November 2014

RSVP now for SCMA Awards Dinner on Dec. 2
Win an iPAD through "Passport to Participation"
Applicants
8 DAYS LEFT TO DEFEAT PROP 46
State News
FEDERAL NEWS
PEOPLE
PRACTICE MANAGEMENT RESOURCES
CLASSIFIEDS
ABOUT SCMA

RSVP now for SCMA Awards Dinner on Dec. 2

All physicians are invited to the Awards Dinner, which runs from 6 to 9 p.m. on Tuesday, Dec. 2 at the Vintner's Inn, 4350 Barnes Rd. in Santa Rosa. Outstanding Contribution awards will be presented to Dr. Joe Clendenin, a retired family physician; Dr. Laurel Warner, an infectious disease physician; and Dr. Charles Elboim, a surgeon with a special interest in breast diseases. The Article of the Year Award will be given to Dr. Robert Woodbury for "Emerging Concepts of Obesity," which appeared in the spring 2014 issue of Sonoma Medicine. Finally, a special Recognition of Achievement will be presented to Ritch Addison, Ph.D.

The evening begins with a social hour at 6 p.m., followed by dinner and the awards presentation. Tickets are free for SCMA members; spouses, guests and nonmembers are $50 each. To RSVP, contact Rachel Pandolfi at 707-525-4375 or rachel@scma.org. Mail orders can be sent to SCMA, 2901 Cleveland Ave. #202, Santa Rosa, CA 95403. For more details, click here to download PDF invitation.

Win an iPad through "Passport to Participation"

To encourage physician collegiality and the advancement of community health, PASSPORT TO PARTICIPATION acknowledges Sonoma County physicians' active engagement with SCMA, CMA and community activities by awarding points for participation. In addition to recognition for exemplary involvement, an iPad will be awarded to the winner at the end of the fiscal year. Click here to learn more.

Applicants

Glen Barrisford, MD, Urology*, Urologic oncology, 401 Bicentennial Way, Santa Rosa 95403, SUNY Syracuse 1998
Kawai Cheung, MD, Internal Medicine, 401 Bicentennial Way, Santa Rosa 95403, Emory Univ 2011
Arlin Chin, MD, Family Medicine*, 401 Bicentennial Way, Santa Rosa 95403. SUNY Syracuse 2011
Shawn Daly, MD, Diagnostic Radiology*, 121 Sotoyome St., Santa Rosa 95405, Univ Arizona 1998
Tashfeen Ekram, MD, Diagnostic Radiology*, 121 Sotoyome St., Santa Rosa 95405, Univ Michigan 2008
Kurt Holt, DO, Pediatrics*, 3925 Old Redwood Hwy, Santa Rosa 95403, Harvard Med Sch 2008
Laurel Imhoff, MD, Surgery*, 401 Bicentennial Way, Santa Rosa 95403, UC San Diego 2006
Andrew Luckett, MD, Family Medicine, 3569 Round Barn Cir., Santa Rosa 95403, Univ Louisville 2013
Anusuya Mokashi, MD, Diagnostic Radiology*, 121 Sotoyome St., Santa Rosa 95405, New York Med Coll 2007
Sarah Stassi, MD, Diagnostic Radiology*, 121 Sotoyome St., Santa Rosa 95405, Louisianna State Univ 2008
Angela Zarate, MD, Pediatrics*, 3925 Old Redwood Hwy, Santa Rosa 95403, Med Coll Wisconsin 2002

* = board certified; italics = special medical interest

8 DAYS LEFT TO DEFEAT PROP 46

* The Press Democrat has joined with every other major paper in the state by taking a NO position on Prop. 46. Click here to read the article.

* Get the facts at www.Noon46.com.
* Click here to watch the "No on 46" ads.
* Order lab coat cards, "No on 46" buttons, posters, bumper stickers, and brochures in English and Spanish. Click here to order them now - Free Shipping! (Or download Order Form.)
* Coordinate a meeting with your medical group. We guarantee a speaker! Contact Cynthia Melody at 707-525-4375 or cmelody@scma.org.
* Wear your "No on 46" button.
* Put a "Vote No on 46" yard sign in front of your office and at your home. We have crateloads at SCMA and will deliver. Just call us at 707-525-4375.
* A pull-out poster is available in the fall issue of Sonoma Medicine along with articles, charts, the order form and more.
* Talk with your colleagues, patients, friends, family, neighbors, the checkout person at the store, etc. about Prop 46: Increased costs; Losing your Doctor; Threatening your privacy.

State News

DHCS releases duals project toolkit
The California Department of Health Care Services (DHCS) has published a physician toolkit to help providers and their patients understand the Cal MediConnect duals demonstration project. The toolkit includes an overview and several fact sheets that include how to submit crossover claims to Medi-Cal plans, contracting with Cal MediConnect plans, how crossover claims are processed for Medi-Cal managed care patients, continuity of care, and sample patient letters (for contracted and non-contracted physicians).

State issues report cards for HMOs, PPOs and large medical groups
The California Office of the Patient Advocate yesterday released its 14th annual "California Health Care Quality Report Cards" that rate the state's health plans and medical groups on a four-star scale.

The report cards allow consumers to compare the quality of care that more than 16 million commercially insured consumers receive from the state's 10 largest HMOs, six largest PPOs and more than 200 medical groups. Data used is drawn from 2013 claims data and patient surveys. Users can drill-down online to see specific plan performance on topics of greatest interest to them, such as chronic disease management, pediatric care and mental health care. The report cards are available at the Office of the Patient Advocate's website.

Blue Shield makes positive changes to reimbursement policy for physicians treating out-of-network exchange PPO patients
Blue Shield of California recently announced a two-part reimbursement policy change for contracted providers that do not currently participate in the plan's Individual and Family Plan (IFP) PPO product, otherwise known as its exchange/mirror PPO product. Blue Shield's policy change is in response to provider feedback of difficulties collecting from exchange/mirror patients they have seen out-of-network. The policy change also brings its physician payment rules in line with Blue Shield's facility payment policy for PPO exchange/mirror patients who are seen out of network.

CMA believes the policy change will be positive for physicians and commends Blue Shield for their responsiveness to provider concerns. Click here for more information or contact Blue Shield Provider Information & Enrollment at 800-258-3091.

FEDERAL NEWS

New rules on prescribing hydrocodone combo products took effect Oct. 6
Medicines containing hydrocodone were reclassified as Schedule II substances, in line with oxycodone and morphine, effective Oct. 6, 2014. As Schedule II drugs, patients will need a new script each time the medication is filled (prescription could be refilled five times). Physicians will not generally be allowed to call, fax or e-mail in a prescription to a pharmacy, instead patients will have to present a written prescription. Click here for more information, or contact: CMA Legal Information Line, 800-786-4262 or legalinfo@cmanet.org.

CMS launches Open Payments website
The Centers for Medicare & Medicaid Services (CMS) launched its Open Payments website, which allows consumers to see the financial relationships between drug and medical device manufacturers and physicians as reported under the Physician Payments Sunshine Act. To view Open Payments physician payment dataset, click here.

The data published online contains 4.4 million payments made between Aug.1 and Dec. 31, 2013, valued at nearly $3.5 billion and attributable to 546,000 individual physicians and almost 1,360 teaching hospitals. The database is divided into three categories, general payments, research payments and physicians ownership and investments. CMS plans to publish these reports annually and will include a full 12 months of payment data, beginning in June 2015.

The Sunshine Act requires drug and medical device manufacturers and group purchasing organizations to report their financial interactions with licensed physicians-including consulting fees, travel reimbursements, research grants and other gifts.

Physicians have until Dec. 31 to file disputes for any inaccurate information that should be corrected in the next data release. View instructions for doing so on the AMA's Sunshine Act website.

PEOPLE

The American Medical Association (AMA) will award Peter Bretan, MD, a Sonoma, Marin, and Mendocino County urologist, with the Benjamin Rush Award for Citizenship and Community Service at its November Interim Meeting of the AMA House of Delegates in Dallas, Texas. The award recognizes a physician who has gone above and beyond the professional call of duty to make an outstanding public service contribution to their local community.

PRACTICE MANAGEMENT RESOURCES

CMA publishes summary of new 2015 health care laws
The California Legislature had an active year, passing many new laws affecting health care. In particular, there was a strong focus on scope of practice for allied health professionals, prescription drug abuse, public health issues and health care coverage. CMA has published a summary of the most significant new health laws. Click here to read CMA's Significant New California Laws of Interest to Physicians for 2015. Click here to download the PDF of new laws (700 KB).

How much revenue is your practice losing by not working denials?
It's no secret that claim rejections and denials can result in a significant amount of lost revenue. Consider this-a practice submitting 80 claims a day at an average reimbursement rate of $100 per claim should expect to receive $8,000 in daily revenue. If 10 percent of those claims were rejected or denied (eight claims per day at $100 per claim equals $800 per day), and the practice only appealed one out of every 10 rejections or denials ($720 per day loss), the practice could expect to lose as much as $180,720 annually (251 business days at $720 per day in denials or rejections). The numbers are staggering and the loss of income could cover the cost of several full time employees

While it might not be feasible for a solo or small physician group to appeal every single denial or rejection, practices can significantly reduce potential lost revenue by identifying and addressing the three most common reasons for denial or rejection: internal billing error; payor error; or medical necessity denial. Click here for more information.

CPR / CMA Practice Resources
CPR is a free monthly e-bulletin from CMA's practice management experts that focuses on critical payor and health care industry changes and how they directly impact the business of a physician practice. Each issue includes tips on reimbursement and contracting related issues along with information on the latest practice management news. The October issue includes:

> Are you ready for the new prescription drug prior authorization form required on Oct. 1?
> DHCS releases duals project toolkit
> New rules on prescribing hydrocodone combo products take effect Oct. 6
> How much revenue is your practice losing by not working denials?
> DHCS announces additional delays for some ACA Medi-Cal primary care rate increases
> DHCS announces new continuity of care rules for duals demonstration project
> DHCS revises Cal MediConnect "Choice Forms"
> Medi-Cal audits began in September
> Meet your CMA affinity partners: Staples Advantage
> Updated payor profiles now available
> The Coding Corner: Coding office E/M at the highest level: 99215

Click here to learn about how you can sign up for a free CPR subscription, contact CMA with questions about articles, and download a printable version of the newsletter.

Classifieds

Seeking sublet to rent
Seeking medical office for sublet in Sebastopol, Santa Rosa, or Petaluma.
Please contact office@marinphysiatry.com or call 415-839-8399.

SCMA members get free classifieds!
SCMA members can place free classified ads in News Briefs or Sonoma Medicine. Cost for nonmember physicians and the general public is $1 per word. To place a classified ad, contact Susan Gumucio at susan@scma.org or 707-525-0102.

ABOUT SCMA

The Sonoma County Medical Association, a 501(c)(6) nonprofit association, supports local physicians and their efforts to enhance the health of the community. Founded in 1858, SCMA is affiliated with the California Medical Association and the American Medical Association.
Visit us at www.scma.org.

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