 (FRI 6:00pm-9:00pm) • Young and Resident Physicians Spring Social
• JUN 5 (SAT 6:00pm-11:00pm) • SDCMS Inaugural SDCMS
• JUN 18–19 (FRI-SAT 8:00am-4:00pm) • Leader's Toolbox Workshop
• JUN 24 (THU 11:30am-1:00pm) • Sexual Harassment Seminar/Webinar

SAN DIEGO COUNTY HEALTHCARE EVENTS

• JAN 13–16 • Anesthesiology Update Conference 2010 [27] • Kona Kai Spa Resort and Spa, San Diego
• JAN 16 • 10th Annual San Diego Heart Failure and Hypertension Symposium for Primary Care and Internal Medicine [28] • Estancia La Jolla Hotel and Spa
• JAN 16–17 • Melanoma 2010: 20th Annual Cutaneous Malignancy Update [29] • Hilton San Diego Resort and Spa
• JAN 21 • Addressing Childhood Obesity: Practical Office-based Resources and Strategies, HEDIS Measures, Latino Cultural Competency, and Real-life Case Studies [30] • CME Webinar • (858) 614-1549, http://www.ourcommunityourkids.org [31]
• JAN 21–24 • 7th Annual Natural Supplements: An Evidence-based Update [29] • Paradise Point Resort and Spa
• JAN 27–30 • Minimally Invasive Robotics Association 5th International Congress [32] • Manchester Grand Hyatt, San Diego
• FEB 3 • SDT Overview for Clinicians [33] • County of San Diego, Rosecrans Health Services Complex • $75
• FEB 3–MAR 24 (Eight Wednesdays, 6:30pm–9:00pm) • Mindfulness-based Stress Reduction • $495 • (800) SCRIPPS
• FEB 4 • Male and Female Genital Exam Skills Practicum [33] • County of San Diego, Rosecrans Health Services Complex
• FEB 4–MAR 25 (Eight Thursdays, 2:00pm–4:30pm) • $495 • (800) SCRIPPS
• FEB 4–6 • 29th Annual Advanced Nephrology: Nephrology for the Consultant [34] • Estancia La Jolla Hotel and Spa
• FEB 5–6 • Ask Screen Intervene: Incorporating HIV Prevention Into the Medical Care of Persons Living With HIV [33] • Hyatt Regency Mission Bay Spa & Marina, San Diego
• FEB 13–16 • Scripps Cancer Center's 30th Annual Conference: Clinical Hematology and Oncology [29] • Omni San Diego Hotel
• FEB 18–20 • 33rd Annual San Diego Postgraduate Assembly in Surgery [35] • Omni San Diego Hotel
• FEB 25 • “Where Are My Keys?”: Understanding and Treating Alzheimer’s Disease in the 21st Century • Leichtag Biomedical Research Building, Main Auditorium, UC San Diego School of Medicine Campus • (858) 279-4586, KDotson@SDCMS.org [36]
• FEB 27 • Headaches: Easing the Pain (15 Minute Evaluation Tools for the Busy Primary Care Physician) [29] • The Dana on Mission Bay
• MAR 4–10 • Topics and Advances in Internal Medicine [37] • Hilton San Diego Resort and Spa
• MAR 5–6 • The Future of Genomic Medicine III [29] • The Neurosciences Institute Auditorium, San Diego
• MAR 11–12 • Topics and Advances in Pulmonary and Critical Care Medicine [37] • Hilton San Diego Resort and Spa
• MAR 13–15 • 3rd Annual UCSD Urology Postgraduate Course [38] • Hilton La Jolla Torrey Pines
• MAR 25–28 • 20th Annual Nelson Butters' West Coast Neuropsychology Conference [39] • Hilton San Diego Resort and Spa
• MAR 26 • 6th Annual San Diego Health Policy Conference • The Hilton Harbor Island Hotel • prt@cwsl.edu [40]
• MAR 26–27 • 5th Annual Brain Injury Rehabilitation Conference [29] • The Schaetzel Center, Scripps Memorial Hospital, La Jolla
• MAR 27–28 • 25th Annual New Treatments in Chronic Liver Disease [29] • Hilton La Jolla Torrey Pines
• MAR 29–Apr. 1 • 15th Annual Primary Care in Paradise [29] • Marriott Kauai Resort, Kauai, Hawaii
• APR 3 • 23rd Annual Review of Vascular and Interventional Radiology [28] • Hotel Del Coronado
• APR 4–9 • 30th Annual Residents' Radiology Review Course [28] • Hotel del Coronado
• APR 9 • Research Summit [29] • The Schaetzel Center, Scripps Memorial Hospital, La Jolla
• APR 17–18 • 3rd Annual Sudden Cardiac Arrest: From Awareness to Prevention [29] • Hyatt Regency La Jolla
• SPRING 2010 • Trauma First Response 2010 [29] • California Center for the Arts, Escondido
• MAY 27–28 • Alzheimer's Disease: Update on Research, Treatment, and Care [41] • Omni San Diego Hotel

“We must be willing to get rid of the life we’ve planned, so as to have the life that is waiting for us. The old skin has to be shed before the new one can come.”
— Joseph Campbell (1904–1987), American Mythologist, Writer, and Lecturer