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2012 Medicare Fee Schedule Set
02/21/2012
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Congress has extended the current fee schedule for the duration of 2012, avoiding a 27.4% cut that was scheduled for March 1st.
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Congress has acted for the second time in as many months to delay a scheduled 27.4% Medicare reimbursement cut from taking effect. Late last week, both chambers of Congress adopted a conference committee report that extended the current fee schedule for the duration of 2012, and President Obama is expected to sign the legislation. The bill also extends a popular payroll tax cut through the end of the year, and contained several other provisions unrelated to Medicare reimbursements.
The AMA, CMA, and ACCMA lobbied Congress to stop the cuts and replace the broken Sustainable Growth Rate (SGR) formula once and for all. The SGR does not accurately reflect the increasing costs of medical practice, resulting in reimbursement cuts despite increasing costs to practice medicine. Because Congress has failed to act year after year, the cost of replacing the SGR will grow from $300 billion to $400 billion. Furthermore, physicians will once again face major reimbursement cuts of more than 30% at the end of 2012, which Congress will once again be forced to address. While organized medicine appreciates Congress taking action prior to the February 29th deadline, we remain disappointed by Congress' repeated failure to take meaningful, long-term action on Medicare payment reform.
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Preliminary ICD-10 Delay Announced
02/21/2012
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Although no details have been released, it appears likely that the planned conversion to ICD-10 will be delayed beyond the current implementation deadline of October 1st, 2013.
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Although details have not yet been announced, Health and HUman Services Secretary Kathleen Sibelius announced last week at the AMA's annual advocacy conference in Washington that the planned conversion to ICD-10 would be delayed beyond the current implementation deadline of October 1st, 2013. No new deadline has been announced. Physicians should note that most medical organizations are encouraging physicians to proceed with planning for implementation since the length of the delay is currently unknown, and the transition to ICD-10 is likely to be complex and will require considerable advanced planning. The ACCMA will inform members as additional details are released.
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Blue Shield Offering New Contract Terms
02/05/2012
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Blue Shield of California is in the process of re-contracting with physicians across the state and their new contracts are being received by physicians in the East Bay now.
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Blue Shield of California is in the process of re-contracting with physicians across the state and their new contracts are being received by physicians in the East Bay now. Blue Shield informed the CMA that the reason for the re-contracting initiative is to ensure consistency and compliance with new laws and regulations, and to offer physicians options for tiered networks (under which physicians would agree to accept varying reductions from Blue Shield’s fee schedule) in anticipation of Blue Shield potentially participating in California’s health insurance exchange when health care reform is implemented in 2014. At this point the Exchange has not yet designated which health plans can participate in the Exchange, so it is uncertain of new groups will be able to sign up for Blue Shield’s tiered health plans.
Physicians are under no obligation to participate in any of the products listed in the new Blue Shield contract, and there are no fee schedule changes at this time, other than for Medicare lines of business and the offer to physicians to accept lower tiered rates as discussed above. The cover letter that will accompany the new contract asks that physicians review, sign and return the new agreement to Blue Shield by February 17. However, Blue Shield has assured CMA that failure to return the new agreement will not affect a physician’s participation status with Blue Shield at this time. To assist physicians, CMA has completed an analysis of the new Blue Shield contract, which is available to CMA members at www.cmanet.org/ces of by calling 510-654-5383.
Physicians are encouraged to carefully review and understand the vast range of legal and practical implications associated with the execution of any contract for the delivery of medical services or the associated management and administrative services. Physicians with concerns about the new contract terms may contact Blue Shield Provider Services at (800) 258-3091. Call the ACCMA with any questions or concerns at (510) 654-5383 or e-mail accma.@accma.org.
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Federal Judge Blocks 10% Medi-Cal Cuts
02/05/2012
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A federal judge has issued a ruling blocking California from implementing a 10 percent Medi-Cal reimbursement rate cut for physicians, dentists, pharmacists and other Medi-Cal providers.
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In response to a lawsuit filed by the California Medical Association (CMA) and other interested parties, a federal judge has issued a ruling blocking California from implementing a 10 percent Medi-Cal reimbursement rate cut for physicians, dentists, pharmacists and other Medi-Cal providers. The 10% cuts were adopted by the Legislature last spring, but were not approved by the Federal government until last Fall and had not as yet been implemented but the State intended to impose them retroactively and recoup “overpayments” that had taken place up until now.
CMA contended in the lawsuit that the Legislature and Federal government violated the law by failing to consider the impact that 10% cuts would have on patients' access to health care or the costs to provide care. Even prior to these cuts, California's reimbursement rates rank near the bottom nationwide. Please contact the ACCMA at 510-654-5383 with any questions.
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CalHIPSO Can Help You Achieve Meaningful Use
02/05/2012
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Bay Area primary care physicians still have the opportunity to receive subsidized technical services to implement and effectively use an EHR, although slots are filling quickly!
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Bay Area primary care physicians still have the opportunity to receive subsidized technical services to implement and effectively use an EHR, although slots are filling quickly! If you join CalHIPSO now (CALHIPSO is sponsored by the California Medical Association and the services it offers are promoted by the ACCMA) you will receive technical assistance with your EHR Implementation from CalHIPSO and a network of skilled professionals who can help you make informed decisions. As a member you will have access to CalHIPSO’s EHR vendor contracts, which include reduced pricing and pre-negotiated contract terms, along with assistance demonstrating Stage 1 Meaningful Use in order to begin receiving EHR incentive payments. Join CalHIPSO by February 29, and pay no fee through 2014. Visit www.CalHIPSO.org to enroll today or contact Kent Waldsmith, 510.285.5745
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CalHIPSO Can Help You Achieve Meaningful Use
02/05/2012
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Bay Area primary care physicians still have the opportunity to receive subsidized technical services to implement and effectively use an EHR, although slots are filling quickly!
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Bay Area primary care physicians still have the opportunity to receive subsidized technical services to implement and effectively use an EHR, although slots are filling quickly! If you join CalHIPSO now (CALHIPSO is sponsored by the California Medical Association and the services it offers are promoted by the ACCMA) you will receive technical assistance with your EHR Implementation from CalHIPSO and a network of skilled professionals who can help you make informed decisions. As a member you will have access to CalHIPSO’s EHR vendor contracts, which include reduced pricing and pre-negotiated contract terms, along with assistance demonstrating Stage 1 Meaningful Use in order to begin receiving EHR incentive payments. Join CalHIPSO by February 29, and pay no fee through 2014. Visit www.CalHIPSO.org to enroll today or contact Kent Waldsmith, 510.285.5745
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Medi-Cal EHR Incentive Funds Still Available for 2011
02/05/2012
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Medi-Cal has finally established its enrollment system for physicians to sign up to collect the Medi-Cal incentive funds (part of the Federal IT initiative adopted in 2009) that are available for implementing an EHR system.
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The California Department of Health Care Services has finally established its enrollment system for physicians to sign up to collect the Medi-Cal incentive funds (part of the Federal IT initiative adopted in 2009) that are available for implementing an EHR system and meeting the Federal “meaningful use” guidelines. Physicians who are qualified may enroll to receive this incentive any time up to 2016 and receive the full incentive of $63,750, but it is paid out in increments over a six year period from the first year of enrollment. The incentive is first made available for calendar year 2011, and those physicians who purchased, implemented or upgraded an EHR system in 2011 may enroll by March 31st to receive the first payment credited to that year (up to $21,250). The requirement to demonstrate “meaningful use” does not have to be met until the second year after enrollment. Physicians qualify for incentives if:
• Medi-Cal patients make up at least 30 percent of their patient volume.
• They are a pediatrician with at least 20 percent Medi-Cal patient volume. (However, pediatricians with 20 to 30 percent Medi-Cal patient volume only qualify for two-thirds of the total incentive.)
• They practice in a federally qualified health center, rural health center or Indian health clinic and at least 30 percent of their patient volume is “needy individuals,” such as Medi-Cal, Healthy Families, sliding scale or uncompensated care.
Accessing these incentives will require a two-part enrollment process. Physicians must first register with the Centers for Medicare & Medicaid Services at https://ehrincentives.cms.gov. They must then enroll in the Medi-Cal Incentive Program at http://medi-cal.ehr.ca.gov. To assist physicians with the somewhat complex enrollment process, a guide has been developed and downloaded from the DHS website (http://www.dhcs.ca.gov). Other guides are available on the Medi-Cal Incentive Program website (http://medi-cal.ehr.ca.gov.) Members encountering difficulties may contact the ACCMA for assistance at (510) 654-5383.
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CMA Endorses Ballot Measure to Increase Revenue
02/05/2012
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Citing California's ongoing fiscal crisis and its adverse impact on California's health care delivery system, the CMA has endorsed Governor Jerry Brown ballot measure to temporarily increase sales and income taxes.
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Citing California's ongoing fiscal crisis and its adverse impact on California's health care delivery system, the California Medical Association (CMA) has endorsed a ballot measure proposed by Governor Jerry Brown to temporarily increase sales and income taxes. The initiative would boost the statewide sales tax by half a cent for four years starting in January 2013, and would also raise the income tax rate on those making $250,000 a year, increasing it from 9.3 percent to a maximum of 11.3 percent, depending on the amount of income, and last for five years. The CMA took this position out of concern that this additional revenue is necessary to avoid deeper cuts that would adversely affect access to care.
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Training Program for Physician Leaders: March 8-10 in San Diego
02/05/2012
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IMQ/PACE Platinum Training Program for Physician Leaders addresses the most challenging decisions facing medical staff leaders
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The IMQ/PACE Platinum Training Program for Physician Leaders addresses the most challenging decisions facing medical staff leaders, such as rehabilitating an impaired or disruptive physician; conducting effective meetings; improving communication; and using data to support better decision-making about quality, patient safety and privileges. It will take place in San Diego at the Coronado Island Marriott Resort and Spa from March 8-10, 2012. See www.imq.org for more information.
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HIPAA 5010 Standards Are Now in Effect
01/06/2012
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The HIPAA 5010 standards went into effect January 1st, 2012, and as a result may impact claims payments and other HIPAA-covered electronic transactions if either you or your trading partners have not yet made the required changes.
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The HIPAA 5010 standards went into effect January 1st, 2012, and as a result may impact claims payments and other HIPAA-covered electronic transactions if either you or your trading partners have not yet made the required changes.
The new 5010 standards apply to all electronically-submitted HIPAA-covered administrative transactions, such as checking a patient’s eligibility, filing a claim or receiving a remittance advice. The new standards mostly affect the configuration of software used in conducting such transactions, but they may also impact physicians who may be required to upgrade billing or EHR systems and/or to make changes in the type of information they collect from patients. Although CMS recently announced a "discretionary enforcement period" through March 31st, this unfortunately means little for physicians since many entities were in compliance by January 1st, and have begun rejecting noncompliant claims. Some payors may choose to continue paying noncompliant claims during this enforcement period.
Regardless, physician practices should immediately contact the trading partners you work with who are primarily impacted by the change (i.e. billing services, EHR vendors, clearinghouses, etc.) to determine how these changes impact your practice specifically. The following tips may help you get the information you need from your trading partners:
- Talk to your current practice management system or EHR vendor.
- Talk to your clearinghouses or billing service (if you use either one) and health insurance payors.
- Identify specific changes they have made to their systems that impact the data you must collect and report to meet these new standards
- Identify the processes and people affected by these changes
- Modify work flow and business processes to account for changes
- Train staff in new changes before January 1st
- Test with your trading partners, e.g., payors and clearinghouses
Please call the ACCMA at 510-654-5383 if you are experiencing claims interruptions, or if you have any additional questions or concerns related to the HIPAA 5010 transaction standards.
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Former CMA President named to Medical Board of California
01/06/2012
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Former CMA president Dev GnanaDev, MD, has been appointed to the Medical Board of California by Governor Jerry Brown.
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Former CMA president Dev GnanaDev, MD, has been appointed to the Medical Board of California by Governor Jerry Brown. Dr. GnanaDev is Medical Director at Arrowhead Regional Medical Center, President of the Arrowhead Surgery Group, is a clinical professor of surgery at Western University for Health Sciences, and is an associate professor of surgery at Loma Linda University.
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CMA Objects to Volume and Tone of Palmetto Audits
01/06/2012
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CMA is objecting to Medicare pre-payment medical review audits currently being conducted by Palmetto GBA.
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CMA is objecting to the Centers for Medicare & Medicaid Services (CMS) pre-payment medical review audits currently being conducted by Medicare Administrative Contractor Palmetto GBA. Palmetto is requesting medical records and delaying payment. In addition, the tone of the audit letters is unnecessarily threatening. CMA has requested that CMS demand that Palmetto reduce the size of the “special study” and cease mailing any more requests for records.
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DHCS Announces Plans to Recoup Medi-Cal Payments
01/06/2012
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Add Article Summary...
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The Department of Health Care Services (DHCS) recently announced it intends recoup a 10 percent reduction in Medi-Cal provider payments retroactive to June 1, 2011, cuts that were originally approved as part of the California Budget Act of 2011 but were only recently approved by the Federal government. Now that the State has approval for the cuts, DHCS intends to retroactively recoup these payments back to July 1st.
DHCS has indicated that recoupments will happen over an extended period, likely more than a year. Providers will be notified in writing of the amount that will be recouped from them. CMA has asked that physicians receive detailed accounting of the recoupment (patient names, dates of service, etc.) so that physicians can reconcile their books. DHCS will employ their standard processes for a payment correction, and the recoupment could be done as a 5 percent additional reduction in future payments, on top of the 10 percent reduction. Physicians will have some ability to work out repayment plans through the Medi-Cal fiscal intermediary.
Seeking recoupment of provider payments is a direct result of the California Budget Act of 2011.On October 27, the Centers for Medicare & Medicaid Services (CMS) approved key elements of the state’s 2011-12 budget proposals to reduce Medi-Cal provider reimbursement rates, effective retroactive to June 1, 2011.
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Two Month Delay on Medicare Cuts Buys Congress until March 1st
01/06/2012
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Congress bought itself 2 months by approving a two-month extension of the 2011 Medicare fee schedule and avoiding a 27.4% Medicare fee-for-service cut on January 1st.
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Shortly before Christmas, Congress approved a two-month extension of the 2011 Medicare fee schedule, thereby avoiding a 27.4% Medicare fee-for-service cut that was scheduled to take effect January 1st. In so doing, Congress averted substantial payment cuts and an administrative nightmare involving delayed payments, claims resubmissions and additional patient billing to collect co-pay differentials. The Centers for Medicare & Medicaid Services (CMS) also extended the annual deadline for physicians to make changes to the Medicare participation status to Feb. 14, from the previous deadline of December 31st.
When Congress returns from its January recess, a one-year or two-year SGR fix will continue to be considered as part of a larger legislative package that includes extending the payroll tax cut for at least one year. Congress will only have a few weeks to act before the across-the-board SGR cuts take effect on March 1st. Congressional leaders have already appointed conferees to seek a longer term solution to work out the differences between the House and Senate bills even though Congress will not officially be in session again until January 23rd. Under the initial House GOP plan, physicians would have received a 1% pay raise in 2012 and another 1% raise in 2013, but the additional spending would have been offset by requiring more higher-income Medicare seniors to pay higher premiums and reducing prevention funding under the health system reform law -- strategies that were roundly rejected by Senate Democrats. Another part of the plan to pay physicians more by cutting certain Medicare bad debt payments to hospitals also faced strong opposition by the hospital lobby.
The ACCMA, CMA and AMA are continuing to push for a permanent fix to the flawed SGR payment formula while Congress confers on longer-term legislation to stop the cuts beyond March 1st. Previously, there had been general agreement on a 1% update each of the next two years, but given the toxic political climate in Washington it is unclear what Congress will do.
Stay tuned to www.accma.org for updates.
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New Member Benefit! Free Secure Messaging
01/06/2012
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ACCMA recently announced DocBookMD – a unique smartphone application just for members that allows you to instantly communicate with fellow ACCMA members in a secure, HIPAA-compliant environment.
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ACCMA and Medical Insurance Exchange of California (MIEC) recently announced DocBookMD – a unique smartphone application just for members that allows you to instantly communicate with fellow ACCMA members in a secure, HIPAA-compliant environment. You can instantly exchange patient information with other physicians at the point of care, and even transmit high-resolution images of a wound, condition, x-ray, EKG, or other pertinent diagnostic images right along with your text message. DocBookMD also provides convenient access to ACCMA members’ contact information and local pharmacies right from your smart phone or tablet.
You can start using DocBookMD right away. For more information, click here or call 510-654-5383.
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