"News You Can Use" <> September 9, 2014 September 9, 2014 MICRA, Prop 46 Prop 46 0 CONTENTS Love / Hate Outlook and Need Some Practical Training? Don’t Have a Clue About Leadership and Need to Learn Quickly? Vote No Prop 46: Order Promotional Materials Free of Charge Optometrist Massive Scope of Practice Expansion Killed by CMA Last Chance to Organize a Team for the SDCMS Foundation’s First Annual Solana Beach Sunset 5K Products That Contain Hydrocodone Reclassified to Schedule II September 10 Last Day to Dispute Sunshine Act Data Huge Chunk of Data Excluded From Open Payments Website Because of Inaccuracies New CMS Rule Changes Meaningful Use Timeline Noridian Denies 300,000 Claims for E&M Services in Error CMA Urges Court to Protect Patient Privacy United to Make Some Changes to Premium Designation Program, but Serious Concerns Remain Los Angeles County Democratic Party Comes out in Opposition to Prop. 46 Joint Legislative Committee Orders Audit of Medi-Cal Managed Care Provider Networks Case Could Have Far Reaching Implications on Managed Care Contracting and Payment for Out-of-network Services Primary Care Physicians: There’s Still Time to Attest! September 20 CPPPH Workshop for Physician Health Committees Work-Life Balance Workshop on Saturday, October 11 Genome: Unlocking Life’s Code “Physicians of Exceptional Excellence” — aka San Diego’s Top Docs — Gala on November 1 UCSD PACE Program Is Recruiting Practicing Physicians Above Age 50 for a PACE Aging Physician Assessment Pilot Study Nominate Your Office Manager for SDCMS’s 6th Annual “Outstanding Medical Office Manager” Contest Ask Your SDCMS Physician Advocate, Marisol Gonzalez CMA Practice Resources: September 2014 CME Certification Now Available Online Follow SDCMS’ Twitter Feed and Get a Treasure Trove of Healthcare News Delivered Daily to Your Smartphone Is Your Office Manager / Practice Administrator Using SDCMS’ Online Forum? Covered California Resources for SDCMS-CMA Member Physician Practices Only Covered California Resources for All Physician Practices ABOVE THE FOLD Love / Hate Outlook and Need Some Practical Training? Attend SDCMS' Taming Microsoft Outlook workshop this Saturday, September 13, from 8:00am to noon. Click Here for Details and to Register Don’t Have a Clue About Leadership and Need to Learn Quickly? SDCMS Members: Attend SDCMS' Leader’s Toolkit seminar on September 27–28. For details or to reserve your spot, email me at Gehring@SDCMS.org. Only 5 seats left! Vote No Prop 46: Need a speaker to energize your physician group about Prop 46? Email Gehring@SDCMS.org. Need bumper stickers, “Ask Me” stickers, “No on 46” buttons, “Ask Me” buttons, brochures in English and Spanish, lab coat cards in English and Spanish, posters, starter kits, office kits, hospital kits? Click here to order them now — it’s free, and they ship it to wherever you want! Are you personally spreading the news about the deleterious effects of Prop 46 if we don’t kill it, i.e., increased costs, losing your doctor, and threatening your privacy? Optometrist Massive Scope of Practice Expansion Killed by CMA: Click Here for Details Last Chance to Organize a Team for the SDCMS Foundation’s First Annual Solana Beach Sunset 5K on Saturday, September 27, at 5pm: Enjoy a low tide walk or run on the beach and the promise of a terrific sunset. Introduce your staff and patients to improving their health by incorporating fun physical activity into their lives. Teams of 20 or more will receive a free team T-shirt if registered by September 10. MEDICAL Products That Contain Hydrocodone Reclassified to Schedule II: The new rule will go into effect October 6, 2014. Click Here for Details FEDERAL September 10 Last Day to Dispute Sunshine Act Data: Click Here for Details Huge Chunk of Data Excluded From Open Payments Website Because of Inaccuracies: Sunshine Act data will be made public beginning September 30. Physicians and authorized representatives can submit questions to the CMS Help Desk at openpayments@cms.hhs.gov. Live Help Desk support is also available by calling (855) 326-8366, Monday–Friday, 7:30am–6:30pm (CST). Click here to access AMA’s “Physician Sunshine Act Tool Kit” online. Click Here for Details New CMS Rule Changes Meaningful Use Timeline: CMS’s new final rule, published September 4, would provide eligible professionals an additional year to upgrade their certified EHR technology. The rule also revises the meaningful use timeline. Click Here for Details Noridian Denies 300,000 Claims for E&M Services in Error: Last fall, CMS editing issues resulted in incorrect claim denials for new patient E&M codes. The issues were thought to have been corrected in late January 2014. CMA recently learned that some claims continued to be denied incorrectly through July 15, 2014. Click Here for Details STATE CMA Urges Court to Protect Patient Privacy: The Court of Appeal has held that a law allowing law enforcement and other government agencies broad access to the state’s electronic prescription drug monitoring program’s database did not violate patients’ privacy rights. Physicians are flagging the ruling as a violation of confidentiality in the physician-patient relationship. Click Here for Details United to Make Some Changes to Premium Designation Program, but Serious Concerns Remain: CMA continues to urge UHC to make additional, more meaningful changes with its physician rating and tiering program. For more information on the Premium Designation program, visit the United Healthcare website at www.unitedhealthcareonline.com. Click Here for Details Los Angeles County Democratic Party Comes out in Opposition to Prop. 46: Lambasting the measure as being “full of gimmicks” while “gaming” an important political issue, the LACDP has voted overwhelmingly to oppose Proposition 46. Click Here for Details Joint Legislative Committee Orders Audit of Medi-Cal Managed Care Provider Networks: The audit is expected to take six to eight months to complete. Click Here for Details CMA Asks California Supreme Court to Review Case That Could Have Far Reaching Implications on Managed Care Contracting and Payment for Out-of-network Services: CMA’s amicus letter brief argues that, if left unchecked, the Court of Appeal’s opinion will dramatically lower the calculations of reasonable and customary value for payment of out-of-network services. Click Here for Details Primary Care Physicians: There’s Still Time to Attest! Eligible physicians who have already attested have received over $200 million in ACA primary care rate increases — don’t miss out! To qualify for enhanced payments for fee-for-service Medi-Cal and Medi-Cal managed care plans, you must first self-attest to your eligibility. The deadline to attest, if you haven’t already done so, is December 31, 2014. If you have attested and not received your additional funds, you should confirm the accuracy of the information submitted through the attestation process. If you have questions, call Medi-Cal’s Telephone Service Center at (800) 541-5555. For more information, see CMA’s “Medi-Cal Primary Care Physician Rate Increase FAQs.” Having Trouble With Your Attestation? The SDCMS Foundation can provide technical assistance at very reasonable costs. Email Victor.Bloomberg@SDCMS.org. LOCAL September 20 CPPPH Workshop for Physician Health Committees: The California Public Protection & Physician Health, Inc. (CPPPH) is holding a workshop for members of medical staff and medical group physician health committees on Saturday, September 20, 9:00am to 12 noon, at the SDCMS Foundation, 5575 Ruffin Road, Suite 250, San Diego, CA 92123. Advance registration is required — click here. Work-Life Balance Workshop on Saturday, October 11: Take an honest look at your life, reacquaint yourself with what you find most meaningful, and then make the changes that will bring your life into greater balance! Join your colleagues and Helane Fronek, MD, certified physician development coach, on Saturday, October 11, from 9:00am to noon to begin to see your life, and your choices in it, in a new light! Workshop limited to 12 physicians. Email Dr. Fronek at hsfronek@aol.com for details or to reserve your spot today! Genome: Unlocking Life’s Code: SDCMS, in association with the NIH, Smithsonian Institution and the Reuben H. Fleet Science Center, is pleased to announce an evening to explore the West Coast premier of “Genome: Unlocking Life’s Code” on October 21, 6–9pm (2 CME credits). You can view the exhibit and learn from three special speakers: “Bringing Genomic Medicine into Focus” by Eric Green, MD, PhD, Director, National Human Genome Research Institute, NIH; “Beyond the Genome: We Are More Than Our Genes” by Gary Firestein, MD, Dean and Associate Vice Chancellor of Translational Medicine, UCSD; “Genomics and the Future of Cancer Medicine” by Razelle Kurzrock, MD, Director of Personalized Cancer Therapy, UCSD. To register, click here. “Physicians of Exceptional Excellence” — aka San Diego’s Top Docs — Gala on November 1: The gala honoring this year’s selectees will be held on Saturday, November 1 at the Birch Aquarium. Click Here for Details and to Purchase Your Tickets! UCSD PACE Program Is Recruiting Practicing Physicians Above Age 50 for a PACE Aging Physician Assessment (PAPA) Pilot Study: Anyone interested in participating should click here, complete the form, and return it to pdreid@ucsd.edu; for any questions, contact Patricia Reid, MPH, at (619) 471-0569. David E.J. Bazzo, MD, Director, PACE Fitness for Duty Program, is heading this effort. Compensation for your time is offered. BENEFITS / PRACTICE MANAGEMENT Nominate Your Office Manager for SDCMS’s 6th Annual “Outstanding Medical Office Manager” Contest: Nomination Deadline November 1, 2014. Click Here for Details Ask Your SDCMS Physician Advocate, Marisol Gonzalez: Member Question: I received a phone call from a company identifying themselves as ICE Corporation. They stated that they were conducting a survey on behalf of Aetna and its patients. They were asking questions specific to how quickly we can see patients on a daily basis. I felt uncomfortable answering these questions as I wasn’t clear about who they were. Is there a survey going on like this? Answer: Yes. The DMHC’s Timely Access to Non-Emergency Health Care Services Regulations (“Timely Access Regulations”) became effective on January 17, 2011. The Timely Access Regulations require health plans to ensure that healthcare services are provided to patients in a timely manner appropriate for the nature of the patient’s condition, consistent with good professional practice. The regulations apply to health plans that are regulated by the DMHC. ICE stands for Industry Collaboration Effort (ICE), and they mobilize volunteers from healthcare industry stakeholders to develop educational and “best practice” materials designed to streamline, simplify, and standardize all regulatory policies and procedures that govern the provision of healthcare services that particularly require the collaboration between health plans and their provider partners. Participation in this survey is not mandatory but reco mmended. SDCMS members can contact your physician advocate, Marisol Gonzalez, with questions at (858) 300-2783 or at MGonzalez@SDCMS.org. CMA Practice Resources: September 2014: Change in Prior Authorization Form for Prescription Medications Becomes Effective October 1: Click Here Are You Losing Money From Virtual Credit Card Payment Fees? Click Here Ask the Expert: How Long Does TRICARE Have to Request a Refund? Click Here System Error Causing Some Anthem Blue Cross Claims to Be Underpaid: Click Here Fall 2015 Is New Implementation Date for ICD-10: Click Here DocbookMD Messaging App Now a FREE CMA Member Benefit! Click Here The Coding Corner: Time as the Controlling Factor in E&M Coding: Click Here CME Certification Now Available Online: Users of the CME certification service offered by CMA’s Institute for Medical Quality are now able to check the status of CME credits, keep track of their progress, and print their transcripts at their convenience from IMQ’s online CME certification user portal. Click Here for Details Follow SDCMS’ Twitter Feed and Get a Treasure Trove of Healthcare News Delivered Daily to Your Smartphone: Click Here Is Your Office Manager / Practice Administrator Using SDCMS’ Online Forum? Click Here to Join COVERED CALIFORNIA Resources for SDCMS-CMA Member Physician Practices Only: Email Membership@SDCMS.org to access a matrix to help answer questions like “Am I contracted to see Covered California patients?” “Which health plans are participating in Covered California?” “How do I check my participation status with these plans?” CMA's "Covered California: Know Your Participation Status" Guide CMA's Surviving Covered California: Tip Sheet #4 CMA’s Got You Covered: A Physician’s Guide to Covered California, the State’s Health Benefit Exchange CMA's "Surviving the Third Month of Covered California" Tip Sheet CMA's Health Insurance Exchange Resources Webpage for Physicians CMA's "Understanding the Grace Period for Subsidized Exchange Enrollees" Resources for All Physician Practices: Upcoming “Covered California: What Your Healthcare Team Needs to Know” Seminars & Webinars: Seminar / Webinar on Thursday, September 18, 11:30am–1:00pm • Seminar / Webinar on Thursday, October 16, 11:30am–1:00pm • Seminar on Thursday, October 16, 5:30pm–7:00pm In-office Education for Staff Provided by the SDCMS Foundation: Email Victor.Bloomberg@SDCMS.org CMA's Frequently Asked Patient Questions About Covered California Covered California Consumer Materials for Your Office Waiting Room: Call (858) 300-2789 “The farther back you can look, the farther forward you are likely to see.” — Winston Churchill (1874–1965) Comments are closed.