Wednesday, May 27, 2015

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Read the latest medical news for the San Bernardino County area.


California Medical Association supports the Fair Medical Audits Act of 2015

The California Medical Association (CMA) issued a strong endorsement for the “Fair Medical Audits Act of 2015,” introduced today by U.S. Representative George Holding of North Carolina. The legislation addresses many concerns that physicians have with regard to the extraordinary lack of transparency and expensive, time-consuming and often unfair processes that plague the current Medicare audit program.
 
Representative Holding declared it time to fix the broken audit program: “Put simply, patients achieve the best health outcomes when practicing physicians do just that – practice medicine. My bill will bring transparency and fairness to the audit process so doctors can spend more time caring for their patients and less time proving their innocence. Medicare frauds must be found and severely punished, but not at the cost of the independent practice of medicine.”
 
Currently, Medicare pays recovery audit contractors (RAC) on a contingency basis to find overpayments to health care providers, providing these contractors with undue monetary incentives to audit doctors. This legislation would establish incentives for RACs to make more accurate audit findings and increase educational efforts to help physicians avoid common mistakes.  Since its inception in 2006, CMA has worked closely with the Physicians Advocacy Institute to advocate for more fair and transparent medical audits.  
 
CMA President Luther F. Cobb, M.D., lauded the legislation, noting: “It is time to address fundamental problems that have contributed to the backlog of audit appeals and caused a great deal of unnecessary expense and confusion for physicians in California.”
 
Robert W. Seligson, President of the Physicians Advocacy Institute and EVP/CEO of the North Carolina Medical Society, also hailed the proposal, stating, “Physicians and their advocates across the nation commend Congressman Holding for his leadership on this critically important issue.”
 
Representative Holding is a member of the House Ways and Means Committee, which has jurisdiction to consider legislation to reform the RAC program.
 
For more information, please contact CMA’s Molly Weedn at (916) 551-2069, or PAI Executive Vice President Kelly Kenney at (312) 543-7955 or k2strategiesllc@gmail.com.

California seniors' state of health ranks 29th in national health study

According to a study released June 20 from America’s Health Rankings, California’s seniors have decreased exercising in the past two years, have begun drinking more alcohol and are experiencing more mental health issues.

Over the past two years, California’s senior population decreased exercising and dropped stopped from a national ranking of 18th in the nation to 29th -- this according to a study conducted by the United Health Foundation, a nonprofit arm of the United Health Group, which also owns the insurer United Healthcare.

The study tracked 35 measures for senior health in each state using data from several federal agencies, including the U.S. Department of Health and Human Services, the U.S. Department of Commerce and the U.S. Department of Labor. Categories assessed included behavior, community and environment, policy, clinical care, outcomes and supplemental measures.

Other study findings for California seniors included a low numbers of smokers (8th in the nation) , 46th for chronic drinking, 4th in the nation for obesity and 48th for poor mental health.

Click here to see the study results for California and here for the full report.


Ask the Expert: If Medicare pays for a procedure, does a Medicare Advantage plan also have to pay?

The California Medical Association (CMA) has received this question from physician practices many times over the past few years. The answer is – it depends.

Title XVIII of the Social Security Act established regulations for the Medicare program, which includes provisions affecting Medicare Advantage (MA) plans. The Centers for Medicare and Medicaid Services (CMS) has interpreted these provisions through the Medicare Managed Care Manual (Chapter 4 – Benefits and Beneficiary Protections). The Manual provides guidance for MA plans under Internet-only manual (IOM) 100-16. These guidelines reflect CMS’ current interpretation of the provisions of the MA statute and regulations (Chapter 42 of the Code of Federal Regulations, part 422) pertaining to benefits and beneficiary protections.

In general, the Act lists categories of items and services covered by Medicare. Congress occasionally adds specific services to be covered by Medicare. The MA plans are required to provide enrollees with all basic categories of benefits under Original Medicare. Some examples of services that are specifically defined in the Act and that MA plans would be required to cover are prostate cancer screening tests for a man over 50 years of age who has not been tested in the preceding year, as well as pneumococcal, influenza and hepatitis B vaccines and administration.

While MA plans are required to provide coverage for the same basic categories of benefits as Original Medicare would provide, MA plans are not necessarily required to pay for all of the same procedures that Medicare would have paid. So, how can you determine when an MA plan is required to pay?

According to the CMS Internet Only Manual 100-16, Chapter 1 (page 4), an item or service classified as an original Medicare benefit must be covered by an MA plan if:

  • The specific service is specifically identified in the Act (section 1861) (unless superseded by written CMS instructions or regulations regarding Part C of the Medicare program);
  • CMS has a National Coverage Determination specifically listing that CPT code as medically necessary/payable; or
  • A local Medicare Administrative Contractor with jurisdiction for claims in your geographic region has a Local Coverage Determination that specifically lists that CPT code as medically necessary/payable.
In other words, if the service in question doesn’t fall into one of the above categories, the MA plan may have its own medical policy and deem a procedure experimental, investigational or not medically necessary and deny payment. For this reason, it’s important to be familiar with the medical policies of the plans for which you contract.


Learn more: Medicare SGR replacement payment system details

On April 16, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) legislation, which negates the Medicare sustainable growth rate (SGR) formula, replaces it with new payment options and extends the Children’s Health Insurance Program (CHIP). The bill was passed in a monumental bipartisan action taken by Congress, after a decade of fighting for change by the California Medical Association, the American Medical Association (AMA) and a host of other medical associations.

In summary, MACRA permanently repeals the SGR formula and stabilizes Medicare payments for physician services, with automatic annual 0.5 percent positive updates starting July 1, 2015. In 2019, it allows physicians to choose to participate in either the fee-for-service program, with a reformed quality reporting system, or alternative payment models. Starting in 2016, the legislation provides $20 million annually to help small practice physicians transition to alternative payment models or meet the new reporting program requirements. Finally, the bill provides additional medical liability protections for physicians. Starting immediately, any Medicare payment policies or quality programs shall not establish the standard of care for medical liability actions.

New fee-for-service program

The current fee-for-service program will remain intact. However, the bill replaces Medicare’s multiple quality reporting programs with a new single merit-based incentive payment system (MIPS) quality program, which will make it more likely that physicians earn bonus payments for reporting on quality and meaningful use.

Under current law, physicians potentially face up to 13 percent in penalties from the Physician Quality Reporting Program (PQRS), meaningful use (MU) and value-based modifier (VBM) reporting programs with no upside bonus payments. MACRA consolidates and simplifies these programs and reestablishes substantial bonus payments. The MIPS program should be more attainable for physicians than the current programs.

Beginning in 2019, MIPS will be the only Medicare quality reporting program. The composite and performance scores will be based on quality (30 percent), resource use (30 percent), meaningful use (25 percent) and clinical practice improvement activities (15 percent). Clinical activities are to be developed by the U.S. Department of Health and Human Services  Secretary in consultation with physician organizations. Clinical registries are one way to meet this objective. The quality measures are also to be developed by physicians.

Maximum MIPS penalties and bonuses are on a sliding scale and start at 4 percent in 2019, 5 percent in 2020, 7 percent in 2021 and 9 percent in 2022 and beyond. However, physicians can earn up to three times higher bonuses. Moreover, there is an additional “exceptional performance” bonus of up to 10 percent.

In addition, the law preserves the current 10-day and 90-day global periods for over 4,000 surgical service codes that Medicare had planned to unbundle.

As the new MIPS program takes effect in 2019, the automatic annual payment updates are 0 percent from 2020-2025. However, the bill stipulates that the Medicare Payment Advisory Commission make recommendations to Congress for further action on payment updates in 2020 and beyond to ensure access to care. In 2026 and beyond, the automatic annual update is 0.25 percent.

The new MIPS program advantages include a sliding scale assessment rather than an all-or-nothing approach in meaningful use and PQRS activities. Physicians will receive credit for partially meeting the performance metrics. Physicians in practices or specialties that were at a disadvantage in the past for meeting meaningful use and quality reporting standards will find that flexible weighting will be used to bring parity to incentive payments. Physicians will now be able to receive substantial credit for clinical practice and quality improvement activities.

Physicians will be able to risk-adjust for patients with an adverse health status and other risk factors such as socio-economic status. Physicians who submit few or no Medicare claims will be exempt from the MIPS requirements and payment adjustments. Physicians will also receive confidential feedback on their performance on quality and resource use, with yearly performance targets set based on the mean/median composite score of all MIPS eligible providers from the previous time period.

Alternative Payment Models (APMs)

Physicians can also choose to participate in APMs. The bill stipulates that the Secretary work with a Physician Advisory Task Force to develop these alternative payment models. Physicians participating in APMs will be required to accept some financial risk. However, primary care and specialty medical homes are not required to accept downside financial risk because they have other financial requirements. Physicians participating in APMs shall receive a 5 percent annual bonus payment from 2019-2024 and are exempt from the MIPS reporting system requirements. In 2026 and beyond, APM participants will receive 0.75 percent annual payment updates, also subject to further action by Congress.

Medicare must also release the “total cost of care” data to help physicians better manage their practices.

AMA has created two documents that give a more detailed look at MACRA. Click here to look at the details of MACRA, and click here to look at a chronological timeline when physicians can expect components of the program to go into effect.


CMA urges physicians to thank Congress for SGR vote

Congress was able to put differences aside and overwhelmingly pass H.R. 2—historic bipartisan, bicameral Medicare reform legislation—once and for all!

The California members of Congress who supported H.R. 2 deserve a hearty "thank you" for their bold action to repeal Medicare's broken sustainable growth rate (SGR) formula and ensure significant reforms are made to Medicare, shifting the focus to better care and better patient outcomes. H.R.2 also extends the expiring Children’s Health Insurance Program. For more details on the bill, click here for the California Medical Association’s (CMA) summary.

Only two out of 55 members of the California delegation did not support the bill: Tim McClintock, R-Sacramento, and Darrell Issa, R-San Diego.

Please take a moment and help us say thank you to those members who supported the bill. Simply click here to send personalized messages to your legislators' Facebook pages and Twitter feeds.


Congress passes Medicare payment reform and eliminates SGR

Last week, the U.S. Senate overwhelmingly passed H.R. 2 with a 92-to-8 vote, which will completely overhaul the Medicare payment program. This move, which follows the U.S. House of Representatives’ near-unanimous vote two weeks ago, is a monumental, bipartisan action taken by Congress that negates the Medicare sustainable growth rate (SGR) formula and extends the Children’s Health Insurance Program (CHIP). President Obama signed it into law on April 16.

The California Medical Association (CMA), along with the American Medical Association (AMA) and other health care organizations, have been fighting to end the SGR for 12 years.

Without action by Congress, physicians faced a 21 percent cut in Medicare reimbursement the very next day. Senate leaders cleared the way for final passage by allowing votes on several amendments sought by both sides of the aisle.

“H.R. 2 is an unprecedented display of bipartisanship on the SGR. After more than a decade of inaction, this is truly a historic moment,” said CMA President Luther F. Cobb, M.D. “This legislation will substantially improve access to care for 5 million California seniors and disabled patients, nearly 1 million military families on TriCare, and nearly 1 million uninsured children.“

CMA applauds this rare bipartisan achievement in a deeply divided Congress. CMA, AMA and more than 780 state and national physician organizations supported the bill. The policy was developed jointly on a bipartisan basis by the three House and Senate health committees. U.S. House of Representatives Speaker John Boehner (R-OH) and Minority Leader Nancy Pelosi (D-CA) are credited with negotiating the budget offsets to fund the final SGR bill.

In addition to eliminating the SGR, H.R. 2 includes changes to the payment system. The other major provisions of H.R. 2 include:
  • Providing automatic, stable 0.5 percent updates each year for four years for Medicare Physician Fee Schedule services.
  • In 2019, physicians can choose to participate in one of two payment track options:
    • A fee-for-service track that simplifies and consolidates the existing quality reporting programs, reinstates large bonuses up to 9 percent and reduces current penalties or;
    • An alternative payment model track that provides 5 percent bonus payments and allows physicians to develop the new models, such as primary care/specialty medical homes.
  • Streamlining the Physician Quality Reporting System (PQRS), Meaningful Use (MU) and Value Based Modifier (VBM) quality programs to create the Merit-Based Incentive Program System (MIPS) quality program. Therefore:
    • PQRS, MU and VBM penalties will end in 2019.
    • The maximum MIPS bonuses and penalties will be 4 percent in 2019, 5 percent in 2020, 7 percent in 2021, and 9 percent in 2022 and beyond. Physicians are eligible for additional bonuses of up to 10 percent for exceptional performance.
    • MIPS scores will include quality, resource use, meaningful use and clinical practice improvement activities. The percentages are adjustable for individual physicians or group practices.
    • Quality feedback will be more relative and timely, and targets will be known at the start of each reporting period.
  • Physicians are also required to be involved in defining quality and in developing new payment models that are not specified in the legislation.
  • $125 million in funding to help small practice physicians transition to the alternative models or quality reporting programs
  • Reinstates bundled payments for the 10-day and 90-day global surgical services
  • Provides total cost of care data to help physicians better manage their practices
  • Mandates interoperatibily of electronic health record systems. By December 31, 2018, vendors will no longer be able to block interoperability.
  • Ensures that any practice guideline or payment policy in the ACA cannot be construed to be the standard of care for professional liability purposes.

  • H.R. 2 also allows for the release of physician claims data. This same data was released in August 2014 and the Centers for Medicare and Medicaid Services is planning on publishing 2013 physician claims data later this year. CMA is concerned about this provision and is working with AMA to advocate for improvements to this process, such as the ability for physicians to review and correct claims information.

    For more information, AMA has published two resources, “Highlights of H.R. 2” and an FAQ.

    The bill represents a significant improvement over the current Medicare program, which mandates penalties of up to 13 percent in the coming years with no opportunities for payment updates or bonuses. By repealing the SGR and providing annual updates, it provides stability to physician practices that allows for longer term planning. Significantly, it allows physicians to design new payment systems that work for themselves and patients instead of government bureaucrats. It also mandates physician involvement in defining and developing quality measures. Moreover, now that the costly SGR is repealed, it will be much easier for physicians to work with Congress to make improvements to the payment system at a lesser cost. The enormous cost of the SGR had been a barrier to making any improvements.

    The bill also extends the expiring Children’s Health Insurance Program for two years at the higher Affordable Care Act (ACA) funding levels. It covers nearly 1 million children in California who would otherwise lose their insurance. CHIP was formerly known as Healthy Families in California before it was folded into the Medi-Cal program. It also extends the moratorium on recovery audit contractor audits of the hospital two-midnight rule, which helps hospitals and physicians. And, finally, it extends the National Health Service Corps and the ACA teaching health centers primary care residency training programs.

    Funding Sources:

    The Congressional Budget Office estimated that the cost of the bill would total $211 billion over 10 years and will not be fully offset with other funding sources.

    For 12 years, Congress has stopped the SGR payment cuts before they have taken effect; because of that, Speaker Boehner and Leader Pelosi concluded that any federal government savings would be phony and the cost to repeal SGR should be $0.

    Another $70 billion for the measure will come from deductibles for new MediGap policies starting in 2020. The top 2 percent of high-income seniors will see their premiums increase to 15 percent more for couples making $267,000 to $320,000, and 20 percent more for couples making more than $320,000 in retirement income. There will also be $35 billion in payment cuts to hospitals and other providing post-acute care services. This final cut does not apply to physicians.

    CMA thanks physicians for their extraordinary efforts to keep fighting to pass this monumental legislation. Fifty-two out of 54 members of the California Congressional delegation supported physicians on this subject. Unity within the physician community helped achieve this stunning victory.


    How will SGR reform affect Medicare reimbursement?

    On April 14, Congress passed the Medicare Access and CHIP Reauthorization Act of 2015. The law eliminates the 21 percent physician fee cut that was scheduled to take effect on April 1 as part of the Medicare sustainable growth rate (SGR). The Centers for Medicare and Medicaid Services (CMS) announced that it will immediately begin work to implement the new provisions of the law.

    In preparation for the possibility that Congress might not act before the April 15 deadline, CMS had instituted a 10-business day processing hold for all impacted claims with dates of service beginning on April 1. While the Medicare administrative contractors (MACs) have been instructed to implement the rates in the new legislation, a small volume of claims will be processed at the reduced rate based on the negative update amount. CMS has asked the MACs to automatically reprocess claims paid at the reduced rate with the new payment rate.

    The California Medical Association spoke with the California MAC, Noridian, and the numbers of physicians that will see a reduced rate were minimal (170 claims submitted on April 1 in 13 states). Claims submitted on April 2 were processed correctly at the levels in place since January 1. Noridian is working on automatically reprocessing claims received on April 1 that were processed at the lower rate with no action needed from physicians.

    Physicians can expect to see a 0.5 percent increase in reimbursement update on July 1, and another 0.5 percent update on January 1, 2016.

    Contact: Michele Kelly, (213) 226-0338 or mkelly@cmanet.org

    CMA updates physician guide to getting started with PQRS

    The California Medical Association (CMA) has just updated the “2015 PQRS and Value-Based Modifier Getting Started Guide,” free for physician members.

    The Medicare Physician Quality Reporting System (PQRS) was federally mandated by legislation and requires physicians to report quality information to Medicare or suffer a fee reduction in 2015.

    This guide will assist physicians in determining how to proceed with successful reporting.

    Contact: Michele Kelly, (213) 226-0338 or mkelly@cmanet.org.

    Senate delays vote on SGR until April, CMS to delay 21% cuts until mid-month

    The U.S. Senate failed to take a vote to permanently fix the Medicare sustainable growth rate (SGR) formula and extend the Children’s Health Insurance Program (CHIP) last night and will take the measure up when it returns from a break on April 13. Majority Leader Mitch McConnell (R-KY) said shortly after the budget debate at 3 a.m. on the Senate floor, “It’s encouraging this passed the House with such a large bipartisan majority, and I want to assure we’ll move to it very quickly when we get back…I think there is every reason to believe it’s going to pass the Senate by a very large majority.”

    The measure, a rare bipartisan achievement in a deeply divided Congress, was overwhelmingly approved on Thursday by the U.S. House of Representatives. The bill would create a new payment formula focused on the quality of care. To help pay for these higher rates, the bill would also impose higher premiums on wealthier Medicare beneficiaries and impose cuts on hospitals for post-acute care.

    The California Medical Association (CMA) is pleased that both Senators Barbara Boxer and Diane Feinstein were prepared to support the legislation and applauds the landslide vote of 392-37 in the House. This momentum should propel the Senate to act quickly when they return from recess. CMA will continue to stay in touch with our Senators over the recess and monitor the situation closely. We will keep fighting until we achieve passage, because we are too close now to let this opportunity slip away.

    Thanks to every California physician who called, emailed and met with our Congressional Representatives to secure their votes. We had an overwhelming vote of support from the California Congressional delegation.

    Regarding payment for services between April 1-14: Physician services provided on or after April 1 will be subject to a cut of 21 percent. However, the Centers for Medicare and Medicaid Services (CMS) is instructing its carriers to “hold” for 10 business days any claims for services provided on April 1 and beyond, until legislation can be passed and signed into law that reverses the 21 percent cut. The 10-day business hold means that April claims will be held through Tuesday, April 14. Since no claims by law can be paid sooner than 14 calendar days from their receipt, this hold should have little practical impact on Medicare remittance in the short-term, although billing for copayments and claims reconciliation will be more complicated.

    CMA and American Medical Association are advising against submitting claims with reduced amounts reflecting the 21 percent cut. 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, 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.

    In the unexpected event that Congress allows the 21 percent cut to take effect, Medicare would pay physicians at the reduced amount no matter what the physician billed and no further action would be necessary. However, non-participating physicians who have collected balance billing amounts for unassigned claims based on the currently-allowed amount could be required to make refunds to their patients based on new, lower balance billing amounts.


    CMA applauds U.S. House of Representatives for passing monumental Medicare-CHIP reform in landslide vote, urges U.S. Senate to act swiftly

    Sacramento – Today, the California Medical Association (CMA) congratulates the U.S. House of Representatives for passing monumental Medicare reform and the Children’s Health Insurance Program (CHIP) extension, and urgently asks their colleagues in the Senate to do the same before spring recess. The 392-37 vote clearly shows that now is the time to make Medicare reform a reality.

    The legislation, H.R. 2, known as the “The Medicare and CHIP Reauthorization Act,” will reform the broken Medicare sustainable growth rate (SGR) physician payment system and extend the expiring Children’s Health Insurance Program. Both of these important reforms will help to improve access to doctors in California for five million seniors on Medicare, one million military families on TriCare and the nearly one million uninsured children currently covered by CHIP.

    “It is imperative that the House AND the Senate act before the 21 percent SGR Medicare payment cut takes effect on March 31,” said Luther Cobb, M.D., CMA president. “A drastic cut to physician payments will result in decreased access to care for some of our country’s most vulnerable patients. It’s crucial to the success of our health care delivery system that the bill passes before Congress goes home.”

    The SGR legislation is nearly identical to the bipartisan, bicameral Medicare physician payment reform package that three Congressional committees unanimously approved in the last Congress and more than 750 state and national physician organizations, including CMA, supported.

    There are more than 1,000 new Medicare enrollees every day in California, yet many physicians are no longer accepting new Medicare patients.

    “California desperately needs payment reform to improve access to physicians because Medicare influences all public and private health insurance,” added Dr. Cobb. “Patients are experiencing access to care problems all across the state and H.R. 2 will help alleviate some of that.”

    With the new bipartisan agreement between House Speaker John Boehner (R-OH) and Minority Leader Nancy Pelosi (D-CA) on how to fund the SGR fix, CMA is calling on Congress to immediately pass this monumental, fiscally responsible legislative achievement that will lead to meaningful improvements in our health care system.


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