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1. It's Time to Make Medicare Participation Decisions for 2008
It is the time of year again when physicians must make decisions about their Medicare participation. Physicians who wish to change their participation status for 2008 must do so by December 31.
As you know, the Centers for Medicare & Medicaid Services (CMS) announced last month that physician payments will be cut by 10 percent on January 1. While CMA, AMA, and others in organized medicine continue to lead an aggressive campaign to pass legislation that would prevent the cut, there is no guarantee that Congress will act before the January 1 deadline.
The U.S. House of Representatives passed a bill in July that would stop the 10 percent SGR cut in 2008 and the 5 percent cut in 2009, replacing them instead with .5 percent increases in each of those years. That legislation would also update California’s geographic payment localities in 2008 and prevent any geographic payment reductions for three years. The bill provides an unprecedented $22 billion in payment fixes for physicians, without mortgaging this debt into future years.
The U.S. Senate, however, has yet to act on the Medicare physician payment issues. The Senate Finance Committee has indicated that it may pass a Medicare bill as early as next week. Once it does so, the House and Senate Medicare packages will be reconciled by a joint House/Senate conference committee. CMA will notify members as soon as the final outcome is known.
Your Participation Options
Physicians have three choices regarding Medicare: be a participating provider; be a nonparticipating provider; or opt out of Medicare entirely.
- A participating physician must accept Medicare allowed charges as payment in full for all Medicare patients.
- A nonparticipating provider can choose to accept or not accept assignment on Medicare claims on a claim-by-claim basis. Nonparticipating physician fees are 95 percent of participating physician fees. If you choose not to accept assignment, you can charge the patient 9.25 percent more than the amounts allowed in the participating physician fee schedule.
- Physicians who opt out of Medicare are bound only by their private contracts with their patients. Medicare’s limiting charges do not apply to these contracts, but Medicare does specify that these contracts contain certain terms. When a physician enters into a private contract with a Medicare beneficiary, both the physician and patient agree not to bill Medicare for services provided under the contract. Once you opt out, you cannot opt back in for two years.
Economic Impact of the Cuts
CMA is urging physicians to assess the impact the potential Medicare payment cuts will have on their practices. It is important that physicians understand how these cuts will affect their bottom line so that they can make informed decisions about Medicare participation for 2008.
- Determine Your Payor Mix: The first step is to complete an internal analysis of your payors to determine your Medicare claim volume. Use CMA’s “Utilization by Payor Class” worksheet.
- Identify Your Top 20 CPT Codes: Next, calculate the financial impact the Medicare payment changes will have on your practice, based on your 20 most commonly billed CPT codes. Use CMA’s “Financial Impact” worksheet.
- Calculate Change in Practice Costs: These latest Medicare rate cuts come at a time when medical practice costs are soaring. Over the last five years, the average cost to run a medical practice has gone up at least 18 percent. Use CMA’s “Cost Analysis” worksheet to determine anticipated increases to your practice costs for 2008.
For more information on your participation options, see CMA ON-CALL document #0151, “Medicare Participation (and Nonparticipation) Options.” 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.
AMA has also published a white paper on physicians' Medicare participation options.
Click here for more information.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
2. You Can Help Stop Medicare Payment Cuts
It continues to be important for physicians to contact California Senators Barbara Boxer and Dianne Feinstein and tell them how the Medicare cuts would impact their ability to care for senior patients. Call, write, or e-mail Senators Feinstein and Boxer and ask them to urge their Senate colleagues to:
- Stop the Medicare physician payment cuts for two years
- Provide a positive physician payment update for two years
- Equalize Medicare Advantage rates with physician rates
- Include a California GPCI fix
Call AMA’s grassroots hotline at 800/833-6354, enter your zip code, and you will be automatically connected with your member of Congress. Please also thank Senators Feinstein and Boxer for their continued support of physicians.
Click here for more information.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
 3. Download CMA's 'Save Medicare' Poster
CMA has produced “Save Medicare” posters to display in your office or hospital to encourage patients to join the fight to stop the physician payment cuts. High-resolution posters are available in a number of sizes for you to download.
Click here to select a size.
4. HIV Consent Law to Change on January 1
A CMA-sponsored law takes effect on January 1 that simplifies HIV testing consent requirements to facilitate routine HIV screening, as recommended by the federal Centers for Disease Control and Prevention (CDC). Under current law, physicians are required to obtain informed consent before ordering an HIV test, which has proven to be a barrier to routine HIV screening.
The new law (AB 682) removes the informed consent requirement and instead simply requires providers to tell a patient that an HIV test is planned, provide information about the test, discuss the treatment options available for a patient who tests positive for HIV, and advise the patient that he or she has the right to decline the test. Physicians must also inform patients that test negative for HIV that they should continue to be routinely tested. If the patient declines the test, the physician must note that fact in the patient's medical file.
The new law is expected to result in earlier detection of the virus and better care for patients. It is estimated that over 40,000 Californians are unaware they are HIV positive.
The CMA ON-CALL system is currently being updated to reflect all new legislation, including AB 682. This new consent law will be discussed in full in the revised ON-CALL document #0414, “Consent for HIV Tests.” This updated document will be available on CMA’s website in January 2008.
Contact: CMA’s legal department, 916/551-2033 or legalinfo@cmanet.org.
5. It's Not Too Late to Vaccinate
Although influenza activity in the United States has been low so far this season, it is expected to increase during the coming weeks, according to the Centers for Disease Control and Prevention (CDC).
CDC encourages continuing vaccination efforts throughout the season, especially among health care workers, individuals with medical conditions that put them at an increased risk of influenza-related complications, and those over age 65. Adults and children in close contact with those at high risk for flu should also be vaccinated.
Vaccine manufacturers report that as many as 132 million doses of vaccine will be produced by the end of the 2007-2008 flu season. This record amount is about 12 million more doses than were produced last year.
Vaccine remains available from some distributors and manufacturers. Find out who has vaccine for sale via AMA’s Influenza Vaccine Availability Tracking System.
Click here for more information.
6. FluMist Approved for Use in Children as Young as 2
The Food and Drug Administration (FDA) recently approved the use of the intranasal flu vaccine FluMist for healthy children 2 to 4 years old, providing another influenza vaccination option for young children. FluMist was first licensed by the FDA in 2003 for use by healthy, nonpregnant persons ages 5 to 49.
In granting the new approval, FDA emphasized that FluMist has not been approved for use by individuals with underlying medical conditions that predispose them to influenza-related complications. FluMist should not be administered to persons with asthma or other breathing problems.
Click here for more information.
7. Member Benefit of the Week: Magazine Discount Program
The CMA Magazine Program gives members up to 50 percent off subscriptions to hundreds of popular magazines. The same low rates apply to new subscriptions and renewals. Renewals with the discount are available no matter how your subscriptions were originally ordered. If you find a lower valid advertised price for any magazine offered through this program, simply send in the promotional offer with your order and pay the lower amount. Subscriptions for both office and personal use are available through this membership program.
For more information, call 800/603-5602, e-mail cma@buymags.com, or visit http://www.buymags.com/cma.
Click here for more information on your membership benefits.
Contact: CMA's membership hotline, 800/786-4CMA (4262) or info@cmanet.org.
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No. 2120
