SBCMS News

rss

Late program changes could mean Medicare penalties for some in 2015

The Centers for Medicare and Medicaid Services (CMS) has announced that a small subset of physicians participating in the Medicare electronic health records (EHR) Incentive Program may get hit with Medicare penalties next year because the attestation system will not be updated with the expanded hardship exemptions before the October 1 deadline to apply for an exemption. It is uncertain how many participants are at risk, but they are affected by a narrow set of circumstances. The problem ironically stems from changes authorized in August to provide more flexibility in ...

New rules on prescribing hydrocodone combo products take effect October 6

Physicians are reminded that effective October 6, 2014, medicines containing hydrocodone will be reclassified as Schedule II substances, in line with oxycodone and morphine. This reclassification will apply to all drugs that contain both hydrocodone, which by itself was already classified a Schedule II drug, and specified amounts of other substances, such as acetaminophen or aspirin. As Schedule II drugs, patients will be limited to up to a 90-day supply of medication and will have to see a provider to get a refill. (Under the Schedule III classification, a prescription ...

Enterovirus D68 confirmed in California; Physicians urged to report unexplained respiratory illnesses to local health department

The California Department of Public Health (CDPH) has confirmed four cases of enterovirus D68 (EV-D68) in patients in San Diego (3) and Ventura (1) counties.  From mid-August to September 22, 2014, a total of 175 people in 27 states have been confirmed to have respiratory illness caused by EV-D68. More cases are anticipated in the coming weeks. Physicians are urged to consider EV-D68 as a possible cause of acute, unexplained severe respiratory illness, even if the patient does not have fever; and consider laboratory testing of respiratory specimens for enteroviruses ...

Mandatory flu vaccination in all licensed health care facilities in San Bernardino County

Health Advisory   Date:        September 18, 2014 To:           All Licensed Health Care Facilities in San Bernardino County From:       Maxwell Ohikhuare, MD, Health Officer Subject:   Health Officer Order Regarding Influenza Vaccination of Healthcare Workers Influenza season will begin in the fall.  In your roles as leaders in healthcare and mine as the County Health Officer, I know that we share common goals: Minimizing the spread of Communicable Disease like influenza Providing excellent healthcare for our community and  Keeping our healthcare workforce healthy The best way ...

CMS opens ICD-10 end-to-end testing to volunteers

At the beginning of 2015, the Centers for Medicare and Medicaid Services (CMS) will begin limited Medicare end–to–end testing of ICD-10 billing code submissions to ensure claims with the new codes can be processed from submission to remittance. Earlier this year, Congress pushed back the ICD-10 implementation date a year to October 1, 2015. CMS is looking for volunteers to participate in the testing the week of  January 26-30, 2015. From the volunteers, CMS will select a sample of 50 participants for each Medicare Administrative Contractor to represent a broad ...

Are you ready for the new prescription drug prior authorization form required on October 1?

Over the next several months, a new law will take effect that streamlines and standardizes the prior authorization process for prescription drugs. The new law (SB 866) requires all insurers, health plans (and their contracting medical groups/IPAs) and providers to use a standardized two-page form for prior authorizations of prescription medications. The law also requires plans and insurers to make a determination on prescription drug prior authorization requests within two days of receipt, and if they fail to do so the requests will be deemed authorized. The new law does ...

DHCS announces additional delays for some ACA Medi-Cal primary care rate increases

The California Department of Health Care Services (DHCS) has released additional information about the timing of the outstanding Affordable Care Act (ACA) Medi-Cal primary care rate increase for certain claim types. Specifically, DHCS had previously announced delays in payment of three types of claims, including certain NICU/PICU services, Child Health and Disability Prevention Program (CHDP) services and crossover claims (also referred to as Medi/Medi claims). Retroactive NICU/PICU claims – At the request of CMA and other stakeholders DHCS will allow claims data to be submitted via ...

DHCS announces new continuity of care rules for duals demonstration project

The California Department of Health Care Services (DHCS) recently announced new continuity of care rules for the Cal MediConnect duals demonstration project. The project – an effort to save money and better coordinate care for the state’s low-income seniors and persons with disabilities – transitions a large portion of the state's dual eligible beneficiaries to managed care plans. Although the program already had continuity of care provisions, the new rules make it easier for a patient to continue receiving needed care from out-of-network physicians without interruption. The new continuity of care ...

CMA responds to CMS 2015 Medicare fee schedule proposals

The California Medical Association (CMA) sent a letter to the Centers for Medicare & Medicaid Services (CMS) commenting on the proposed rules that would impact many aspects of physician payment and federal regulatory programs for 2015. The 39-page letter strongly opposes the agency's plan to accelerate the implementation of the value-based modifier (VBM) payment methodology. CMS has said it will expand the VBM to all physicians in 2017 and increase the potential penalty from 2 percent to 4 percent. CMA also argued that because the agency is ignoring the law that ...

Medi-Cal audits began in September

The California Department of Health Care Services (DHCS) has begun post-payment claims review of Medi-Cal claims in California. The purpose of this audit is to identify and correct improper Medicaid payments through the collection of overpayments and reimbursement of underpayments made on claims for health care services provided to Medicaid beneficiaries. The program will enable the Centers for Medicare and Medicaid Services (CMS) to implement actions that will prevent future improper payments in all 50 states. DHCS has contracted with Health Management Systems, Inc. (HMS) to act as the Recovery ...