Sunday, December 17, 2017

OCMA Blog

Mental Illness and the ACA — Expanding Behavioral Health Benefits and Fighting Stigmas

By Donald Sharps, M.D.
CalOptima Behavioral Health Medical Director

The phrase, “people fear what they do not understand,” is true when dealing with the stigma that surrounds mental illness. In the media, behavioral health is often blamed for irrational behavior and acts of violence. In schools and offices, you can hear name-calling using words like crazy, insane or psycho. A lack of awareness continues to spread this stigma and it can be a barrier for people to get behavioral health services to improve their quality of life. 

Just as diabetes is a disease of the pancreas, mental illness is a disease of the brain. People are not their diseases. Be aware and do not label a person as schizophrenic or bipolar. A person can have schizophrenia or a bipolar disorder, just as a person can have diabetes. It is important that people increase their awareness of mental health and wellness to reduce the stigma of mental illness. To accept and cope with having a mental illness is difficult enough. It is even harder when a person feels there is a stigma associated with mental illness. Treatment is available for behavioral health issues and it is possible for people to achieve and maintain recovery.

How has the Affordable Care Act changed the way people access behavioral health services and treatment for mental health disorders?

As of January 1, 2014, the Affordable Care Act (ACA) expanded health care benefits to include behavioral health services. However, many people still do not access services for reasons ranging from lack of awareness, to the fear of being labeled and being treated differently. By reducing the stigma of behavioral health issues, we can assist people in getting the needed treatment that is available to them.
With ACA, Medi-Cal has expanded so that more people are eligible, by providing coverage for people who earn up to 138 percent of the federal poverty level (about $15,800 for an individual). It has also increased coverage among non-elderly adults by extending Medi-Cal eligibility to childless adults and increasing Medi-Cal eligibility for parents who lose access when their income fluctuates and slightly exceeding the poverty level.

The ACA also ensures that all health plans offer a comprehensive package of services, known as essential health benefits, which includes Mental Health and Substance Use Disorder Services. 

These Behavioral Health Services are now available to all Medi-Cal members:

  • Individual and group psychotherapy
  • Psychological testing to evaluate a mental health condition
  • Psychiatric consultation and ongoing treatment, that cannot be managed at the primary care level of health care
  • Screening, Brief Intervention, and Referral to Treatment (SBIRT) provided in a primary care setting for alcohol misuse
  • Drug Medi-Cal Services

Members can call the Orange County Mental Health Plan Access Line at 1-800-723-8641 for screening and referral to services. Primary care providers, network providers, community-based organizations and county programs can also call the Access Line. This line is available 24 hours a day, 7 days a week.

To get information regarding the Drug Medi-Cal County Alcohol and Other Drug Program (AOD), call the OC LINKS behavioral health services and referral line at 1-855-OC-LINKS (1-855-625-4657).


Noridian incorrectly denies 300,000 claims for E&M services

Last fall, the Centers for Medicare and Medicaid Services (CMS) experienced some editing issues with new patient E&M codes that resulted in incorrect claim denials. These problems started in October 2013, and was thought to have been corrected in late January 2014. The California Medical Association recently learned, however, that some claims continued to be paid incorrectly through July 15, 2014.
 
Noridian, California's Medicare contractor, in January began making mass adjustments and correcting claims subjected to overpayment recovery. Unfortunately, while implementing the corrections, Noridian inadvertently subjected established patient E&M codes to incorrect editing, resulting in incorrect denial of codes 99211- 99215.
 
Noridian has corrected the editing for both the new patient codes and the established patient codes, and claims received by Noridian on and after July 16, 2014, should be processing correctly. Noridian is now beginning the process of mass adjustments to the incorrectly denied claims. Due to the number of claims involved (~300,000 claims back to October of 2013), this process could take a month or so to complete.
 
Physicians do not need to do anything to have their claims adjusted and they should NOT resubmit the claims. The claims will be automatically adjusted.
 
For more information, see Noridian's notice on this issue.
 
Contact: Mitzi Young, OCMA Physician Advocate (888) 236-0267 or myoung@cmanet.org.

Physician Advocate Mid-Year Report: 127,000 Reasons to be Member

127,000 REASONS TO BE A MEMBER


The California Medical Association's (CMA) Center for Economic Services' (CES) reimbursement specialists have recouped $127,168 on behalf of physician members of OCMA since the beginning of 2014!

Mitzi Young is OCMA's Physician Advocate from CMA's CES team. Since the start of 2014, Mitzi has met with over 43 physician practices to assist with practice management needs and perform complimentary practice assessments. 

Your Personal Physician Advocate
Meet Mitzi Young, staff member and CMA Center for Economic Services (CES) Physician Advocate for the OCMA. Mitzi is dedicated to handling your practice management issues and is only a phone call away!

Mitzi brings 21 years of practice management experience and expertise in the health care industry. She has worked in numerous health care settings including county organized health programs, surgery centers and specialty health care practices. 
 
Mitzi understands the needs of physicians and their staff, the challenges that face medical practices, and is very passionate about advocating on behalf of doctors in the ever-changing healthcare environment.

 

When do you call Mitzi?

  • When you have questions about Covered California
  • When your claims are not being paid in a timely manner
  • When you are not being paid according to your contract
  • When your claims are being denied after obtaining prior authorization or verifying eligibility
  • When you receive unreasonable requests for medical records or untimely requests for refunds
  • When you are having difficulty obtaining fee schedules and/or payment rules
  • When your claims are denied despite timely filing
  • When you've been presented with a managed care contract and you're not sure if the terms are consistent with California law
  • When you've done everything you can to resolve an issue with a payor and have been unsuccessful
  • When you need help evaluating your practice
  • When you need ANY practice management guidance

Would you like a FREE Practice Assessment?

Find opportunities to increase revenue through the billing process, accounts receivable and collections. Increase efficiency with patient scheduling, appointments and check-in process and discuss all of your practice-related concerns. Contact Mitzi to schedule your member-only practice assessment.
 
Receiving practice management guidance from Mitzi Young is a FREE OCMA member benefit!
 
Contact Mitzi to schedule a one-on-one consultation to discuss your practice management needs: 
Mitzi Young
Physician Advocate, CMA Center for Economic Services
(888) 236-0267
myoung@cmanet.org

Not a member?

Join today!  
Contact Mark Morones, Director of Membership:
(949) 398-8103
mmorones@ocma.org


MICRA lawsuit measure assigned proposition number

Via the California Medical Association-

The unprecedentedly broad and diverse coalition working to defeat the trial lawyers’ MICRA lawsuit measure is now officially the “No On 46” campaign, following the assignment of proposition numbers to qualified ballot measures by the Secretary of State’s Office on Monday.

If approved by voters, Proposition 46 would increase health costs, reduce access to care and threaten patient privacy, all to make it easier and more profitable for lawyers to sue doctors and hospitals. In addition to increasing the overall number of medical lawsuits and the cost of health care across the board, Proposition 46 contains a number of unrelated provisions designed to mislead and deceive voters – including a little-discussed mandate relying on a massive expansion of a government-run prescription drug database, which third-party analysts say cannot be implemented as written and will leave personal medical information vulnerable to privacy breach.

For these reasons, health providers, education groups, labor unions, business organizations, working men and women, and community clinics have all announced their opposition to Proposition 46.

On Monday, two additional groups – the State Building and Construction Trades Council of California (SBCTC) and the California NAACP – joined the “No On 46” campaign, pointing out the devastating effects it would have on California.

“This initiative will cost state and local governments hundreds of millions dollars and raise health costs for everyone,” said Robbie Hunter, President of the SBCTC. “That hurts job creation and will negatively impact California’s future.”

According to California’s independent Legislative Analyst, the proposed measure could increase state and local government health costs by “hundreds of millions of dollars annually.”

“This measure is terribly flawed and will reduce access to quality health care for underserved communities,” said Alice Huffman, President of the California NAACP. “At a time when we’re working hard to cover as many Californians as possible under the ACA, Proposition 46 takes us in the wrong direction. Proposition 46 will disproportionately hurt minority communities. It’s bad medicine for California.”

These two organizations join the growing list of California public entities and private organizations that have announced their formal opposition. For a complete list, please visit the campaign website, www.noon46.com.


IMQ Expands Peer Review Services

Does your medical staff need help with peer review? The Institute for Medical Quality is expanding its services to include Clinical Case Review of individual cases and Judicial Review services in addition to our existing Comprehensive Peer Review services.
 

Through off-site patient chart review, an IMQ Clinical Case Review consultation provides an objective evaluation of the clinical practice of one or more physician members of a hospital medical staff, physician group, or ambulatory care practice through peer review of selected cases. IMQ's involvement is especially helpful when an organization will benefit from expert review of one or more patient cases, but needs physicians of the appropriate specialty who have no real or perceived conflicts of interest.

Additionally, IMQ is seeking physicians to support this expansion of services. For more information about any of IMQ’s peer review services, or about becoming a physician reviewer, please contact Julie Hopkins at 415-882-5165 or jhopkins@imq.org


OCMA CEO Advocacy & Legislative News Update


Local: CalOptima

Thanks in part to OCMA advocacy, in March, the CalOptima Board of Directors approved establishing a 'Community Network', allowing direct contracts with physicians in order to provide greater access to services for CalOptima enrollees.
 
Also in March, the County Board of Supervisors modified the county ordinance governing CalOptima to require an additional supervisor be added to the CalOptima Board of Directors. As a result, Supervisor Todd Spitzer has joined Supervisor Janet Nguyen on the CalOptima Board. 
 
For details and resources on the state's Coordinated Care Initiative (CCI) - Dual Eligibles Demonstration, please click here.

State: Health Care Bills

SB 1215 (Hernandez): Healing arts licensees: referrals (CMA Position: OPPOSE) - which aimed to eliminate the in-office exception to the self-referral law for advanced imaging, anatomic pathology, radiation therapy, and physical therapy. This bill would have been a major blow to the integrated care model, resulting in increased costs as these services would have been driven toward the more expensive hospital setting and inhibit the development of practices that integrate and coordinate care. We have successfully managed to defeat this harmful bill in committee.
 
SB 1000 (Monning) the Sugar-Sweetened Beverages Safety Warning Act (CMA Position: SPONSOR)  - passed the Senate Floor after receiving 21 yes votes. Facing significant opposition from the beverage industry, it was a hard-won vote. 
 
AB 1771 (V.M. Perez) Telehealth Reimbursement (CMA Position: SPONSOR)  - was approved through a 76-1 vote. This bill seeks to require health insurance companies licensed in the State of California to pay contracted physicians for telephone patient management. 
 
AB 2400 (Ridley-Thomas) Health care coverage: provider contracts (CMA Position: SPONSOR) - was approved through a 55-8 vote. If signed into law, this bill will prohibit contracts issued, amended or renewed after January 1, 2015, from including a provision that terminates a provider if he or she exercises the right to negotiate, accept or refuse a material change to the contract. It would also prohibit plans from requiring participation in unspecified current and future products or product networks, unless the plan discloses the reimbursement rate, method of payment and any other contract terms that are materially different from those of the underlying commercial agreement. 

National: Medicare SGR

Over CMA's strong opposition to another short term patch, on March 31, the night before the SGR cut, the House and Senate voted on the 17th patch in a decade.  With the President's signature, the bill takes effect and provides the following: 

  • Stops the 24% Medicare physician payment cut for 1 year until April 2015.
  • Provides a 0.5% payment increase through Dec 31, 2014; 0% through April 1, 2015.
  • Delays the burdensome ICD-10 coding system until October 2015.
  • Permanently Reforms the California physician payment localities. 


For the full OCMA CEO Advocacy & Legislative Report, click here.


Stepping Up to Leadership Courses Available Online

Couldn’t make it to the IMQ-PACE Stepping Up to Leadership conference this spring? Why not make the conference content come to you? Selected courses from Stepping Up to Leadership are now available online at IMQ Online Education!  All content is available for AMA PRA Category 1 CreditTM—take this opportunity to earn CME credit at a time and place that’s convenient for you.

Stepping Up to Leadership courses cover a variety of important skills for successfully running a medical staff, particularly issues of communication, problem-solving, and improving outcomes for patients and staff.  Choose from Nancy Dickey, MD’s keynote presentation, Successful Leadership: What It Really Takes, Donald David, MD on The Role of the Physician In Patient Safety, Carol Havens, MD on Using CME as an Organizational Improvement Tool, and a 2014 Legal Update by Greg Abrams, Esq. covering hot medico-legal topics in California. To browse the full IMQ Online Education catalog, visit http://imq.inreachce.com.


2014 CalOptima Circle of Care Award: Requesting Nominations

About CalOptima and the Circle of Care Award
 
CalOptima’s mission is to provide members with access to quality health care services delivered in a cost-effective and compassionate manner.

The CalOptima Circle of Care Award recognizes health care professionals, community groups and individuals who demonstrate excellence in the delivery of accessible and high-quality health care services to CalOptima members. The award honors those who go above and beyond in serving their profession, patients or clients. Since the award’s inception in 2000, CalOptima has recognized more than 250 distinguished people or groups whose dedication to our members and community is extraordinary.   
 

Nomination Criteria and Deadline
 
Please join CalOptima in recognizing outstanding health care professionals, community groups and individuals who, in the past 12 months, went above and beyond to serve our members by submitting the attached Nomination Form. Award recipients will be selected based on:
•         The nominee’s service to CalOptima members
•         The nominee’s accomplishments during the past 12 months

Nominators, please note the following criteria:

  • A nominee may only be a Circle of Care Award recipient a total of five times.
  • Only one Nomination Form per nominee is needed.
  • Self-nominations are welcome.
  • Completed Nomination Forms must be submitted by Friday, June 20, 2014.

Click here for the Nomination Form

Mail, deliver, fax or email Nomination Forms to:         

CalOptima Provider Relations Department 
Attention: Maria Wahab
505 City Parkway West, Orange, CA 92868
Email: mwahab@caloptima.org 
Fax: 714-796-6679  

Award recipients will receive an invitation to attend the Circle of Care Awards luncheon on Friday, September 12, 2014.  
 
If you have any questions, please contact Maria Wahab at 714-796-6143. Please allow adequate time before the nomination deadline for CalOptima to respond to any inquiry.


Now Accepting Nominations for the 2015 Physicians of Excellence Awards!

Is your doctor the BEST in Orange County?

Nominate him or her for the 2015 Physicians of Excellence Awards!

OC Register Magazine in conjunction with the Orange County Medical Association (OCMA), will publish its annual list of Orange County Physicians of Excellence in the February 2, 2015 issue of OC Register Magazine, and is currently seeking nominations. The Physicians of Excellence program was designed to honor outstanding physicians practicing in Orange County. The selection criteria that will be used to determine physician excellence were developed by a multi-specialty collaboration of the OCMA. Anyone can nominate a physician to be considered for the Physicians of Excellence program. Physicians need to be nominated only once to be eligible to apply for selection as a Physician of Excellence. Multiple nominations for the same physician are discouraged. Self-nominations will not be accepted. Once nominated, an application packet will be mailed to the nominee with the details of the application process. Membership in the OCMA is not a requirement for selection.

Minimum criteria for Physicians of Excellence include:

  • Hold board certification within specialty of nomination.
  • Maintain a primary practice location in Orange County, California for the last 5 years.
  • Be in good standing with the Medical Board of California
  • Have been in practice within his/her specialty field for the last 5 years consecutively
Nominators are not required to certify that the physician they are nominating meets these criteria.


Nomination forms are located at: 
www.ocma.org/ForPhysicians/Programs/PhysiciansofExcellence.aspx

You may also download the form by simply clicking here.
 
Submit your nomination form to the Orange County Medical Association by July 10, 2014
 
Send to:
OCMA, 17322 Murphy Avenue, Irvine, CA 92614 or 
fax to (949) 398-8120. 
For questions call (949) 398-8100 ext 106 


CalOptima Seeks Candidates to Participate on its Provider Advisory Committee (PAC) 2014-2016

The CalOptima Board of Directors welcomes input and recommendations from the provider community regarding issues concerning CalOptima programs. For this reason, the CalOptima Board encourages providers to become involved through an advisory group known as the Provider Advisory Committee (PAC).

The Provider Advisory Committee advises the CalOptima Board of Directors and staff. The CalOptima PAC is composed of 14 members representing diverse provider constituencies. These include but are not limited to health plans, hospitals, physicians, nurses, allied health professionals, long-term care services and community health centers. The charge of the committee is to:
 
  • Provide advice and recommendations to the CalOptima Board on issues concerning CalOptima programs as directed by the CalOptima Board;
  • Engage in study, research and analysis of issues assigned by the Board or generated by thecommittee;
  • Serve as a liaison between interested parties and the Board;
  • Assist the Board in obtaining public opinion on issues relating to CalOptima programs;
  • Initiate recommendations on issues for study to the CalOptima Board for their approval and consideration; and
  • Facilitate community outreach for CalOptima and the Board.

At this time, CalOptima is seeking candidates to participate on its Provider Advisory Committee (PAC). Service on the PAC is voluntary and with no salary. You need to be available to attend monthly meetings and serve on subcommittees. The following two-year seats are available:
 

  • Long Term Care Services Representative (two seats) 
  • Non-Physician Medical Practitioner Representative 
  • Pharmacy Representative 
  • Physician Representative (two seats)

The committee encourages interested individuals with knowledge and support of Medi-Cal and Medicare to apply. To apply or to nominate an individual for the Provider Advisory Committee, please mail, fax, or email the attached candidate application by Friday, April 11, 2014, along with a biography or resume plus two letters of reference to:

CalOptima
Attn: Maria Wahab
505 City Parkway West
Orange, CA 92868
 
Office: 714-796-6143 
Fax: 714-796-6679 
Email: mwahab@caloptima.org
 
If you have any questions, please call Maria Wahab at 714-796-6143.  


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