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1. AMA Creates CPT Codes for HIN1 Vaccine; Many Billing
Questions Remain
AMA has published a new CPT code specific to H1N1 vaccine administration (90470) and revised existing code 90663 to include the H1N1 vaccine. The new CPT codes are effective immediately. 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.
There continues to be significant uncertainty regarding billing for H1N1 vaccinations. For example, some payors, clearinghouses, and physician billing systems may not be able to accommodate a zero dollar charge, and the practice would have to bill vaccine claims with a $0.01 charge. We are awaiting clarification from CMS to ensure that it would not be considered fraud to bill with $0.01 to accommodate systems that can't process a $0.00 charge.
CMA is working closely with AMA and other state and specialty societies to iron out these and other kinks in the H1N1 billing process and we will provide an update in CMA Alert as soon as we have more information.
Contact: CMA’s reimbursement help line, 888/401-5911 or drice@cmanet.org.
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2. First Doses of H1N1 Delivered to Physicians This Week
With H1N1 infections in California now classified as “widespread,” state public health officials announced today that the first shipments of H1N1 flu vaccine will be delivered to California health care providers this week. Select clinics and physician offices will receive small shipments of FluMist nasal spray vaccine as soon as Wednesday. If you have been identified to receive doses from this first small batch of vaccine, you will be notified a few days before the shipment is set to arrive at your location. Physicians are reminded that FluMist is not approved for pregnant women, those with chronic health conditions, weakened immune systems, or a history of asthma.
According to the California Department of Public Health, the first shipments of vaccine to California providers total 400,000 doses. Larger shipments of the vaccine – in both the nasal spray and the traditional injectable form – are expected to arrive later this month. California is expected to receive 6.25 million doses by early November, which is expected to be more than enough to vaccinate all high risk individuals. California should receive a total of 22 million doses by December.
If you have questions about where you fall on the priority list for vaccine, please contact your local health department. Vaccine distribution decisions are being made at the local level based on a number of factors, including the number of patients you has that fit into the high risk groups (you would have given this information as part of the preregistration process).
CMA continues to work with the CDC, the California Department of Public Health, and other stakeholders to ensure that physicians have the information they need heading into what is likely going to be a very hectic flu season. According to a report released last week by Trust for America’s Health, California and 14 other states could run out of available hospital beds during the peak of the outbreak. The report, H1N1 Challenges Ahead, estimates that the number of people hospitalized could exceed 168,000 in California alone. These figures are based on estimates from the FluSurge model developed by the CDC. Trust for America's Health is a nonprofit, nonpartisan organization dedicated disease prevention.
For more information, visit CMA’s H1N1 resource center.
Contact: Veronica Ramirez, 916/551-2887 or vramirez@cmanet.org.
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3. CMA Voices Serious Concerns About Senate Reform Bill
Federal health reform discussions took a turn for the worse last week with the introduction of the "America's Healthy Futures Act of 2009" by Senator Max Baucus (D-MT), chairman of the influential Senate Finance Committee.
Together with the Texas Medical Association, the California Medical Association sent a letter to Senator Baucus to express our serious concerns and to urge him and his committee to work towards universal access to care for the uninsured and health care delivery reform based on proven models from around the country that work for patients and physicians in all modes of practice. Read our joint letter to Senator Baucus.
While the Baucus proposal has some positives, such as a 10 percent Medicare bonus payment to expand access to primary care and the authorization of non-profit community co-ops in lieu of a public insurance option, CMA strongly opposes many other provisions that will undermine the profession of medicine and threaten patient access to their doctors.
Initial analysis by CMA projects that the net effect of various provisions relating to Medicare payments could result in a 33 percent cut in Medicare payments for California primary care physicians and as much as a 48 percent cut in Medicare payments for specialists, depending on the region and mode of practice.
Other notable shortcomings in the bill include:
- Expands the unreliable "Physician Feedback" program;
- Imposes 5% penalties on physician outliers;
- Fails to eliminate the Medicare Sustainable Growth Rate (SGR);
- Creates independent and unaccountable Medicare Commission to set Medicare policies;
- Includes an enrollment fee for Medicare and Medicaid providers;
- Fails to protect physicians from expanded liability from new clinical guidelines;
- Fails to update Medicaid physician payments;
The Baucus bill is still undergoing "mark-up" in committee, so the exact nature of the final proposal remains very fluid. The mark-up process to date has not improved the bill.
However, Chairman Baucus has committed to propose an amendment on the Senate floor to eliminate and rebase the current SGR. CMA and AMA are also exploring a floor strategy to include additional medical liability protections for physicians.
As things stand now, the Baucus proposal is a tremendous step backwards for Medicare/Medicaid payment reform efforts, particularly compared to the health reform legislation moving through the House, which includes an SGR fix and Medicaid payment updates, and does not include many of the punitive measures against physicians contained in the Baucus proposal.
CMA believes that we must reform our health care system by building upon what works and fixing what is broken. Unfortunately, the version of health reform advancing in the Senate promises to undermine what is working and is based on unproven, unsuccessful models of care, while failing to address aspects of health care that need to be fixed. CMA and organized medicine will continue to advocate on behalf of patients and physicians of all modes of practice.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
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4. CMA Proposes Health Reform Amendments to
Protect Physicians from Increased Liability
CMA and Californians Allied for Patient Protection have developed amendments to the House and Senate health reform bills that would protect physicians from increased liability. CMA's proposed amendments would ensure that physicians are protected if they deviate from any clinical guidelines produced through clinical effectiveness research and other provisions in the health reform legislation.
CMA believes that physicians must be allowed to deviate from practice guidelines when in their clinical judgment it is in their patient's best interest, without being exposed to increased liability. CMA also believes that data gleaned from such research must not be independently used to establish standards of care or deny coverage, or be used as evidence in medical malpractice cases.
CMA's amendments would also prevent government performance-based value purchasing decisions – such as nonpayment for hospital acquired conditions – from being used to create a presumption of medical negligence.
Henry Waxman, Chairman of the Energy Commerce Committee, has expressed an initial interest in including our amendments in HR 3200, the House health reform bill. CMA has also approached Senator Feinstein and asked her to offer these changes as floor amendments on the Senate side.
Click here to read CMA's letter to Waxman on this issue.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
5. Attorney General Opinion Reinforces California's Ban
on the Corporate Practice of Medicine
California Attorney General Jerry Brown recently issued an opinion reinforcing California's ban on the corporate practice of medicine. In the opinion, the Attorney General concludes that an entity or individual not licensed to practice medicine may not perform professional radiology services, including selecting radiology equipment or billing for radiology services.
The issue in question was whether or not medical provider networks (MPN) could "select radiology equipment for examination sites, or secure, schedule, pay, or bill for radiology physicians performing radiology services for workers' compensation benefits."
Under workers' comp reform legislation passed in 2004, insurers and self-insured employers can establish MPN to provide care for injured workers. The goal is to cut costs by allowing employers to direct where their employees go for treatment of work-related injuries. In a network system, the employer or insurer can negotiate reimbursement upfront with its network of physicians, thus maintaining some control over costs.
The Attorney General last year solicited CMA's opinion on this matter. In a letter dated November 17, 2008, CMA explained that the Legislature did not intend for MPNs to be exempt from the corporate practice of medicine bar. "While the Legislature authorized MPNs to engage in select activities, such as contracting with and paying physicians for medical services provided to employees, this limited authorization was insufficient to constitute an implied repeal of the corporate practice of medicine in its entirety," wrote CMA in the letter.
The Attorney General agreed wholeheartedly with CMA, ruling that the activities in question "involve the exercise of professional judgment as part of the practice of medicine" and it is unreasonable to suggest that by merely introducing a new administrative structure the Legislature intended to exempt MPNs from state law that bans the corporate practice of medicine. This important law was created to prevent corporations or other entities from unduly influencing the professional judgment of licensed physicians.
Contact: Samantha Pellon, 916/551-2872 or spellon@cmanet.org.
6. New Federal Regulations Require Physicians to Notify
Patients of Security Breaches
The U.S. Department of Health and Human Services (HHS) recently implemented regulations that require health care providers, health plans, and other entities covered by the Health Insurance Portability and Accountability Act (HIPAA) to notify patients when their health information is breached.
These regulations were mandated under the Health Information Technology for Economic and Clinical Health (HITECH) Act, passed as part of American Recovery and Reinvestment Act of 2009 (ARRA).
The regulations require HIPAA covered entities to promptly notify affected individuals of a breach and, in cases where a breach affects more than 500 individuals, the HHS and the media must also be notified. Breaches affecting fewer than 500 individuals must be reported to HHS on an annual basis.
California law already requires any person or business that conducts business in California, including physicians and physician groups, to disclose any security breach to any California resident whose unencrypted computerized personal information was or is reasonably believed to have been acquired by an unauthorized person.
To help physicians understand their obligations under this new federal regulation, as well as existing state law, CMA has published On-Call document #1144, "Security Breach of Health Information." On-Call documents are free to members at the members-only website. Nonmembers can purchase On-Call documents for $2 per page in the CMA bookstore.
Contact: Samantha Pellon, 916/551-2872 or spellon@cmanet.org.
7. Don't Forget Blue Cross Switches to
Paperless EOBs Tomorrow
Physician practices that have previously registered for Blue Cross's online provider portal, ProviderAccess, will no longer receive printed EOBs with their checks. Effective October 6, you will be required to go to Blue Cross website to obtain claims information and to download or print out EOBs, if necessary. EOBs will be only available online for 18 months. Practices that have not registered for ProviderAccess will continue to receive paper EOBs.
Although the notice sent to physicians did not include information on opting out, Blue Cross has agreed to allow physicians to opt out of the paperless EOB program. If you would like to continue receiving paper EOBs, call Anthem Network Relations at 800/933-6633.
The paperless EOB program is one of many changes affecting Blue Cross physicians in coming months. The insurer is also making changes to its Prudent Buyer fee schedule and its claims processing system, as well as requiring physicians to sign new contracts and accept reduced rates to continue treating Healthy Family and AIM patients. To help physicians understand the impact these changes will have on their practices, CMA has published a Blue Cross tool kit, available free to members at the members-only website.
Contact: CMA's reimbursement help line, 888/401-5911 or jblack@cmanet.org.
8. CMA Publishes Blue Cross Tool Kit
Over the past several months, Anthem Blue Cross has announced several changes that will impact physicians. The changes include fee schedule, payment policy, and claims editing software updates, a switch to paperless EOBs, well as a requirement that physicians sign new contracts and accept reduced rates to continue treating Healthy Family and AIM patients.
To help physicians understand the impact these changes will have on their practices, CMA has published a Blue Cross tool kit. The tool kit contains information on each of these changes, including important dates and links to important documents and sample letters.
The tool kit is available free to members-only at the members-only website.
Contact: CMA's reimbursement help line, 888/401-5911 or jblack@cmanet.org.
9. Medical Students: Apply for the CMA Foundation's
Community Leadership Grant Program
The CMA Foundation awards small grants to California medical student organizations to support educational, advocacy, community service, and other outreach programs that enhance the well-being of California communities. Most recently, the foundation awarded a total of $3,000 in scholarship grants to medical students so they could attend CMA's annual Medical Student Leadership Conference in Los Angeles.
The CMA Foundation reviews applications during the first week of each month and then awards grants ranging from $250 to $1,000 to worthy applicants. All allopathic and osteopathic medical student organizations are eligible. Priority is given to projects for which funding traditionally is not provided by medical schools or community sponsors.
Applicants must supply a 250-word-maximum statement, on one page, describing the project or program and how it contributes to the community. It must be signed by the medical school dean to affirm the "good status" of the student organization.
Applications should be received in the CMA Foundation offices by the last business day of each month to be considered the first week of the next month.
Click here for more information.
Contact: Leslie Barron, 916/779-6623 or lbarron@cmanet.org.
10. CMA's Coalition Invited to Next Round of Federal Applications
to be California's Regional Health IT Extension Center
The U.S. Department of Health and Human Services last week asked a coalition led by CMA, the California Primary Care Association (CPCA), and the California Association of Public Hospitals (CAPH) to file full applications to be designated as a Health Information Technology Regional Extension Center (REC) for Northern and Southern California. Today's request indicates that the CMA-led coalition has successfully cleared the first hurdle to receiving as much as $60 million in federal grants to help California providers adopt electronic health records (EHRs).
The REC program is funded by the American Recovery and Reinvestment Act of 2009, the federal economic stimulus bill passed earlier this year. It is intended to create centers throughout the country that will provide technical assistance to physicians and other providers in their transition to EHRs. The grants are for a maximum of $30 million each, with a total of $600 million nationwide.
Realizing the importance of providing physicians with credible, physician-driven expertise and counsel in the complicated and often daunting transition to EHRs, CMA and it county medical societies began a joint health IT taskforce to work through the various issues and determine how best to get physicians the help they will need. Because REC applicants are required to represent multiple stakeholder groups, we joined in partnership with CPCA and CAPH this summer, and the three groups have since been working together on a plan to offer all providers in this large and diverse state with the assistance they need.
CMA's coalition filed letters of intent to apply for two grants – one covering Northern California and one covering Southern California on September 8. Now that the coalition has been invited into the next round for both grants, we will be filing a full application by November 3. The federal government expects to make final grant awards on December 11.
While there is another stage of the application process to navigate, this is a significant step towards ensuring that CMA and its coalition partners are in the best position possible to assist physicians and other providers who want to transition to EHRs.
Contact: David Ford, 916/551-2554 or dford@cmanet.org.
11. Best Practices: Performing an EHR Needs Assessment
Selecting and implementing an electronic health record (EHR) system is one of the most complex and resource intensive activities a medical practice can undertake. Before taking on this challenge, it is important for you to assess your EHR needs, with an eye for what will work best for your specialty, the size of your practice, the stage in your career, and your comfort level with technology.
Chapter 7 of CMA's Best Practices tool kit will show physicians how to perform an EHR needs assessment and create a road map for the EHR selection and implementation process.
CMA published the 140-page Best Practices tool kit with generous support from the Physicians' Foundation, to help physicians improve the efficiency, and in turn the quality, of their practices. In addition to learning how to perform an EHR needs assessment, the tool kit will also teach you:
- How to find and keep qualified staff;
- How to build a defensible fee schedule;
- When it makes sense to cancel a payor contract;
- How to make sense of your revenue stream;
- How to improve the patient experience;
- And much more.
The Best Practices tool kit, available free to all physicians, is organized into nine chapters that can be read sequentially or on an as-needed basis. Download the tool kit today.
Contact: CMA's reimbursement helpline, 888/401-5911 or fnavarro@cmanet.org.
12. CMA's Annual House of Delegates Convenes Next Week
At this year's House of Delegates, physicians from across the state will debate and set policy on important health care issues including health reform, pandemic influenza, and end-of-life issues. The House of Delegates convenes October 17 to 19 in Anaheim.
During the three-day meeting, the 500 delegates will address more than 120 resolutions on these and other key issues that affect the practice of medicine. Orange County physician J. Brennan Cassidy, M.D., will be installed as the association's new president and the delegates will choose a president-elect.
CMA invites all members to visit its online forum by 11:59 p.m. on October 11, to discuss or comment on the resolutions and reports that will be considered by the delegates.
Click here to participate in the online discussion.
Contact: Roger Purdy, 916/444-5532 or rpurdy@cmanet.org.
13. All Physicians Invited to Attend CMA's OMSS Annual
Assembly, October 16 in Anaheim
CMA's Organized Medical Staff Section (OMSS) will hold its Annual Assembly and Education Conference Friday, October 16, at the Disneyland Hotel in Anaheim. All CMA physicians interested in the role of strong self-governing medical staffs in improving patient care and safety are encouraged to attend. The conference takes place the day before the 2009 CMA House of Delegates meeting, also in Anaheim.
Attendees will learn about legal and legislative issues affecting medical staffs, the roles and responsibilities of medical staff leaders, how to manage conflicts of interest, and more. The conference has been approved for 4.5 AMA PRA Category 1 Credits™.
All CMA physicians and medical staff professionals are invited to attend, but seating is limited. Registration is free for medical students and for physicians and representatives from OMSS member hospitals. Members of CMA's Hospital Based Physicians' Forum pay $50, and all other CMA members $100. The registration deadline has been extended and new registrations will be accepted until all available slots are filled.
Click here to download a registration form.
Contact: Patti Moyle, 415/882-3352 or pmoyle@cmanet.org.
14. Featured Member Benefits
Practice Financing: Members get reduced loan administration fees from Banc of America Practice Solutions (a subsidiary of Bank of America) for software upgrades, practice expansion, and equipment purchasing. A members-only coupon code is required to access this benefit. Get your code by calling CMA's Member Help Line 800/786-4262.
CMA Credit Card: Physicians can show their CMA pride with CMA-branded credit cards from Bank of America. Call Bank of America at 800/789-6701 for more information.
For more information on your member benefits, visit http://www.cmanet.org/benefits or contact CMA's member service center at 800/786-4CMA or memberservice@cmanet.org.
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