CMA publishes MACRA preparation checklist On April 16, 2015, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), changing the health care financing system in the most significant and far-reaching way since the program's inception in 1965. To help physicians understand MACRA payment reforms, and what they can do now to start preparing for the transition, the California Medical Association (CMA) has published an important checklist titled, “MACRA: What Should I Do Now to Prepare?” The checklist is available in CMA's MACRA resource center at www.cmanet.org/macra. There you will also find an overview of MACRA, and a comprehensive list of tools, resources and information from CMA, the American Medical Association and the Centers for Medicare and Medicaid Services. Also available is CMA’s recent webinar, "MACRA: What Is CMA Doing to Improve It? What Steps Can You Take to Prepare Now?" This on-demand webinar is available free to CMA members. August 8, 2016 CMA, Medicare Practice Resources, Running a Practice, MACRA, Medicare 0 0 Comment Read More »
California Medical Association promotes child and adult vaccinations during National Immunization Awareness Month August marks National Immunization Awareness Month, a national effort to promote vaccinations to protect children and adults from serious, and sometimes deadly, preventable diseases. According to the Centers for Disease Control and Prevention (CDC), immunizations are one of the top 10 public health accomplishments of the 20th century. Among children born during 1994-2013, vaccination will prevent an estimated 322 million illnesses, 21 million hospitalizations and 732,000 deaths over the course of their lifetimes. In response, CMA President Steve Larson, M.D., MPH, issued the following statement: “By protecting your loved ones, we can protect our entire community against vaccine-preventable diseases. Vaccines have proven the safest way to greatly reduce and prevent infectious diseases like measles, pertussis, polio and bacterial meningitis that once routinely harmed or killed children and adults. August also marks back-to-school month for many families. Unvaccinated children risk diseases that can spread through play groups, child care centers and classrooms, which puts those unable to receive immunizations due to cancer or health conditions at even higher risk. We encourage Californians of all ages to ensure their immunization records are up-to-date.” As of January 1, 2016, California schoolchildren are required to have the appropriate vaccinations prior to enrolling in a public or private elementary school or childcare center, unless the child has a physician-provided medical exemption. A study in JAMA Pediatrics determined it will take California six years for the benefits of its new school vaccination law to be fully realized. For more information, please visit CMA’s vaccination resource center at www.cmanet.org/vaccinations. August 8, 2016 General Immunization, Practice Resources, Public Health, Vaccination, I Heart Immunity 0 0 Comment Read More »
Reminder: Practices should be wary of virtual credit card fees Is your practice accepting virtual credit card (VCC) payments from payors? If so, you risk losing a significant amount of your contractual reimbursement to high interchange fees. When paying claims, some payors have shifted from paper checks to electronic payment methods, including payor-issued VCCs. With this method, when issuing payment a payor sends credit card payment information and instructions to physicians, who process the payments using standard credit card technology. This method is beneficial to payors, but costly for physicians. Health plans often receive cash-back incentives from credit card companies for VCC transactions. Meanwhile, VCC payments are subject to transaction and interchange fees, which are born by the physician practice and can run as high as 5 percent per transaction for physician practices. While there is no requirement that payors continue to issue paper checks, physicians have the right to request electronic funds (EFT) instead. The Health Insurance Portability and Accountability Act requires all health plans offer standardized EFT using the Automated Clearinghouse (ACH) Network. Similar to direct deposit, ACH EFT allows health plan payments to be directly paid into a physician’s designated bank account. Each ACH EFT transaction carries only one fee of about $0.34, far less than the potential 5 percent fee charged to VCC transactions. In order to receive ACH EFT, physicians should request and register for this payment method with payors. For more information on electronic payments and avoiding high fees, including a VCC tip sheet, see the American Medical Association’s (AMA) EFT toolkit, "The effect of health plan virtual credit card payments on physician practices" (free AMA login required). April 12, 2016 General Practice Resources, Payment 0 0 Comment Read More »
Like it or not, ICD-10 is here - what practices need to know After much debate and years of delay, the October 1, 2015, implementation date for ICD-10 has finally arrived. While concerns remain as to the preparedness of physician practices for this monumental transition, the full impact of the ICD-10 conversion will likely not be felt for several weeks or until the first payment remittances are received. CMA resources As the implementation unfolds, there likely will be unanticipated hurdles that need to be overcome. The California Medical Association (CMA) has a number of resources to help members prepare. CMA ICD-10 Tip Sheet: In an effort to help practices navigate the transition, CMA has published an FAQ to help practices survive ICD-10 implementation. ICD-10 Transition Guide: This guide will help practices of all sizes successfully make the switch to the new ICD-10 coding system. It answers frequently asked questions and includes CMA’s “ICD-10 Transition Preparation Checklist” to help ensure the transition is a smooth one. The guide is FREE to members only. One-on-one assistance: If you are having trouble with claims being denied or delayed—whether it’s related to ICD-10 or not—CMA is here to help. Members can call on our practice management experts for one-on-one help with payment, billing and contracting problems. This is a FREE service to CMA members only. CMA ICD-10: An Overview webinar: Presented by AAPC, this on-demand webinar is available free to members on the CMA website. The previously recorded webinar is intended as a final review for those who have a base knowledge of ICD-10. Nonmembers can access the webinar for $99. To download, click here. Discounted ICD-10 education and training: CMA has partnered with AAPC to offer discounted specialty-specific documentation training for physicians (three-hour, online courses). For more information on the 21 different specialty-specific documentation courses offered, visit www.cmanet.org/aapc (be sure to login to the CMA website to access member pricing). ICD-10 news alerts: 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 areas, including ICD-10 issues. To sign up, go to www.cmanet.org and visit your account dashboard, click on “My Alerts,” then select “ICD-10." The above resources are all accessible on CMA’s ICD-10 resource page at www.cmanet.org/icd10. Claim submission alternatives The Centers for Medicare and Medicaid Services (CMS) recently announced it is offering claim submission alternatives for providers who have difficulties submitting ICD-10 claims. Specifically, if your practice has been unable to complete the necessary systems changes or you are having issues with your billing software, vendor(s), or clearinghouses, the following claim submission alternatives are available: Free billing software Provider internet portals Direct data entry Paper claims (in limited circumstances) – Providers must apply for and meet all of the following requirements to qualify for a waiver of the Administrative Simplification Compliance Act provisions: Your software or software vendor is not ICD-10 ready, and it will cause a financial hardship for you to switch to another software or vendor; and Your Medicare Administrative Contractor’s provider Internet portal does not support electronic claims submissions; and It would cause financial hardship for you to procure the services of a billing agent/clearinghouse. For more information, visit Medicare Learning Network Matters Number SE1522. Please note that while CMS is offering claim submission alternatives, they still require the use of ICD-10 code sets on and after October 1, 2015. Also, the claim submission alternatives offered above only work for Medicare claims and will not work for other claim types. What does the CMS “flexibility” really mean? In early July, CMS announced that for a period of one year, it will allow for flexibility in the claims payment, auditing and quality reporting processes as the medical community gains experience using the new ICD-10 code set. CMS issued an FAQ in early July and updated the FAQ with clarifying guidance on July 22. However, CMS issued updated guidance on September 22 that included additional questions and answers. So, what does the CMS flexibility really mean? First, the ICD-10 implementation date of October 1, 2015, has not changed. Claims submitted with ICD-9 codes on or after that date will be rejected. Additionally, the guidance only applies to fee-for-service Medicare claims and does not extend to commercial, Medi-Cal, Medicare Advantage or workers’ compensation claims. Claim denials: According to the CMS guidance, as long as the code submitted is from the right family of codes, is coded to the maximum level of specificity, and as long as there isn’t a local or national coverage determination that requires a specific code, the Medicare claim will be processed and will not be audited. If, for example, you submit a valid five-character code, you wouldn't be audited simply because you selected the wrong fifth character. This flexibility will continue for a period of 12 months. Quality reporting: Physicians also will not be penalized under the quality reporting programs for errors related to the additional specificity of the ICD-10 diagnosis code, again as long as a code from the correct family of codes is used. Advance payments: If Medicare contractors are unable to process claims within established time limits because of administrative problems, such as contractor system malfunction or implementation problems, advance payment may be available to keep resources flowing to physician practices. ICD-10 ombudsman: CMS has set up an ombudsman, Dr. William Rogers, to monitor the implementation of ICD-10 and to help triage physician and provider issues related to the transition. Inquiries can be submitted via email to ICD10_Ombudsman@cms.hhs.gov. For more information on the CMS guidance, see the updated FAQ. Workers’ compensation claims transitioning to ICD-10 on October 1 Regulations requiring the transition to ICD-10 by the California Division of Workers’ Compensation were recently approved. Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the implementation of ICD-10 would have been exempt for workers’ compensation programs unless required under state regulation. With approval and publication of the new regulations, California will now require use of ICD-10 for workers’ compensation claims on and after October 1, 2015. CMA will continue to provide practices with updates and important information through the ICD-10 transition webpage at www.cmanet.org/icd10. If you need further assistance, members may contact CMA’s reimbursement help line at (888) 401-5911 or economicservices@cmanet.org. October 14, 2015 General, Managed Care ICD-10, Practice Resources 0 0 Comment Read More »
ICD-10 less than two weeks away; are you ready? With less than two weeks until the implementation of ICD-10, practices should be in the final stages of preparation and training for conversion to the new code set on October 1, 2015. The California Medical Association (CMA) has a number of resources to help members prepare. ICD-10 Transition Guide: This guide will help practices of all sizes successfully make the switch to the new ICD-10 coding system. It answers frequently asked questions and includes CMA’s ICD-10 Transition Preparation Checklist to help ensure the transition is a smooth one. The guide is FREE and available for members only. Specialty-Specific Training: CMA has partnered with AAPC to offer discounted specialty-specific documentation training for physicians (three-hour, online courses). For more information on the 21 different specialty-specific documentation courses offered, visit www.cmanet.org/aapc (be sure to log into the CMA website to access member pricing). ICD-10 News Alerts: 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 areas, including ICD-10 issues. To sign up, go to www.cmanet.org and visit your account dashboard, click on “My Alerts,” then select “ICD-10." One-on-One Assistance: If you are having trouble with claims being denied or delayed—whether it’s related to ICD-10 or not—CMA is here to help. Members can call on our practice management experts for one-on-one help with payment, billing and contracting problems. This is a FREE service to CMA members only. For more information, visit CMA’s ICD-10 Resource Center at www.cmanet.org/icd10. ` September 23, 2015 Managed Care Practice Resources, ICD-10, Webinars 0 0 Comment Read More »
Aetna issues physician terminations over frequency of E/M visits The California Medical Association (CMA) has received several reports from physicians in the San Francisco Bay Area that they’ve received contract termination notices from Aetna due to their above-average use of high-level Evaluation and Management (E/M) codes. The termination letters, issued by Aetna in mid-January, advised physicians that upon review of claims for a one year period, their usage of high level E/M codes was “significantly outside the norm” of comparative physicians within their market. CMA has learned that approximately 40 physicians within the Northern California Aetna PPO network were issued the notice of termination. Contrary to the one-year timeframe for review stipulated in the termination notice, Aetna has advised that the review actually included approximately 30 months of prior claims data. Physicians whose billing pattern of high-level E/M codes exceeded two standard deviations above the mean for their assigned marketplace were issued a notice of termination per Aetna. As a result, CMA sent a letter to Aetna outlining a number of serious concerns regarding this initiative, including the following: Patients’ access to care may be unnecessarily jeopardized if physicians are not offered a meaningful opportunity to appeal or address the underlying issue prior to physician termination from the network. The inappropriateness of terminating physicians who billed outside the norm with respect to higher level E/M codes, without any prior-notice or opportunity to correct or explain the medical necessity of the care at issue, or to appeal the termination. The termination of physicians based solely on their billing levels without first engaging them to discuss factors that may have led to higher than average billing, such as physicians treating a sicker patient base (e.g., HIV patients or seniors with underlying conditions), thereby wrongly punishing providers who treat these most vulnerable patients. While physicians have been advised by Aetna of the right to request both a reconsideration of the Aetna E/M findings as well the ability to submit a separate appeal of their termination from the Aetna network, both processes failed to advise physicians of what information Aetna would consider relevant for review of this issue. However, feedback to CMA from physicians who were successful in the appeal of their termination highlighted valid reasons why their billing patterns differed from the norm, including being an urgent care practice or serving a high-risk population. This underscores the need for physicians and their staff to carefully read all payor correspondence; ensure contractual notices of any kind are immediately routed to the physician for review and response; and call CMA with any questions. Physicians impacted by the Aetna termination are encouraged to contact CMA at (916) 551-2865 or mlane@cmanet.org for additional assistance. July 6, 2015 General Billing/Coding, Coding and Documentation, Practice Resources, Aetna 0 0 Comment Read More »
Practice Check-Up: Marketing your practice This is the third in a series of articles aimed at highlighting key areas practices should examine in an effort to improve practice performance. This month we focus on how effectively managing the appointment schedule can have a positive impact on both patient and practice satisfaction. Even with the influx of approximately 6.5 million newly insured patients in California as a result of health reform, many physicians in small and solo practice are concerned that they will be unable to compete with the large groups and large health care systems in order to access patients. A physician's reputation for providing accessible quality of care should go a long way in assuring a stable patient base. However, physicians may also wish to consider a marketing strategy. While there are many consultants who can help physicians with the creation and implementation of a marketing plan, adopting just a few steps may help physicians build and/or maintain a viable practice. Understand your environment – It’s important to understand the types of patients cared for and the environment in which the practice is located. For example, is there a particular “culture,” i.e., do patients prefer alternative, complementary practices versus traditional medical care? If so, your marketing goals may need to be tailed to meet the needs of the patients and culture of the area in which the practice is located. Identify and strengthen ties with your target audience – A practice’s “target audience” is the entities to which the practice’s marketing efforts should be directed. This includes not only current and prospective patients, but also hospitals, third-party payors, and even patient practices who represent the medical condition that fall within your specialty, i.e., the American Diabetes Association would be a great target audience for an endocrinologist. Referrals from existing patients are a great way to attract new patients. These referrals can be obtained through the following: An office sign reminding patients that you welcome their referrals, such as, “We appreciate you as our patient and want you to know that the highest compliment from you is for you to refer your friends and family to our practice.” Create a brochure that patients can provide to their family and friends. Send thank you notes or emails to patients who do refer to your practice. Sent patients birthday messages. If appropriate, remind them of their annual check-up. Make the office a welcoming experience. Ensure exam rooms are clean and welcoming after each use. Keep the waiting room clean and make sure there are current magazines for patients to peruse while they wait. Consider providing water with lemon slices and/or coffee in the waiting room. Be visible in your community by donating medical services for a local charity auction. Have a practice presence at health fairs, sporting events, etc. Just as patients are important to boost referrals, so are other physicians in the community. Techniques with physician colleagues are similar to those for patients, including: Maintain a collegial relationship with other physicians, such as having lunch or engaging in other social events with them. Have a visible presence – physicians who give public lectures or provide a strong presence in the medical community raise their profiles as experts in the area. Join and participate in your local and state medical societies. Many medical societies have patient referral programs. You may also want to consider creating a website for your practice that includes photos of the physicians, staff and office. It’s also helpful to include testimonials, office hours and appointments, patient forms, etc. For more information on marketing a practice, including a sample patient brochure, see CMA On-Call Document #0100, "Accessing Patients: Marketing and Other Steps Physicians Can Take," available FREE for CMA members on our website at www.cmanet.org. June 26, 2015 General Practice Resources 0 0 Comment Read More »
Is your Medicare practice information up-to-date? The February issue of CMA Practice Resources (CPR) contained an article discussing the importance of maintaining up-to-date practice demographic information with contracted managed care payors (see “Ensure your practice information is up-to-date with contracted payors”). This advice applies equally to government payors, such as Medicare, that you are enrolled in. Medicare administrative contractors (MAC), such as Noridian in California, obtain practice contact information from a practice’s Medicare enrollment application, from either the Internet-based Provider Enrollment, Chain and Ownership System (PECOS), or through a paper application. The MAC may contact you by mail, telephone or email, when necessary. Outdated information may cause delays in payment, and even deactivation of your enrollment status if required actions, such as revalidation, are not completed timely. For example, some physicians recently received notices from Noridian that their National Provider Identifier (NPI) was being deactivated due to lack of response to a revalidation request. While Medicare did send a paper notice to affected physicians, in many cases, the practice had not updated its contact information with Medicare, and the paper notice went to the wrong address. Most government payors require completion of enrollment forms for updates and changes. To ensure your practice’s information is up-to-date with Medicare, practices are encouraged to do the following: Complete the appropriate enrollment forms through the Internet or on paper to report changes. Changes generally cannot be made by letter. Complete any necessary forms to notify the contractor of changes in your office’s primary point of contact. Many agencies will speak only to the person enrolled, or the primary point of contact on the enrollment form. If you are not the contact, they may not assist you when needed. Notify the MAC or other government contractor of changes in address through the enrollment update process, even if it is to a different suite in the same building. Complete an enrollment update if your correspondence address changes, even if your physical address remains the same. Update all email addresses if they change. Government payors are often using email to contact physicians for needed information. Don’t forget to check your spam or junk folders for any emails that may come from contractors you submit claims to. Update phone numbers and area codes if they change. Don’t expect contractors to search for changes. The Medicare link to paper enrollment forms and the Internet-based PECOS can be found on the Centers for Medicare and Medicaid Services (CMS) Medicare Provider-Supplier Enrollment page on the CMS website (see left sidebar). Click here for additional information on using the Internet-based PECOS. Updates may take as little as 30 days, or as long as 120 days. Once the change is completed in the system, the physician will receive written confirmation. Prompt notification to government payors of any change will help ensure there are no disruptions in enrollment or payment for your practice March 17, 2015 Medicare Practice Resources, Medicare 0 0 Comment Read More »
Practice check-up: proactive patient communication As practices begin to schedule patients for their annual check-ups, remember that conducting an internal practice check-up is equally important. This is the first in a series of articles aimed at highlighting key areas practices should examine in an effort to improve practice performance. This month we focus on how clear, proactive patient communication can have a positive impact on both patient and practice satisfaction. Many practices take the important step of confirming patient appointments ahead of time. However, if you’re not also taking the time to inform your patients about any outstanding balances, copays, deductibles or coinsurance that will be due at the time of their appointment, you’re missing out on a big opportunity. Proactively communicating with your patients about any balances due at the time of service helps to set expectations and prevent disputes at the receptionist desk. Additionally, failure to collect amounts due at the time of service can be very costly for a practice, as the ability to collect can decrease significantly after patients leave the office. If you use an automated appointment confirmation system, identify those patients who have balances due and consider pulling them from the automated system and, instead, call them personally. Contacting the patient personally can help in several ways: The practice is able to clarify any changes to eligibility or insurance coverage prior to the patient’s visit, which decreases time required for patient check-in by the front office staff. Patients are able to discuss financial or coverage concerns individually with a practice representative rather that at the front desk or in front of other patients, which helps to keep the office running smoothly and calmly. Patients who receive individualized communication are more likely to refer other patients to the practice Remember, every interaction with your patients is a reflection on the practice – a positive patient experience goes a long way. Taking these proactive steps to educate your patients prior to their visit, respond to their questions and alleviate any potential points of contention at the time of service can increase patient satisfaction levels, reduce the stress level of practice staff and ultimately save the practice money. Happy patients…happy practice! February 18, 2015 General Practice Resources, Physician-Patient Relationship 0 0 Comment Read More »
ICD-10 transition guide now available; new resource webpage available With eight months until the transition to ICD-10, will your practice be ready be October 1, 2015? To help physicians prepare for the transition, the California Medical Association (CMA) has published a new resource, “ICD-10 Transition Guide – What physicians need to know,” which includes an ICD-10 transition preparation checklist. CMA has also created an ICD-10 transition webpage, www.cmanet.org/icd10, that includes important news articles and other ICD-10 transition information. CMA will also be hosting a number of live training events to assist physicians with the transition, with details announced soon. February 5, 2015 General Insurance/Reimbursement, Practice Resources, ICD-10 0 0 Comment Read More »
