California Medical Association
Physician practices have less than 75 days before the October 1 deadline to implement the ICD-10 code set. The AMA and CMS have put together a guide to ensure a seamless transition to ICD-10.
If you’re still in the early stages of prepping your practice, spend the month testing your practice’s ICD-10 readiness and identify potential problems.
One type of external test is acknowledgement testing with Medicare, which simply acknowledges that a claim has been received. Physicians can perform acknowledgement testing with their Medicare Administrative Contractors and the Common Electronic Data Interchange contractor any time until the October 1 implementation date.
Now is the time to prepare for possible disruptions in claims processing. While organized medicine (AMA, CMA, SFMS) have secured provisions and confirmed 1-year grace period from CMS to ease the transition to the new code set, physicians should still be ready, especially because private payers may not ease up their claims payment processes.
Make sure you have taken the most important steps to prevent cash flow interruptions. They are to ensure:
If you’ve been following a solid transition plan, you should be well-prepared to handle any potential claims disruptions.
The provisions the AMA secured from CMS address claims denials, quality reporting penalties, payment disruptions and navigating transition problems. Click here to learn details of the agreement.
CMS will host a National Provider Call from on August 27, 2:30 pm to 4 pm EST (11:30 am to 1:00 pm PST). Experts will discuss coding guidance and tips, answer coding questions, and provide information about claims that span before and after the implementation date. Click here to register for the free call.
Click here to view CMS’ Road to 10 Guide implementation guide for solo/small group practices.
The Centers for Medicare and Medicaid Services (CMS) recently released the 2016 proposed Medicare physician payment rule. The rule reflects the 0.5% increase in payment as of July 1, 2015, and the additional 0.5% increase in payment on January 1, 2016, recently adopted by Congress. Overall, Medicare will pay physicians nearly $700 million more in 2016 than they will have paid in 2015.
Most notable in the payment rule is CMS’ proposal to pay for advance care planning and end-of-life counseling. The fee schedule would establish two new codes to cover early conversations between patients and their physician about care options. These codes were recommended by the American Medical Association (AMA) Relative Value Scale Update Committee (RUC). The codes include discussion before an illness progresses and during the course of treatment so patients can make decisions about appropriate treatment for their personal situation. One code would cover the first 30 minutes and the other would cover additional 30-minute blocks of time. AMA, CMA, and SFMS have been pushing CMS to cover such services.
CMS is seeking comments on the 2019 implementation of the new Medicare payment systems recently adopted by Congress as part of the permanent repeal of the sustainable growth rate (SGR) formula. The agency also noted its strong support for promoting primary care services and is soliciting comments on potential coverage of collaborative care services and an expansion of the Comprehensive Primary Care initiative. The proposal also includes an expansion of payment for telehealth services mainly for in-home treatments for end-stage renal disease.
There are numerous changes to the relative values of services; many recommended by the AMA RUC. Most notably, payment for gastroenterology services will be reduced 5%, with colon and rectal surgery reduced by 1%. Organized medicine is fighting many of these changes.
Other notable provisions of the rule include:
The overall payment impact by specialty can be found on page 711 of the rule. Please note that these payments do not account for adjustments made by PQRS, the value-based payment modifier, or meaningful use.
CMS is also updating the Geographic Adjustment Factors for all localities nationwide. California will see increases of 0.1 to 0.3%. Please note that starting in 2017, California localities will move to Metropolitan Statistical Areas due to the CMA-sponsored geographic practice cost index legislation, with there will be larger payment increases to the urban counties currently within the "Rest of California" locality.
Physicians can use the Medicare Physician Fee Schedule (MPFS) look-up tool to find payment information for services covered by the MPFS.
In June, Governor Jerry Brown convened a special legislative session on health care financing. Specifically, legislators will be working to come up with new funding for developmental disability services, in-home supportive services, and the Medi-Cal program, which is facing a shortfall of at least $1.1 billion through the loss of the managed care organization (MCO) tax.
Since 2005, the state has taxed MCOs and used the money to cover the costs of provider reimbursement. However, federal officials informed California in 2014 that its MCO tax structure was not compliant with new federal requirements. The loss of the MCO tax and the federal matching funds would mean the loss of over $2 billion for the Medi-Cal program.
The budget that Brown introduced in January proposed a new MCO tax that would conform to the new federal requirements, but health plans objected to the new tax and the legislature failed to adopt the proposal.
The special session will look at sources of funding, from another MCO tax to alternative sources. Legislators will also tackle other issues, including:
The special sessions began in June with informational hearings, but the hard work isn’t expected to begin until late August after the summer recess. SFMS and CMA continue to work with its legislative allies and coalitions to push the issue of reimbursement rates and patient access over the finish line.
Medi-Cal currently covers approximately one-third of the population of the state of California, 12.3 million people. California has ranked among the bottom three states in the nation for Medicaid reimbursements since 2011. Low reimbursement rates have forced many of California’s providers to stop seeing Medi-Cal patients. As a result, more than half of Medi-Cal patients report difficulty finding a doctor. SFMS and CMA, along with We Care for California coalition partners, are committed to ensuring that Medi-Cal is not a broken promise of access to care for millions of Californians.
This summer, the Centers for Medicare & Medicaid Services (CMS) will recognize ways in which Medicare and Medicaid have transformed the nation’s health care system over the past five decades. As we mark the 50th anniversary of Medicare and Medicaid, we are reminded of the critical role these programs play in protecting the health and well-being of millions of families and improving America’s economic security. These are life changing programs that keep Americans healthy.
To commemorate the anniversary, CMS Region IX, Health and Human Services, and San Francisco General Hospital and Trauma Center are hosting an event from 10:00-11:30 am on July 30, exactly 50 years from the day President Johnson signed the Social Security Amendments of 1965 into law. The event will feature remarks from health care experts about how Medicare and Medicaid continue to build a health care system that is better, smarter, and healthier.
Keeping US Healthy for 50 Years
Thursday, July 30
10:00 am – 11:30 am
Carr Auditorium, San Francisco General Hospital
Roland Pickens, Director of the San Francisco Health Network, and Interim CEO of SFGH will make introductory remarks and Dr. Edgar Pierluissi, Medical Director of the hospital’s Acute Care for Elders Unit will be a panelist. The keynote speaker will be Dr. Sandra Hernandez, President and CEO of the California HealthCare Foundation and former SFDPH Director.
The event is open and free with advanced registration.
Join the medical community to celebrate this historic anniversary!
California lawmakers reintroduced a package of six tobacco bills this week to fight the No. 1 cause of preventable death in California: tobacco use.
The bills will be taken up during the second extraordinary session, called by Governor Jerry Brown to address health care. The package of bills was introduced by Democratic lawmakers in both the Assembly and state Senate, and includes:
SFMS and CMA join our Save Lives California coalition partners to applaud California legislators spearheading legislation to keep tobacco out of the hands of our youth and increase the overall health and wellness of Californians. Smoking contributes directly to heart disease and stroke, the number 1 and number 5 leading causes of death for Californians. The passage of this package of bills will have an immediate, life-saving impact by reducing the number one preventable cause of pre-mature death and disability.
Save Lives California is a coalition of doctors, dentists, health plans, labor, and non-profit health advocate organizations, including American Cancer Society Cancer Action Network, American Heart Association Western States Affiliate, American Lung Association, California Dental Association.
Click here for more information about Save Lives California.