Monday, December 18, 2017

OCMA Blog

Congress stops Medicare cuts for one year as part of fiscal cliff legislation

HR 8 is a prime example of the need for physicians to speak with a unified voice through your local and state medical association. Clearly, the work is not over as these are merely temporary fixes. A strong physician perspective is critical in further debates. To the members of OCMA/CMA, thank you for your support and participation in important efforts such as this - it does make a difference. If you are not a member of OCMA/CMA, we need to add your voice to strengthen our advocacy on behalf of doctors and the patients you serve. 


Congress on January 1 passed HR 8, the American Taxpayer Relief Act, narrowly averting the so-called "fiscal cliff." The bill includes a one-year Medicare fee-for-service physician payment freeze, meaning the 26.5 percent sustainable growth rate (SGR) cut has been averted, for now. The 2 percent sequestration cuts have also been deferred for two months.

 

The one-year fix comes with a $25 billion price tag. The cost of physician payment reform has been growing over the years as Congress continues to enact frequent short-terms fixes. As recently as 2005 the cost of permanent reform would have been $48 billion, but today it is estimated to be nearly $300 billion over the next 10 years. If action is not taken soon, the cost will continue to escalate to $500 billion in only a few short years.

 

The one-year freeze will be paid for with cuts to the Affordable Care Act's (ACA) new CO-OP program and other health care programs ($15 billion of the cuts impacting hospitals). At CMA's urging, the ACA's Medicaid increase for primary care physicians was not used to pay for this temporary fix, despite earlier attempts to do so.

The Medicare fix is being paid for by:

  • Cuts to the ACA's CO-OP program (unobligated funds)
  • Extending the statute of limitations for recouping overpayments.
  • Adjusting the equipment utilization rate for Advanced imaging services.
  • Rebasing end stage renal disease payments based on utilization of drugs.
  • Equalizing stereotactic radiology hospital outpatient services with physician services.
  • Rebasing of Disproportionate Share Hospital payments.
  • Reducing multiple procedure payments when more than one therapy procedure is provided on the same day.
  • Eliminating funding for the Medicare improvement fund.
  • Eliminating the ACA long term care (LTC) CLASS act. (But establishes a LTC commission.)
  • Adjusting Medicare Advantage payments to account for differences in coding practices between fee-for-service and managed care risk adjustment formulas.

Importantly, the bill also lays the groundwork for an alternative Medicare payment system by establishing data systems and a registry for reporting on quality that will help physicians.


What does this mean for physician claims?

 

Because federal law requires Medicare contractors to hold claims for 14 days before releasing payment, there should be little if any impact on physicians' cash flow. Although there has been no official word from the Centers for Medicare and Medicaid Services, claims for services provided in the early days of 2013 will likely be processed under the new 2013 fee schedule. Palmetto, California's Medicare contractor, should have the new fee schedule posted on its website in about 10 days.

 

The 2013 fee schedule will not be exactly the same as the 2012 fee schedule. Although Congress stopped the 26.5 percent SGR cut, there were other components of the fee schedule formula that affect payment that may have changed, such as the relative value units (RVUs).

 

Physicians have the option of holding claims and submitting them after the new fee schedule is released. If you choose to submit claims in the interim, the California Medical Association (CMA) suggests that both participating and non-participating physicians bill their usual and customary fees-for-services to Medicare. Billing at your customary fee ensures that Medicare pays the highest amount possible when the claim is processed.


Orange County Medical Association Selects Farmers & Merchants Bank as Preferred Business Partner

ORANGE COUNTY, Calif., Dec. 19, 2012 -  Farmers & Merchants Bank (F&M) has been selected by the Orange County Medical Association (OCMA) as a Preferred Business Partner for physicians seeking personal and professional banking products and services.

 

"F&M is dedicated to delivering tailored products and services for the medical community," said Daniel K. Walker, F&M's Chairman and CEO. "We have served the community for more than a century and have worked with medical professionals in our Memorial Hospital branch for more than 30 years. This rich history and depth of experience allows us to ensure physicians' banking needs are met with the utmost efficiency and convenience."

 

F&M's Physician Banking Suite of Services provides attentive service and specialized products to the medical community, including concierge services, account analysis, business credit cards, remote deposit capture, lockbox service, online business banking, merchant services and lines of credit and loans. OCMA members will receive a 15 percent credit toward their analysis fees as part of the partnership.

 

F&M and OCMA also will join forces to provide educational seminars and resources geared toward effective financial planning and practice management and will feature insights from some of the region's leading medical and financial professionals.

 

The strategic business partnership with F&M Bank reinforces OCMA's commitment to bring added value to its members by aligning with companies who offer specialized services for physicians, allowing physicians to focus their attention on patient care.

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About Farmers & Merchants Bank


Founded in Long Beach in 1907 by C.J. Walker, Farmers & Merchants Bank has 21 branches in L.A. and Orange counties. The Bank specializes in commercial and small business banking along with business loan programs. Farmers & Merchants Bank of Long Beach is a California state chartered bank with deposits insured by the Federal Deposit Insurance Corporation (Member FDIC) and an Equal Housing Lender. For more information about F&M, please visit the website at www.fmb.com or contact Brian Nakamura, Vice President/Physician's Banking Suite Coordinator  at: 

(714) 472-6611 or brian.nakamura@fmb.com.



How Should You Deal With Negative Online Reviews?

"Had to wait 1 1/2 hours."
"The staff was horrible, rude and unprofessional."
'The doctor misdiagnosed my problem."

In the past, a physician's reputation and practice were built by word of mouth. Today, word of mouth is no longer limited to people talking face-to-face. Websites, such as Yelp.com, AngiesList.com, HealthGrades.com, RateMDs.com and Vitals.com, allow anyone with access to a computer to share his or her opinion about a physician with the public at large.

Physicians tend to focus on the negative comments, but not all comments are negative. A recently published study in the Journal of Internal Medicine found that an overwhelming number (88 percent) of online reviews for physicians were positive. The following is an excerpt of the study:

We identified 33 physician-rating websites, which contained 190 reviews for 81 physicians. Most reviews were positive (88%). Six percent were negative, and six percent were neutral. Generalists and subspecialists did not significantly differ in number or nature of reviews. We identified several narrative reviews that appeared to be written by the physicians themselves.

The CAP Hotline has received an increasing number of calls from physicians asking how to respond to negative comments. So what can a physician do in response to a negative online opinion? Some physicians fear that negative comments may harm their reputation and want to seek legal remedies to battle unsubstantiated online libel and defamation. This may not always be the best solution to the problem. Lawsuits are time consuming, expensive, and may not produce the outcome desired by the physician. Courts may view negative statements made online at review websites as opinion, not fact.

Physicians should accept that rating websites are here to stay, at least for the foreseeable future. An occasional unfavorable review must be seen as a cost of doing business in the age of social media. If a physician desires to respond to a negative comment, much caution and thought should be put into the method and type of response. Some websites, like Yelp.com, have sections in its "Support Center" for business owners which discuss how to respond to comments.

Whether to respond is a personal choice and should be given careful consideration. A response may be made publicly or in private to the individual. All responses should be kept simple, polite, honest, professional, and compassionate. If the criticism is true, it should also describe what changes are being made to prevent this from occurring in the future. You may end your reply by showing that you care by stating: "Thank you. We appreciate all feedback."

What other steps can be taken to address patient opinions?

  • Go online and see what is being said about your practice.
  • Assign a staff member to regularly monitor these sites.
  • Update incorrect demographic information.
  • Personalize your comments with a clear professional photo.
If a comment is not appropriate, consider taking another approach. CAP provides free Patient Satisfaction Surveys to its members. In today's environment, a satisfied patient is an important part of a successful practice and it is better for the feedback to come directly to you and not to the Internet.

If you are a CAP member, we encourage you to take advantage of this free opportunity, by calling 800-252-7706 to request a packet of 100 surveys.

If you are not yet a member of CAP but are interested in learning more about the myriad benefits of membership, including superior medical professional liability coverage, contact Membership Development at 800-356-5672 or request an online quote at www.CAPphysicians.com/join.

Ann Whitehead is a Senior Risk Management & Patient Safety Specialist for the Cooperative of American Physicians, Inc.

CALL TO ACTION: CONTACT CONGRESS AND URGE THEM TO PROTECT HEALTH CARE TODAY!

Congress has three weeks left to stop the 26.5 percent Medicare sustainable growth rate (SGR) physician payment cuts (to take effect on January 1, 2013) before they adjourn for the holidays. The Orange County Medical Association urges physicians to keep the pressure on Congress to stop these cuts.

Call AMA's Grassroots Hotline, (888) 434-6200, to be connected with your members of Congress.

Description

Members of Congress have returned to Washington, D.C. for a Lame Duck Session to address the so-called "fiscal cliff" issues affecting the future of medicine and our country. These issues must be addressed before January 1, 2013 or the following occurs:

  •  26.5 percent Medicare physician fee-for-service rate cut because of the SGR formula;
  • Across-the-board spending cuts known as "sequestration" - $109 billion/year. While Medicaid is exempt from the sequestration cuts, the Medicare program faces 2 percent cuts; Defense takes $500 million in cuts and the rest comes from domestic programs.
  • Expiration of the Bush 2001 and 2003 tax cuts (including individual rates, capital gains, dividends, child tax credit, marriage penalty reduction, and the estate tax).
  • The Alternative Minimum Tax patch expires.
  • The Social Security Payroll tax cut expires.
  • Unemployment benefits extension expires.

It is important that members of Congress work together in a bipartisan way to resolve these vital issues and avoid going over the "fiscal cliff." Most economists speculate that if Congress fails to act, economic growth will drop significantly, unemployment will rise, and the country will slip back into a deep recession. 

CALL your members of Congress and urge them to work together to stop the Medicare SGR physician payment cut of 26.5 percent and the Medicare sequestration cut of 2 percent before they take effect on January 1, 2013.


How to contact members of Congress:

Phone:  Call AMA's Grassroots Hotline, (888) 434-6200, to be connected with your members of Congress. You will be asked to enter your zip code and select your Representative.

Email: Federal legislators must be contacted via the email forms on their websites: www.writerep.house.govwww.boxer.senate.gov and www.feinstein.senate.gov.


Talking Points

Urge California Senators and your member of Congress to:

  • Repeal the Medicare SGR and stop the 26.5% physician payment cut.
  • Stop the Medicare 2% Sequestration Cut.    
  • Adopt long-term Medicare Payment Reform.
  • Update the California Medicare Geographic Payment Localities.
  • Stop Medicaid and Other Health Care Cuts  


Background

Tough decisions will have to be made in the coming weeks but Congress must make Medicare funding a top priority. We can't allow Congress to ignore the nearly 30 percent Medicare cuts facing physicians and patients in California. Such cuts will certainly harm access to doctors for seniors, military families and potentially all California patients because private insurers follow Medicare. 

 

Moreover, comprehensive reform of the Medicare physician payment system is long overdue. Working together, CMA, AMA, the national specialty societies and state medical associations are currently developing an alternative Medicare payment system that will stabilize the Medicare program and promote high quality, high value care. Physicians are leading the way. But first, Congress must act responsibly and stop the scheduled Medicare SGR payment cut of 26.5 percent. Such cuts seriously threaten the viability of California physician practices and your ability to care for patients. Physicians are also important employers crucial to the California economy.

 

In recent days, Senate and House Republicans have forwarded a proposal to cut the Affordable Care Act (ACA) Medicaid (Medi-Cal) physician payment increase as a way to fund the fiscal cliff issues. CMA is opposed to such cuts. California Medi-Cal rates are already some of the lowest in the nation - 50 percent below Medicare. Because of these low rates, 75 percent of physicians cannot afford to participate in Medi-Cal and thus, 50 percent of Medi-Cal patients can't find a physician. Regardless of the ACA, California needs the Medi-Cal rate increase to protect access to care. 

 

CMA will also be working to stop sequestration budget cuts to other vital health care programs, such as public health and graduate medical education (GME).

 

Finally, CMA is pursuing an update to the Medicare physician payment localities in the Medicare/Budget Sequestration legislative package. California's localities have not been updated and thus, 14 urban counties are still designated as rural and physicians in these counties are paid up to 14 percent less than their urban counterparts.  


OCMA Selects Citizens Business Bank as Preferred Business Partner

Irvine, Calif., Nov. 13, 2012 – The Orange County Medical Association is pleased to announce another benefit of membership.  The OCMA has designated Citizens Business Bank as a Preferred Business Partner for physicians seeking deposit and lending services for their professional or personal needs. 

Citizens Business Bank offers a comprehensive array of credit products and services designed to meet the specific needs of OCMA members, including: working capital loans, equipment loans and leases, real estate loans and SBA loans.  Citizens Business Bank also offers accurate and reliable depository accommodations that provide convenience and flexibility for busy professionals, so that they can spend less time banking and more time focusing on their patients.

Citizens Business Bank has a reputation as one of the safest, strongest and best managed business banks in the United States.  Their specialists are ready to help support OCMA members with the personal attention and customized solutions needed for their practices to grow. 

Citizens Business Bank provides banking services throughout Orange County at its seven Business Financial Centers located in Brea, Fullerton, Orange, Santa Ana, Irvine Spectrum and Laguna Beach.  Founded in 1974, the bank is the largest financial institution headquartered in the Inland Empire with assets of $6.3 billion and 41 business financial centers statewide.    

The strategic business partnership with Citizens Business Bank reinforces OCMA’s commitment to bring added value to its members by aligning with companies who offer business practice expertise, allowing physicians to focus their attention on patient care.

About CVB Financial Corp.

CVB Financial Corp. is the holding company for Citizens Business Bank.

Shares of CVB Financial Corp. common stock are listed on the NASDAQ under the ticker symbol of CVBF.  For investor information on CVB Financial Corp., visit the Citizens Business Bank website at www.cbbank.com and click on the Our Investors tab.

For more information contact Arthur Bergmann, Vice President & Manager -- asbergmann@cbbank.com -- work: (949) 581-4444 cell: (714) 864-0378


The Doctors Company Announces Five-Year Anniversary of the Tribute Plan

Career Award Represents Tangible Proof of Membership for Nearly 20,000 Doctors in California

The Doctors Company is the sponsored medical liability carrier of the Orange County Medical Association (OCMA). We share a joint mission of supporting doctors and advancing the practice of good medicine.

One of the many advantages of coverage with The Doctors Company is the Tribute® Plan, a significant financial benefit that rewards doctors for their loyalty to The Doctors Company and for their dedication to outstanding patient care. This year marks the Tribute Plan’s fifth anniversary.

“The Tribute Plan is recognition of a career spent practicing good medicine,” said Richard E. Anderson, MD, FACP, chairman and CEO of The Doctors Company. “In the last five years, more than 1,300 Tribute awards have been distributed, and over 22,700 members of The Doctors Company have qualified for awards when they retire from the practice of medicine. These members have an average Tribute balance of $11,500, and the highest distribution to date is $88,708.”

A special Tribute Plan five-year anniversary video—featuring details about Tribute, perspectives from members of The Doctors Company, and commentary from Dr. Anderson—can be viewed at www.thedoctors.com/tribute.


About The Doctors Company


Founded by doctors for doctors in 1976, The Doctors Company (www.thedoctors.com) is relentlessly committed to advancing, protecting, and rewarding the practice of good medicine. The Doctors Company is the nation’s largest insurer of physician and surgeon medical liability, with 71,000 members, $4 billion in assets, an A (Excellent) rating from A.M. Best Company, and an A (Strong) rating from Fitch Ratings.


Medi-Cal Requiring Re-Enrollment

The California Department of Health Care Services (DHCS) will soon be notifying physicians that they must re-enroll in Medi-Cal as one of the provisions of the Affordable Care Act (ACA). The ACA requires every state Medicaid program (Medi-Cal in California) to re-validate provider enrollment information at least every five years  beginning January 2, 2013.

DHCS is currently working to identify an initial list of all physicians and other providers who will be required to re-validate. Notices of re-validation will be mailed beginning the second week of January 2013. Notices will be sent to business location on file with DHCS. Each notice will include information on which application(s) must be completed. Anyone receiving a notice must complete and return the requested form(s) and required attachments within 35 working days of the date of the notice. Failure to do so may result in payment delays.

Physicians who have re-validated, updated or submitted new applications to the Medicare program within the last 12 months (January 1 through December 31, 2012) will not be required to re-validate at this time. However, your Medicare enrollment information must match the information on file with the Medi-Cal program. If it does not you will receive notice from DHCS requiring you to re-validate.

The California Medical Association (CMA) and DHCS have worked collaboratively over the past year to establish a phased, tightly-controlled re-enrollment process within the confines of current state and federal laws and regulations.

In addition, CMA will host two live webinar training courses with representatives from DHCS to walk attendees through the Medi-Cal enrollment process for both individual providers and groups. Also to be discussed will be program requirements and how to avoid common mistakes that can lead to delays, denials and exclusion from the Medi-Cal program. These extended-length webinars will be held November 15, 2012, and January 16, 2013, from 12:15 to 1:45 pm. These webinars are free and open to everyone.

OCMA/CMA members can contact the CMA reimbursement helpline: (888) 401-5911 or economicservices@cmanet.org


Anthem Blue Cross Amending Some Physician Contracts to Include Individual/Exchange Product

On October 24, Anthem Blue Cross sent a notice to 8,345 physicians who are part of the Blue Cross Select PPO network announcing its intent to participate in the California Health Benefit Exchange, the state's new insurance marketplace called for under the Affordable Care Act.  Beginning in 2014, individuals and small business will be able to purchase health insurance using tax subsidies and credits from the exchange.

 

According to the notice, Blue Cross will be creating a new provider network called the "Anthem Individual/Exchange Network," which will serve both individuals who purchase coverage through the exchange and individuals who purchase coverage from Anthem Blue Cross in the individual market outside of the exchange. In other words, the fee schedule would apply to all individual business, whether bought on or off of the exchange. 


Blue Cross has clarified for the California Medical Association (CMA) that this fee schedule change will not apply to Small Business Health Options Program (SHOP) business purchased through the exchange.


It's important to note that the letter also states that Blue Cross is amending the physician's Blue Cross Prudent Buyer Agreement to automatically include the new individual/exchange network, effective January 1, 2014. The new fee schedule associated with this product was included with the notice.

CMA has been actively working with exchange stakeholders to address significant concerns regarding the exchange grace period, monitoring of network adequacy and clinician-level performance measurement in qualified health plans offered in the exchange. (Click here for more information about contracting with exchange plans.)  


Though not mentioned in the Blue Cross cover letter, Sections VI and VIII of the enclosed amendment provide instructions for physicians who wish to opt out of the individual/exchange network. Physicians who do not wish to participate in this network must notify Blue Cross of their intent to opt out by December 31, 2012. Opt out notices should be in writing and sent via certified mail, return receipt to the address specified in Section VI of the amendment.


CMA is working with Blue Cross to obtain additional clarification on the amendment and will provide updates as they are received.

Please note that a small subset of Select PPO Network physicians did not receive the October 24 notice automatically opting them into the individual/exchange network. This subset of physicians received a notice from Blue Cross dated October 9 regarding fee schedule reductions. Physicians who choose to discontinue participation in the Select PPO network at the reduced rates have until December 14 to notify Blue Cross in writing.

As always, physicians are encouraged to carefully review all proposed amendments to payor contracts. You do not have to accept substandard contracts that are not beneficial to your practice.


Physicians who did not receive a letter and are unsure whether they are affected by this change or those who have general questions about the amendment can contact Blue Cross's Network Relations Department at (855) 238-0095 or networkrelations@wellpoint.com.


OCMA/CMA members can contact the CMA reimbursement helpline: (888) 401-5911 or economicservices@cmanet.org


Recovery Audit Contractor Overpayments: Pulmonary Diagnostic Testing and E/M Services

The Medicare Modernization Act of 2003 established the Medicare Recovery Audit Contractor (RAC) program to identify fraud and waste in the Medicare system.

The California Medical Association (CMA) has recently learned that RAC contractor Health Data Institute (HDI) is currently assessing overpayments for evaluation and management services billed without a modifier -25 on the same day as a diagnostic pulmonary study. Affected claims have dates of service of 2009 or 2010.

In order for a physician to receive payment for a E/M visit on the same day as a service in the pulmonary diagnostic range (i.e., any service in the series from 94010 to 94620), the physician must append a modifier -25 with the visit code, indicating that the patient's condition required a significant, separately identifiable visit above and beyond the diagnostic service provided. For additional information, please refer to The National Correct Coding Initiative Policy Manual (http://cal.md/ncci-manual). See Chapter 11, Evaluation and Management Services, Codes 90000 to 99999, Section J. Pulmonary Services.

Physicians should appeal the overpayment if medical record documentation supports the E/M code. Submit the medical record and request that the modifier -25 be appended to the E/M code. Redetermination request forms for RAC overpayments are available at http://cal.md/rac-redetermination.


Introducing: WorldPay

Irvine, Calif. - The Orange County Medical Association is pleased to announce another benefit of membership. The OCMA has designated financial processing partner WorldPay as its Business Partner for physicians seeking credit card processing solutions, check verification services, Cash Advance services and other processing technologies for the medical field.

OCMA members may receive complimentary consultations and discounted rates on a wide range of processing needs, including stand-alone terminals, integrating into current POS/Software systems, check verification services, wireless methods of payment, cash advance products and the latest in HIPAA and PCI Security. They process all card types such as VISA, MasterCard, Discover, AMEX, and JCB.

"Our Medical Professional Plan is designed to specifically help busy physicians protect their professional practices against fraud," said Andy Varble, Regional Sales Manager at WorldPay. "We offer quality credit card processing at an attractive rate while keeping each doctor PCI-DSS compliant which in turn keeps them HIPAA compliant. We look forward to offering our many services through this special arrangement to the OCMA membership."

The following services are included within WorldPay's healthcare practice: current credit card processing reviews at no cost, fraud protection reviews, PCI-DSS training to keep each doctor HIPAA compliant. WorldPay can offer integration with many of the physician-specific POS systems and software that is available on the market today along with check verification services and cash advance programs.

Carla Mullet, who has 19 years industry experience, has been chosen as the point of contact for the relationship between the OCMA and WorldPay. With her tenure she is experienced in every facet of credit card processing and the fraud prevention features that are unique to WorldPay. She uses a consultative approach with each doctor to ensure she understands completely their business model, current needs, and also keeps in mind the future growth strategies for each office with which she consults. Located in the heart of Orange County, Carla Mullet is local to meet face-to-face with each doctor and staff to ensure she is providing the best service, technology and pricing to their practice.

The strategic business partnership with WorldPay reinforces OCMA's commitment to bring added value to its members by aligning with companies that offer business practice expertise, state-of-the-art technology at a competitive price point, and allowing physicians to focus their attention on what matters most, patient care. 

For assistance please contact Carla Mullet at 714-878-2031 or Carla.mullet@worldpay.us 

Or contact Andy Varble at 714-380-1491 or andy.varble@worldpay.us 


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