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1. Accountable care organizations:
How will they impact your practice?
The recently passed federal health reform legislation authorized the creation of “accountable care organizations” (ACOs) to encourage greater coordination of care. ACOs may give physicians the opportunity to get back in the driver’s seat when determining the most efficient and appropriate ways to provide care to patients.
The idea behind ACOs is that coordination of care will improve quality, avoid unnecessary hospitalizations and emergency room visits, and ultimately produce a more cost-effective health care system. Under the new federal law, providers who join an ACO will share in the cost savings they achieve for the Medicare program.
To learn more about ACOs and how they will impact the delivery of health care in California, sign up for CMA’s webinar, “Medical Foundations, Accountable Care Organizations, and the Bundling of Services.” In this webinar, professor and attorney Anthony Schiff will discuss federal health reform and the new drive to “capture” physicians, consolidate practices, and further integrate physicians and hospitals.
The webinar will be presented twice, once on Wednesday, June 9, 6:00 - 7:00 pm, and again on Tuesday, June 15, 12:15 - 1:15 pm. The webinar is free to members. Nonmembers can register for $100. For more information, or to register, visit CMA's calendar.
Contact: CMA’s member service center, 800/786-4CMA or memberservice@cmanet.org.
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2. Blue Shield physicians: Did you get a blue ribbon?
Blue Shield of California's "Blue Ribbon" physician rating program goes live today, June 1. Blue Shield decided to publish this faulty data despite serious concerns about the validity and accuracy of the underlying California Physician Performance Initiative (CPPI) data and with blatant disregard for the confusion will cause patients and the irreparable harm it will do to physicians' reputations.
CMA vehemently objects to this program and is evaluating all avenues to protect physicians from Blue Shield's misleading physician rating program.
If you are contracted with Blue Shield, please take a few minutes and complete a very brief survey. Your responses are confidential and will be used to help us advocate on your behalf on this issue.
If you have additional questions or concerns, we encourage you to contact CMA at 800/786-4262 or legalinfo@cmanet.org.
Click here for more information.
Contact: CMA's member service center, 800/786-4CMA or legalinfo@cmanet.org.
3. CMA provides resources to help physicians
comply with new medical board signage regs
California physicians will by June 27 be required to inform their patients that they are licensed by the Medical Board of California, and to provide patients with the 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 members only at http://www.cmanet.org/mbc_notice.
The regulations require physicians to provide this notice by one of three methods:
Prominently posting a sign in an area of their offices that is conspicuous to patients, in at least 48-point type in Arial font.
Including the notice in a written statement, signed and dated by the patient or patient's representative, and kept in that patient's file, stating the patient understands the physician is licensed and regulated by the board.
Including the notice in a statement on letterhead, discharge instructions, or other document given to a patient or the patient's representative; the notice must be placed immediately above the patient's signature line in at least 14-point type.
Regardless of which method you choose, the notice must read as follows: "NOTICE TO CONSUMERS: Medical doctors are licensed and regulated by the Medical Board of California, (800) 633-2322, www.mbc.ca.gov."
According to the medical board, physicians, not facilities, are responsible for compliance with this regulation. In group settings, only one sign must be posted (should that option be chosen), but it must be posted in a location where it can be seen by all patients.
Despite CMA objections, the Office of Administrative Law recently approved these regulations, which are intended to let consumers know where to go for information on or with complaints about California medical doctors. CMA believes these regulations are an unnecessary administrative burden as state law already requires physicians to post their medical license or wear a name tag indicating their licensing status.
Although CMA strongly supports patient access to information about a physician's education, training, and other qualifications, we believe that it would be more useful to provide patients with specific information about the education and training of their physicians. To that end, CMA is cosponsoring a "truth in advertising" bill along with the California Society of Plastic Surgeons. Our bill would require all health care practitioners to display their educational degree, license type and status, and board certification either on their name tag or in their offices, to help patients better understand the credentials of a health care practitioner prior to receiving treatment.
Contact: Yvonne Choong, 916/444-5532 or ychoong@cmanet.org.
4. Congress again recesses without stopping 21% SGR cut
For the third time this year, Congress has recessed without stopping the 21.3 percent sustainable growth rate (SGR) cut. Congress' inaction is jeopardizing senior citizens' access to health care and aggravating physicians who are doing their best to serve their patients but don't know if they can pay their bills month to month.
This represents the third time in 2010 that Congress has missed a deadline, causing a Medicare payment cut to take effect. Although the U.S. House of Representatives today passed a scaled back 19 month fix, the Senate went home for the Memorial Day recess without taking any action, leaving patients and physicians in limbo with a 21 percent cut that takes effect on Tuesday, June 1.
"Doctors are outraged by Congress's inability to protect health care for senior citizens and provide stable funding for Medicare," says CMA President Brennan Cassidy, M.D. "This is a recurring nightmare for seniors and the doctors who serve them. When physicians don't know what they are going to get paid each month and whether they can remain economically viable, it's make it very difficult to provide patients with the certainty and access they deserve."
The House passed an amended version of H.R. 4213, the "American Jobs and Closing Tax Loopholes Act of 2010," which would stop Medicare SGR cuts for 19 months. In lieu of the 21 percent cut originally scheduled for 2010, the House-passed proposal would implement a 2.2 percent payment update for the remainder of this year, and a 1 percent payment update for 2011. Because this is just another short term fix, not a permanent repeal of the SGR, physicians will end up facing another significant cut in 2012 (33 percent).
The House-passed bill also includes a California geographic payment (GPCI) fix, which provides $300 million so that currently underpaid counties will be reimbursed based on more accurate geographic practice costs.
CMS orders 10 day payment hold
Because the Senate is adjourning for the week-long Memorial Day Recess, it will not vote on the legislation until after it returns on June 7. As was previously the case, the Centers for Medicare & Medicaid Services has instructed its contractors to hold physician claims for 10 business days. The hold, which will only affect claims with dates of service on or after June 1, 2010, gives Congress additional time to act before claims are processed at the lower rate.
As we know from the previous payment hold in April, once the hold is lifted California's Medicare contractor, Palmetto, will begin processing held claims one to two days at a time. Physicians may, therefore, see minor cash flow disruptions as a result of the hold. Questions regarding the payment hold and the processing of claims can be directed to Palmetto at 866/931-3901.
Tell Congress enough is enough!
CMA continues to aggressively advocate for a permanent repeal of the Medicare sustainable growth rate. Congress has known for years that the faulty formula Medicare uses to pay doctors does not work, but it has not fixed the problem. We need a rational Medicare physician payment system that automatically keeps up with the cost of running a practice and is backed by a fair, stable funding formula.
Congress needs to hear from you! Call or e-mail Senators Dianne Feinstein and Barbara Boxer today to let them know the impact these cuts will have on your practice. Urge them to end their mismanagement of these important health care programs, and honor their commitment to military families and older Americans. Use the toll-free AMA hotline to contact Senators Feinstein and Boxer (800/833-6354). Just enter your zip code and you will automatically be connected.
"Every senior and his or her doctor should contact their member of Congress today and demand action," says Dr. Cassidy. "Health care means nothing if patients cannot get access to care."
We have also prepared a flyer that you can use to get your patients involved in the fight to protect Medicare. Download the flyer.
Contact: CMA's member service center, 800/786-4CMA or memberservice@cmanet.org.
5. Federal Medi-Cal audits to begin in August
The Centers for Medicare & Medicaid Services will be conducting audits of Medicaid claims in California. The audit is part of the federal Payment Error Rate Measurement (PERM) Program, mandated by the Improper Payments Information Act of 2002. The purpose of PERM is to estimate the number of payment errors made in the Medicaid programs of all 50 states and report back to Congress with an "improper payment estimate."
Five hundred California Medi-Cal claims will be selected for audit over the course of one year, approximately 130 claims per quarter. Audited claims will have dates of service of October 1, 2009, to September 30, 2010. Providers whose medical records have been selected for review will begin receiving written requests for medical records beginning this August.
DHCS is urging all providers to comply with requests for medical records from the federal contractors or DHCS. If you fail to submit the requested records, an error will be counted against California and you will be required to refund the claim payment amount to DHCS. Your cooperation will help ensure that the audit results are accurate and that California retains its much-needed federal matching monies for the Medi-Cal program.
For more details on the federal audits, see DHCS's March 2010 Medi-Cal Update newsletter.
The DHCS Audits and Investigations Unit has also been stepping up anti-fraud efforts, including investigations of physicians and other providers. This year's budget proposal includes a request for 38 additional DHCS positions to implement an anti-fraud initiative, with an estimated net savings of $26.4 million resulting from the increased audit efforts.
For more information on Medi-Cal audits, see CMA On-Call document #0626, "Medi-Cal Audits." CMA also recently hosted a webinar on Medi-Cal fraud and abuse. The previously recorded webinar is available for on-demand viewing to members only.
Contact: CMA's reimbursement help line, 888/401-8911 or economicservices@cmanet.org.
6. State auditor finds that Medi-Cal TAR process
should be streamlined
The Bureau of the State Auditor last week released its long-delayed audit of Medi-Cal's Treatment Authorization Request (TAR) process. CMA requested the audit, which was coauthored by Assembly members Ted Lieu (D-Torrance) and Jim Beall (D-San Jose).
In its report, the auditor found that of all the services that require TARs, 40 percent of them have denial rates of less than 4 percent. That means that from 2007 to 2009 the state spent approximately $14.5 million processing four million medical TARs for services and procedures that are very rarely denied. Since 96 percent of these TARs are granted, the process does little more than delay treatment and increase administrative costs.
The auditor recommended that the Department of Health Care Services (DHCS) either create a system for automatically adjudicating these TARs or eliminate the need for them altogether.
CMA has been advocating for a more efficient TAR process for many years. Over the last six years, the TAR process has been a target for review; however, changes have yet to materialize. The need to change the TAR system was recognized by a 2003 Medi-Cal Policy Institute report and in the 2005 California Performance Review. Both stated that the process was slow, inefficient, inconsistent, and outdated. The TAR program costs the state $1.5 billion to administer and creates considerable added paperwork for physicians serving Medi-Cal patients. CMA also supported legislation last year that would have reformed the TAR process. That bill was held due to concerns about the state budget.
View the auditor's report on the California State Auditor's website.
Contact: David Ford, 916/551-2554 or dford@cmanet.org.
7. AMA sues FTC to stop Red Flag Rule;
FTC again delays implementation
AMA has filed a lawsuit to stop the Federal Trade Commission (FTC) from extending its "Red Flag Rule" to physicians. The rule, after yet another delay, is now scheduled to take effect on December 31, 2010.
As you know, the Red Flag Rules require financial institutions and "creditors" to implement identity theft detection and prevention programs. Despite objections from CMA, AMA, and others in organized medicine, the FTC insists that physicians who regularly bill their patients for services (including copayments and coinsurance) are considered "creditors" and must develop and implement written identity theft prevention programs for their practices by the June 1 deadline.
CMA and AMA for two years attempted to get the FTC to reconsider its interpretation of physicians as "creditors." CMA believes the Red Flag Rule imposes an unnecessary burden on physician practices, which often already operate under severely strained conditions. CMA also believes the new rules are unnecessary for most physicians because the Health Insurance Portability and Accountability Act (HIPAA) imposes strict requirements to safeguard the confidentiality and security of electronic patient information.
AMA's lawsuit asks for a declaratory judgment finding the rule is unlawful and void as applied to physician members of medical associations and state medical societies. The lawsuit does not, however, suspend the December 31 deadline.
For more information on the Red Flag Rule, see CMA's Red Flag Rule toolkit and webinar, available free to members.
Contact: Samantha Pellon, 916/551-2872 or spellon@cmanet.org.
8. PECOS enrollment deadline moved up to July 6, 2010
The Centers for Medicare & Medicaid Services (CMS) recently announced that the PECOS enrollment deadline will be moved up by six months. Pending any changes resulting from the public comment period, physicians now have less than 60 days to update their enrollment in Medicare if necessary.
As previously reported, Medicare physicians who have not updated their enrollment information in the past five years may need to fill out another application or risk facing payment problems for ordered or referred services. Although the new rules were previously scheduled to take effect January 1, 2011, with the signing of the federal health reform law that deadline was moved up to July 6, 2010. CMS announced the change on May 5 in the Federal Register.
Under the new rules, Medicare is authorized to reject claims if an ordering or referring physician is not identified in Medicare's Internet-based PECOS enrollment system. Thousands of otherwise acceptable Medicare claims could go unpaid merely because they were submitted by providers who enrolled in Medicare before the PECOS database was developed.
Physicians should also be aware that federal law requires providers who are enrolling or revalidating their PECOS enrollment to also sign up for electronic funds transfer (EFT). Although the online PECOS revalidation process appears to allow you to opt out of EFT, opting out is not an option. If you do not also complete the CMS-588 EFT enrollment form, you will be notified by CMS of the requirement and must do so before your claims are paid.
CMA has developed a step-by-step guide to walk physicians through the process, from determining if they are already in PECOS to accessing the Internet-based PECOS enrollment system. This guide is available to members only at the members-only website. CMA also hosted a PECOS enrollment webinar with Palmetto, California's Medicare contractor. The previously recorded webinar is available for on-demand viewing to members only at the members-only website.
Contact: CMA's member service center, 800/786-4CMA or memberservice@cmanet.org.
9. DMHC orders health plans to terminate or modify
contracts with La Vida Medical Group
The Department of Managed Health Care (DMHC) has ordered its licensed health plans to terminate or modify any contractual arrangements with La Vida Medical Group. Plans by June 21 must terminate or modify their contracts so that La Vida no longer assumes risk for payment of claims. Plans may, however, continue to contract with La Vida for administrative claims processing. The order results from the medical group's failure to meet several of DMHC's financial solvency standards for risk-bearing organizations.
La Vida (aka La Vida Medical Group & IPA, La Vida Multispecialty Medical Group, Prairie Medical Group) currently serves about 54,000 enrollees in the Los Angeles area through risk-bearing contracts with nine different health plans. La Vida previously served 40,000 patients in the Central Valley through a single risk-bearing contract with Blue Cross. Blue Cross terminated its Central Valley arrangement with La Vida on February 1, shortly after DMHC ordered La Vida's contracted health plans to freeze enrollment due to financial solvency concerns.
CMA is working with the health plans, DMHC, and La Vida to facilitate a smooth transition for the patients and physicians affected by this order. For more details, including information on each plan's transition plan, see CMA's La Vida Medical Group information guide at the members-only website.
Contact: CMA's reimbursement help line, 888/401-5911 or economicservices@cmanet.org.
10. Medicare fee schedule revisions take effect June 1
Palmetto, California's Medicare contractor, recently posted a revised Medicare fee schedule on its website. The new fee schedule includes changes resulting from practice expense and malpractice relative value unit (RVU) corrections in the 2010 Physician Fee Schedule Final Rule and the federal health reform bills signed into law by President Obama in March.
The new fee schedule takes effect June 1 and is retroactive to January 1, 2010. Although it still represents a zero-percent update, most codes will see a slight decrease due to changes in practice expense and malpractice RVUs. Most medical codes will result in a decrease of less than a dollar, but surgical and imaging codes could see much larger decreases. Some codes will, however, see increases.
Although the new fee schedule is retroactive to January 1, Medicare contractors will not go back and adjust previously paid claims. Physicians who render services that are now paying at higher levels can, however, ask for a redetermination based on the change.
Additional fee schedule changes may be necessary pending the outcome of the Medicare sustainable growth rate (SGR) fix currently being debated in Congress. The latest proposal would provide a 2 percent SGR update for the remainder of 2010, with another 1 percent in 2011. For more information on the SGR, see "Congress again recesses without stopping 21% SGR cut," above.
Contact: Michele Kelly, 213/226-0338 or mkelly@cmanet.org.
11. Deadline to nominate a colleague for the
CMA Foundation leadership awards is June 30
The CMA Foundation is accepting nominations for the 2010 Leadership Awards, which celebrate the efforts of individuals or organizations making a difference in the health of Californians. The deadline to submit nominations is June 30. Nomination information and packets are available at the CMA Foundation website.
Contact: Carol Lee, 916/779-6622 or clee@cmanet.org.
12. June issue of CMA Practice Resources (CPR) now available
The June issue of CMA Practice Resources (CPR) is now available. The free monthly e-mail bulletin from the reimbursement experts in CMA's Center for Economic Services is full of tips and tools to help physicians and their staff improve practice efficiency and viability. Sign up now for your free subscription.
Contact: Jennifer Williams, 916/551-2061 or economicservices@cmanet.org.
13. Survey: How do prior authorization requirements
impact your practice?
CMA is interested in your feedback on prior authorization requirements for medical services and prescription drugs. We invite you to participate in a 10-minute survey on your experience with health insurer prior authorization and prior notification programs.
This survey is open to physicians and their practice staff and will help us determine how we can best equip your practice to effectively address prior authorization and prior notification program issues.
Please complete the survey by June 15, 2010. Take the survey online. For a paper version of the survey, contact Jennifer Williams, 916/551-2061 or jwilliams2@cmanet.org.
Thank you in advance for your participation.
14. Featured member benefits
Epocrates: CMA members save 30 percent on all Epocrates mobile and online products. Epocrates provides point-of-care access (via mobile devices and the web) to information on drugs, diseases and diagnostics.
A members-only link is required to access the discount. To access the link, visit http://www.cmanet.org/benefits or contact CMA's member help center at 800/786-4CMA or memberservice@cmanet.org.
For more information on these and other member benefits, visit http://www.cmanet.org/benefits or contact CMA at memberservice@cmanet.org or 800/786-4CMA.
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