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1. CMA Clarifies Medical Liability Provisions in Health Reform Bills
There is a significant amount of misinformation surrounding the issue of medical liability as it relates to health reform. California physicians are understandably nervous that the health reform bills might result in increased liability for physicians or undermine MICRA, our state's landmark medical malpractice reform law.
The truth is that neither proposal would pre-empt or otherwise directly impact MICRA and other similar state laws, although the U.S. House bill does incentivize states to adopt pilot programs using early offer and certificates of merit while explicitly excluding MICRA-like caps from such incentives. CMA also was instrumental in getting language into the House bill to ensure that any practice guidelines or payment policies established in the bill do not increase the liability exposure for physicians. CMA is seeking similar language in the Senate bill.
To help physicians understand this issue, and clarify what the health reform bills do and don't do with regards to medical liability, CMA has published a medical liability issue brief on its health reform page.
There you will also find briefs on other health reform issues, including the SGR and other Medicare payment issues, and Medicaid/Medi-Cal. Additional issue briefs will be published in the coming weeks.
Click here for more information.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
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2. CMS Delays Implementation of PECOS Enrollment Policy
Thanks to CMA advocacy, the Centers for Medicare & Medicaid Services (CMS) recently announced that it would delay implementation of new rules that authorize Medicare to reject claims if an ordering physician has not reenrolled in Medicare via the agency's web-based PECOS enrollment system. Enforcement of the new rule, scheduled to begin on January 2, 2010, will delayed until April 5, 2010.
CMA has been pushing for a delay to this policy, which could negatively impact thousands of physicians and other health care providers. If the rule were enforced today, hundreds of thousands of otherwise acceptable Medicare claims would go unpaid merely because they were submitted by providers who enrolled in Medicare before November 2003, when the PECOS database was developed.
According to CMS, the extension will give physicians and other health care providers sufficient time to reenroll in Medicare, if necessary.
In order to continue submitting Medicare claims after April 5, physicians who have not updated their enrollment information since 2003 may need to fill out another enrollment application. (If you are not sure if you are already in the PECOS system, call Palmetto at 866/931-3901 to confirm your status before submitting a new enrollment form.)
If you determine that you do need to submit a new enrollment form, you can do so online using the web-based PECOS system or by filling out the appropriate paper enrollment form(s) (CMS-855I and CMS-855R, if appropriate) and mailing the forms, along with any required additional supplemental documentation to Palmetto, who will enter your information into PECOS and process your enrollment application. If you enroll online, be sure to also mail to Palmetto the signed and dated Certification Statement.
Contact: Michele Kelly, 714/634-3908 or mkelly@cmanet.org.
3. CMA Heads to Washington to Fight for Improvements
to Senate Health Reform Bill
As the U.S. Senate begins to debate sweeping health reform legislation, CMA leaders are heading to Washington, D.C., to fight for changes to the bill to ensure reform delivers on its promise of providing patients access to a doctor when they need it.
CMA has encouraged lawmakers all year long to craft a workable plan that provides universal access to health care. While CMA supports meaningful health reform, and the general thrust of legislation passed last month by the House of Representatives, the CMA Executive Committee voted two weeks ago to oppose the Senate bill as currently written.
"There is no way health care reform can work if patients can't get access to a doctor," says CMA President Brennan Cassidy, M.D. "The Senate bill fails to fix major problems in Medicare and Medicaid, which currently suffer from chronic underfunding that undermines access and continues to undermine the success of these government programs.
"As physicians, we remain committed to meaningful reform that best serves our patients. Building reform on the foundation of Medicare and Medicaid can only work if that foundation is sound, and unfortunately both programs need major improvements and better funding to function properly."
What is meaningful health reform? Meaningful reform would truly build on what works and fix what's broken by ensuring people have affordable access to care and ensuring health care decisions are made by physicians and patients, not insurance companies or government bureaucrats. It would rein in the health insurance industry to increase competition and choice for consumers; protect the needs of patients; prohibit coverage exclusions due to pre-existing conditions and prevent insurance companies from cancelling policies after patients get sick and file expensive claims; and provide sufficient resources so that public programs can deliver on their promise of health care. CMA is working with senators to draft amended legislation that meets these goals.
Find more information on CMA's Health Reform page.
Contact: Elizabeth McNeil 415/882-3376 or emcneil@cmanet.org.
4. CMA Urges CMS to Restore Payments for Consultation Codes
As we reported in the last issue of CMA Alert, the 2010 Medicare payment rule contains a controversial change that would eliminate payments for inpatient and outpatient consultation codes and require physicians to instead bill for either new or established office visits or for initial hospital stays.
Although the payment rule will provide minor increases in payments for some inpatient and outpatient E&M visits to offset losses from the elimination of these codes, physicians asked to provide expert opinions will see an 8 percent reduction or more in reimbursement as a result of this new policy.
The Centers for Medicare & Medicaid Services (CMS) took this step largely due to the Office of Inspector General's findings in 2006 that indicated a high error rate in the use of consultation codes. These inaccuracies are often a product of confusion over what qualifies as a consult, resulting largely from unclear CMS billing guidelines.
CMA is urging CMS to restore the consult codes to the payment rule, and keep the E&M increases. Although CMA fully supports increased payments for E&M services, those increases cannot be paid for by cutting payments for other services. Moreover, elimination of consult codes will create significant confusion as physicians will be required to use codes that do not accurately describe the service they provide. Rather than eliminate these codes, CMA is encouraging CMS to educate physicians about the proper use of consultation codes.
CMA leaders will be meeting with CMS this week in Washington, D.C., urging them to eliminate the provision or at least delay implementation until alternatives solutions can be vetted. CMS has also reopened the comment period on the consultation code issue until December 31, 2009. CMA urges physicians submit comments urging CMS to maintain the E&M increases, but to eliminate the new consult code payment policy.
Click here for more information.
Contact: Michele Kelly, 714/634-3908 or mkelly@cmanet.org.
5. Physicians: Be Prepared for Disruption in
Medicare Cash Flow this Month
California's Medicare contractor recently announced a temporary operational change that will result in a "front loading" of payments in December. On Wednesday, December 9, the waiting period for claims payment will be reduced to zero days (normally 14 days for electronic claims and 30 days for paper claims). All claims that have been cleared will be paid immediately.
The temporary elimination of the claims payment floor is part of Palmetto's transition to a new financial accounting system. This may give the appearance that your cash revenues have increased, when in fact payments for some of your claims may have simply been made earlier than normal. Physicians are encouraged to monitor their payments and make adjustments as necessary to prevent cash flow problems later in the month.
No payments will be issued from December 10 through December 15 while the accounting systems are being switched from the old Multi-Carrier System (MCS) to the new Healthcare Integrated General Ledger Accounting System (HIGLAS). Normal payment cycles will resume on December 16.
Physicians should continue submitting claims as normal during this transition. Although no payments will go out December 10 – 15, the payment floor clock WILL tick for claims received during that time period. Physicians should also be aware that access to claims data (both online and from Palmetto customer service) will be extremely limited during the 5-day transition.
Contact: Michele Kelly, 714/634-3908 or mkelly@cmanet.org.
6. DOI Lawsuit Against PacifiCare Begins Today
Opening arguments begin today in a lawsuit filed by the California Department of Insurance against PacifiCare for widespread unfair payment processes in the wake of United Healthcare's takeover of PacifiCare in 2005.
The California Department of Insurance (DOI) and the California Department of Managed Health Care (DMHC) in 2007 launched a joint investigation into the health care giant's unfair payment practices. The investigation was prompted by complaints filed by CMA's Center for Economic Services on behalf of CMA member physicians.
Doctors throughout the state complained to CMA about problems with the insurer. Among the complaints were charges of chronic delays processing new contracts and contract terminations. These delays not only caused patients to be misinformed about physicians' participation status, but also resulted in significant administrative hassles for physician offices.
Some patients were told erroneously that they would have to switch doctors, or that their doctors were out of network when they actually were not, and were given extremely outdated lists of network doctors. The mistakes caused delays and denials of patient care.
The DOI alone uncovered 133,000 violations of state laws and regulations regarding payments for medical care. Each violation carries a maximum penalty of $10,000 for a possible total of $1.33 billion.
CMA publicly opposed the United/PacifiCare merger from the beginning, saying it would be a detriment to patient care. Although not a named plaintiff, CMA is working with DOI lawyers on this case and will testify to substantiate the DOI's case at trial.
Click here for more information.
Contact: CMA's Reimbursement Helpline, 888/401-5911 or jwilliams2@cmanet.org.
7. New E-Mail Scam Preys on Patients' H1N1 Fears
CMA is urging physicians to warn their patients about a new H1N1 e-mail scam. According to the CDC, the agency has received reports of fraudulent phishing emails promoting a fake CDC sponsored State Vaccination Program.
The fraudulent e-mail insists that anyone over the age of 18 (regardless of having been vaccinated or not) must create a personal H1N1 vaccination profile on the cdc.gov website. It provides a link to a fake CDC webpage where patients are prompted to enter their personal information.
There is no such thing as a "personal H1N1 vaccination profile" as mentioned in the phishing e-mail. The CDC has not implemented any state vaccination program that requires patients to register their personal information. Patients should be reminded that no special registration is required to receive the vaccine.
Users who click on the email are exposing themselves to identity theft and are at risk of having malicious code installed on their computers. Physicians, patients, and others are reminded to take the following steps to reduce the risk of being a victim of a phishing attack:
- Do not follow links in unsolicited e-mail messages;
- Do not respond to unsolicited e-mail messages;
- Use caution when visiting unknown or untrusted websites; and
- Always use extreme caution when entering personal information online.
Click here for more information on common phishing schemes.
8. State Extends H1N1 Vaccine Thimerosal Exemption
California's Department of Public Health (DPH) last week announced it would continue to exempt the H1N1 vaccine from state law banning the use of mercury-containing vaccines for pregnant women and small children. Exemptions to the ban are allowed in the event of potential public health emergencies, including an epidemic or vaccine supply shortage. DPH has extended the exemption through September 30, 2010, because of continued production delays and the high public demand for the vaccine. According to DPH, there are not enough doses of thimerosal-free vaccine to comply with the law and the health threat from H1N1 outweighs the worries about mercury-containing vaccines.
See CMA's H1N1 page for the latest information.
Contact: Veronica Ramirez, 916/551-2887 or vramirez@cmanet.org.
9. CMA Publishes H1N1 Billing Guide
With H1N1 vaccination now in full swing, physicians are reminded that AMA has created a new CPT code specific to H1N1 vaccine administration (90470) and revised existing code 90663 to include the H1N1 vaccine. 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.
To help physicians understand how to bill for H1N1 vaccine, CMA has reached out to all the major payors in California for clarification on their H1N1 billing policies. We have compiled this information into an easy to read chart available to members. You may also request a copy of the chart using the contact information below.
For more details, visit CMA's H1N1 page.
Contact: CMA's reimbursement help line, 800/786-4CMA or memberservice@cmanet.org.
10. State Resurrects Regulations that
Would Expand Scope of Nonphysicians
The California Department of Public Health (CDPH) has resurrected previously rejected regulations that would potentially expand the scope of practice of psychologists and all other health care practitioners working in licensed health care facilities. Although the California Office of Administrative Law rejected the regulations in October, state law allows CDPH to submit a revised proposal within 120 days. CDPH has made minor unsubstantive revisions to its proposal and has opened a second 15-day comment period.
The regulations—which are intended to clarify state law as it applies to medical staff membership and privileges for psychologists—would weaken medical staff self-governance rights and could be broadly interpreted to allow unqualified health care professionals to carry out the duties of a physician or surgeon, putting patients at risk.
The proposed regulations could, among other things, allow nonphysician practitioners to admit patients, perform medical examinations, place patients in restraints, complete medical records, coordinate care, and order transfers. The regulations would also circumvent the self-governance rights of medical staffs to establish and enforce the rules, regulations, criteria, and standards for medical staff membership and privileges. A strong, independent self-governing medical staff is critical to ensuring that patients receive the highest quality care.
CMA continues to vigorously oppose the proposed regulations and has submitted comments outlining our serious concerns with the regulations as written.
Contact: Veronica Ramirez, 916/551-2887 or vramirez@cmanet.org.
11. AHRQ Looking for Practices to Participate in
E-Prescribing Implementation Study
The U.S. Agency for Healthcare Research and Quality, in conjunction with the nonprofit RAND Corporation, is pilot testing an "E-Prescribing Implementation Toolset," which serves as a how-to guide for e-prescribing implementation across various organizational settings. RAND is seeking ambulatory physician practices to evaluate the usefulness of this toolset. Practices selected to participate will receive financial compensation for participating.
To be eligible, practices need to be planning an initial implementation of e-prescribing in the first quarter of 2010. Of particular interest are safety net practices and offices that are considering e-prescribing in the context of an electronic health record. Practices would receive an initial orientation via teleconference, and field researchers would visit participating practices before and after e-prescribing implementation to conduct interviews and observations of work processes. Practice staff would later be surveyed about the success of e-prescribing and the usefulness of various toolset components.
To learn more about participating, please email memberservice@cmanet.org or call 800/786-4CMA (4262).
12. Featured Member Benefits
Staples: Members get Up to 80% off office supplies and equipment from Staples. The Staples Advantage program allows CMA members to leverage group purchasing power for all of their office supply and furniture needs. A members-only link is required to access this discount.
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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