Saturday, December 16, 2017

OCMA Blog

Notice: Due October 1: Employee Notices - Health Insurance Exchange

One of the provisions of the ACA requires employers to provide their employees notice of the new state health insurance exchange (Covered California). Regardless of whether or not your practice offers employees health insurance, employers subject to the Fair Labor Standards Act (FLSA) are required to provide notification of purchasing options and subsidies available through the Covered California health exchange by October 1, 2013 (model notices are available at www.marshhealthoptions.com).  Generally employers with one or more employees who generate sales of $500,000 or more annually are required to provide the notice. There is one notice for employers who provide their employees with health insurance and one notice for employers who do not provide health insurance to their employees. Since the FLSA applies broadly, most employers are subject to the requirement. 

A Department of Labor online compliance tool: http://www.dol.gov/elaws/esa/flsa/scope/screen24.asp can help employers determine whether they are covered by the law. 

Your Participation is Requested - 2013 Employee Salary Survey

The California Medical Group Management Association (CAMGMA) is coordinating their 2013 salary survey. They are using a dynamic new instrument which provides real-time results back to the participants, along with customized reports.
 
Data entry and support is being coordinated for OCMA members by Jay Wikum, CPA (Business Partner - HMWC CPAs and Business Advisors).
 
The link to the online instrument can be found at: http://www.camgma.com/.  The data entry period is scheduled to run through September 30, 2013
 
If you have any questions on the survey or the instrument, feel free to contact Jay Wikum at (714) 505-9000.
 
Click here to access the form directly.

Lyme Disease: Delayed Diagnosis Is Greatest Risk for Healthcare Providers

Risk Tip by The Doctors Company

Lyme disease, a bacterial tickborne disease, is one of the fastest-growing infectious diseases in the U.S. Summer is peak season, and most people are bitten by blacklegged ticks, which are small and difficult to see. Lyme disease progresses in phases: early localized disease with skin rash and flu-like symptoms, followed by disseminated disease with heart and nervous system involvement (palsy and meningitis), then late disease with severe fatigue, neurocognitive symptoms, and severe joint and muscle pain leading to physical disability. The challenge is diagnosing this disease in the early phases, when treatment is typically curative.

A claims review found that the main liability risk for Lyme disease is system issues that result in delayed diagnosis. The chief system issue is communication failure in reporting test results to the healthcare provider. In one case, the patient had ongoing headaches, nausea, and vomiting. Although the patient did not recall a recent tick bite, the patient lived in an area with a high incidence of Lyme disease. The provider ordered a Lyme screen, which was positive. A confirmatory test was also positive. The lab faxed the report to the provider and contacted the health department. However, the provider claimed he had not received test results.

The flu-like symptoms of early Lyme disease mimic a viral syndrome, so providers need to consider Lyme disease in their differential diagnosis whenever they see patients with this presentation. 

Tips to help make an early diagnosis include:

  • Because most people do not recall a tick bite, ask about recent travel or outdoor activities.
  • According to the Centers for Disease Control and Prevention (CDC), in 2011 96 percent of cases came from Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Pennsylvania, Vermont, Virginia, and Wisconsin.
  • In the early phases, 70 to 80 percent of patients will get a red, spreading rash that can appear anywhere on the body.
  • The classic rash has a bulls-eye appearance with a red outer ring surrounding a clear area, but the rash may not have this appearance.
  • Fatigue, chills, fever, swollen lymph nodes, headache, muscle, and joint aches are common early symptoms.
  • Early phase blood tests are typically negative because antibodies have not yet developed. Therefore, a negative test does not rule out Lyme disease.
  • Those patients who develop a rash should be treated with antibiotics.
  • Remain current on CDC guidelines regarding diagnosis and treatment.
  • Oral antibiotics commonly used with adults include doxycycline, amoxicillin, and cefuroxime axetil. For children younger than 8 years old, amoxicillin is recommended.
  • Have a system in place for following up on lab test results.
  • Advise patients to avoid tick-infested areas, use insecticides containing DEET, and conduct daily exams for ticks on themselves, their children, and their pets.
  • If they find a tick, advise patients to gently remove it with tweezers and save it for identification.
Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety

Upcoming CalOptima Provider Forum on Duals Demonstration

On July 10, the OCMA, CalOptima and the Health Networks in the CalOptima health care delivery system co-hosted a forum for physicians to learn about the contracting options for the upcoming "duals demonstration."  The demonstration will entail enrolling the dual-eligible (Medicare/Medi-Cal) beneficiaries in Orange County into CalOptima. OCMA has been advocating that physicians and their dual-eligible patients have multiple options for participating in the demonstration, including an option that allows physicians to contract directly with CalOptima. 

 

On Wednesday, August 14, CalOptima will host another forum which will include the Health Networks to once again reach out to physicians and educate them on the various contracting options the CalOptima board of directors will consider at their next board meeting.  If you missed the July 10th forum, OCMA strongly encourages you to attend the forum on August 14.  It is imperative that CalOptima and the Health Networks hear from the physicians that are caring for the dual-eligible patients in Orange County. The invitation to the August 14 forum is attached.

 

Note: this forum will be held at CalOptima. See invitation for full details.

 

Thank you for your attention to this matter.


Resources to Assist Physicians with the Medicare Contractor Transition

Goal:   Provide members with information and resources to prepare their practices for the transition of Medicare contractors from Palmetto to Noridian on September 16 (Part B).

 

Current CMA Resources

 

1. CMA’s Medicare Transition webpage – CMA has created a dedicated Medicare transition webpage, www.cmanet.org/medicare-transition, offering practices the ability to access updates and important information regarding the transition in one easy-to-access to location. All resources related to the Medicare transition will be accessible through this site.

2. CMA’s Medicare Transition Guide: What physicians need to knowThis guide, which members can download free from the CMA website, includes an FAQ that includes information on the transition dates, what will remain the same with the transition and what will change, Noridian’s online provider portal, what practices can do to prepare for the transition, and links to additional resources and way to stay apprised of new information on the transition.

3. CMA Practice Resources (CPR)CMA Practice Resources is a free monthly newsletter from CMA’s practice management experts that focuses on critical payor and health care industry issues, including the Medicare transition, and how these issues directly impact the business of a physician practice. To sign up, visit the CMA website or contact CMA Member Services at (800) 786-4262.

4. CMA webinarAt the request of CMA, Noridian has agreed to conduct a webinar for CMA members on August 7 from 12:15-1:30pm.  The other webinars Noridian is offering is open to all provider types in California, Nevada, Hawaii, and the U.S. territories of American Samoa, Guam and the Northern Mariana Islands. However, the August 7 webinar will be limited to CMA members and will give attendees an opportunity to ask their specific questions. This webinar will be held at the OCMA Conference Center during a "Lunch & Learn." 
During the gathering, we will participate in the "live" CMA Medicare Transition webinar and then discuss any questions. To register for the Lunch & Learn, click here.


For those who miss the live webinar, it will be available on-demand via the CMA website.

 

5. Content alert updates - The CMA website allows registered users to create custom content alerts on the top­ics that are of interest to you. Once signed up, you will be notified any time there is new content posted in one of your interested areas, including Medicare issues. To sign up, users should visit their account dashboard on the CMA website and click on “my alerts,” then select “Insurance Reimbursement -> Medicare.”

 

CMA Resource in Development

 

  • Practice preparation checklist indicating all of the steps practices should take to prepare for the transition to Noridian. This document will be added to the Medicare Transition Guide.

 

MEC Engagement

 

The Priority Assistance Committee recommends that MEC proactively educate members about the resource available from CMA to help navigate contracting with the exchange.


  • Promote CMA Medicare transition website
  • Promote CMA’s Medicare transition guide
  • Promote Aug 7 Medicare transition webinar (promo from CMSS coming)
  • Include articles and announcements in CMS publications and communications
  • Alert CMA’s Michele Kelly 213/226-0338 mkelly@cmanet.org of any issues related to the transition. 

Additional Resources


  • Noridian’s transition website: The Noridian transition website includes information on what’s new/changing and what will remain the same during and after the transition.
  • Paul O’Donnell, Noridian (701) 277-2401.  NOTE: MEC are welcome to contact Mr. O’Donnell directly; however, it is important to keep CMA/Michele Kelly in the loop so that she is aware of issues as they arise.

 

Additional Medicare-related Resources

 

1.      Medicare Enrollment Guide for Physicians - This document guides  physicians through the enrollment process and assists enrolled physicians who are making changes or who must revalidate their enrollment.

2.      Getting Started with the Medicare Physician Quality Reporting System (PQRS) – this guide assists physicians with understanding and complying with PQRS.

3.      Medicare Electronic Prescribing Overview: Payment Incentives and Payment Reductions – Overview of electronic prescribing (eRX) program, including incentive payments for physicians who e-prescribe and payment penalties for physicians who do not.

4.      Medicare Part B Important Changes: What they mean to your practice

5.     Medicare Audit Guide for Physicians – Guide for preparing and responding to a Medicare audit.

6.      Various Medicare webinars available on demand at www.cmanet.org/events

7.      Numerous Medicare-related CMA On-Call documents can be downloaded at www.cmanet.org


Announcement: Medicare SGR and GPCI Bill Clears Committee

On Wednesday, July 31, the House Energy & Commerce Committee voted UNANIMOUSLY to approve H.R. 2810, the bill to repeal and replace the Medicare SGR. Included in that bill is a California Medicare locality reform (known as the "California GPCI Fix") which will update payments for the urban physicians in Locality 99 and Locality 3 while holding the rural physicians in these localities harmless from payment cuts. 

 

OCMA and CMA are pleased with this herculean effort to move Medicare SGR legislation on a bipartisan basis as well as update the outdated Medicare physician payment localities.  CMA physicians have cleared the first hurdle in a long legislative process. The Medicare SGR and GPCI Locality  issues will now be taken up by the House Ways & Means Committee as well as the Senate Finance Committee.   

 

While there are several aspects of the bill that concern CMA, including the downside penalties and lack of adequate updates, the bill meets many of the goals that CMA advocated to Congress to eliminate the annual threat of nearly 30% SGR payment cuts, 5 years of stable updates, a continuation of the Fee-for-Service (FFS) program with opportunities for updates, and incentives to help physicians transition to new payment and delivery models. There is still much work to be done on the entire bill and Congress recognizes that.  

 

If you would like further details on this matter, please contact OCMA.

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