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1. HHS Proposes Move to ICD-10 by 2011
The U.S. Department of Health and Human Services (HHS) recently announced plans to replace the ICD-9-CM code sets now used to report health care diagnoses and procedures with greatly expanded ICD-10 code sets, effective Oct. 1, 2011.
CMA, AMA, and others in organized medicine are deeply concerned that the 2011 compliance deadline proposed by HHS will not provide adequate time for a smooth transition from ICD-9 to ICD-10. CMA has urged HHS to reconsider its proposed timeline, as moving from ICD-9 to ICD-10 will be a significant change for the health care community. A transition of this magnitude will require a workable implementation process and realistic timeline for all HIPAA covered entities, and comprehensive outreach and education initiatives to support health care providers, especially small physician practices, throughout this complex move to ICD-10. CMA and AMA have proposed an 8-year transition plan.
Developed almost 30 years ago, ICD-9 is now widely viewed as outdated because of its limited ability to accommodate new procedures and diagnoses. ICD-9 contains only 17,000 codes and is expected to start running out of available codes next year. The ICD-10 code sets—which are already used in other countries and by the World Health Organization—contain more than 155,000 codes and can accommodate a host of new diagnoses and procedures.
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Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
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2. Please Tell Us About Your Medicare Payment Problems
As you likely know, thousands of California physicians continue to face problems getting paid for the care they provide to Medicare patients. The transition to NPI numbers earlier this year, followed by the switch in September from NHIC to Palmetto as the Medicare carrier for California, has created a bureaucratic nightmare of red tape and rejected claims for doctors, delaying Medicare payments for months for some doctors. To help us assess the full extent of the situation, we are asking physicians to complete a brief questionnaire about their Medicare payment problems.
The questionnaire can be completed online here. You may also request a copy by fax by calling CMA’s Member Help line, 888/786-4CMA (4262). The data we gather will assist us in our efforts to work with CMS and Palmetto to resolve these problems.
And remember, CMA and your county medical society are here to help you. If you are currently having difficulties receiving payment through Medicare, please call CMA Member Services at 800/786-4262 or contact your county medical society directly. (A list of phone numbers for county medical societies is available here.)
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Contact: CMA Member Help Line, 800/786-4262.
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3. CMA Objects to FTC Interpretation of
“Red Flag” Identity Theft Rules
The Federal Trade Commission’s “Red Flag Rules” require financial institutions and “creditors” to develop and implement identity theft detection and prevention programs by May 1, 2009. CMA recently learned that FTC staff has informally interpreted “creditors” to include physicians, if they regularly permit patients to defer payment for medical services by paying in installments. CMA and AMA vehemently dispute this interpretation and have sent letters to the FTC challenging its interpretation of “creditors.”
“The Red Flag Rules would impose an excessive and unnecessary burden on a severely strained system,” wrote CMA attorney Long X. Do in a letter to the FTC last week. “They are unnecessary for many physicians because the Health Insurance Portability and Accountability Act (HIPAA) imposes many strict requirements to safeguard the confidentiality and security of electronic patient information.”
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Contact: Long X. Do, 916/444-5532 or ldo@cmanet.org.
4.
Balance Billing Regs Apply to Care Provided on or After 10/15
Despite the vigorous efforts of organized medicine, the Department of Managed Health Care (DMHC) regulation that prohibits “balance billing” of HMO patients for out-of-network emergency services took effect on October 15.
DMHC has indicated that the prohibition applies only to services provided on or after the regulation’s effective date. Bills sent after October 15 for services provided before October 15 are not affected.
For more information, see CMA’s Balance Billing Advocacy Tooklit available to members-only. CMA published the toolkit to help physicians deal with the uncertainty caused by this regulation and to answer any questions they have about their rights and responsibilities.
CMA and a coalition of provider groups have filed a lawsuit against DMHC arguing, among other things, that the regulation is unlawful and unenforceable not only because DMHC lacks the authority to regulate doctors, but also because it violates the intent of the Knox Keene Act, which is to ensure that HMOs provide adequate physician networks to provide care for their enrollees.
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Contact: Samantha Pellon, 916/551-2872 or spellon@cmanet.org.
5.
Subscribe to CMA’s Press Clips
Need more news? Get daily reports on health care policy and medicine from newspapers and magazines throughout California and around the nation delivered to you by e-mail every morning. It’s free to subscribe. And you can rest assured that CMA never sells its mailing lists. To subscribe, click here.
6. Member Benefit of the Week: 6% off athenaCollector
CMA members receive 6 percent off athenaCollector, athenahealth’s unique web-based billing and practice management service. athenaCollector combines software, a continually updated database of payer rules and a state-of-the-art billing, collections, and service center.
To find out more about the benefits of athenahealth from one California practice’s perspective, view “Growing your Practice with athenahealth.” This on-demand webinar is presented by Thomas Mohr, M.D., the founder, president and CEO of Pediatric Partners Medical Group in Temecula. Dr. Mohr shares how his practice grew with athenahealth from a single site in 2001 with three physicians into what is today a 20-physician group with 10 locations in California.
Click here for more information on your membership benefits.
Contact: CMA’s member help line, 800/786-4CMA or vsatt@cmanet.org.
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