Wednesday, January 16, 2019

Nondiscrimination Statement Posting

Physicians who provide services to Medicare or Medi-Cal patients must comply with new nondiscrimination posting requirements effective October 16th. Here are the steps RCMA recommends for compliance:

1. Read the members only FAQ: Section 1557 Nondiscrimination Final Rule: Notices of Consumer Rights and Taglines

2. Download the Notice of Nondiscrimination in English along with the Tagline Statements with the 15 top languages spoken in California.

3. Customize the Notice of Nondiscrimination and tagline statements with your practices information:

  • Your practice name [Name of covered entity]
  • Your phone numbers (use your office number)
  • TTY (TTY: 1-xxx-xxx-xxxx) if your office has one.

4. If you have 15 or more employees you must also:

  • Designate a responsible employee “Civil Rights Coordinator” to coordinate the practice’s efforts to comply with and carry out its responsibilities under Section 1557. (Note: the taglines must include the phone number for the practice’s designated “Civil Rights Coordinator”)
  • Adopt Grievance Procedures to provide for prompt and equitable resolutions of any allegations of Section 1557 violations. See OCR Sample Grievance Procedures.

5. Post the Non Discrimination Notice along with the 15 Tagline Statements in conspicuous physical locations where the physician practice interacts with the public (See FAQs for more details)

6. Submit an Assurance of Compliance form to OCR

A couple of additional resources include:

If you still have additional questions, please contact our Physician Advocate Mitzi Young at myoung@cmanet.org, (888) 236-0267, (909) 654-0381-mobile or CMA Legal at (800) 786-4262.


2015 Meaningful Use Exception Deadline: July 1, 2016

Because of a delay in the publication of regulations governing the Medicare meaningful use program, CMS is allowing eligible physicians and hospitals to apply for an exception under the “extreme and uncontrollable circumstances” category.

Physicians are urged to preemptively file for a 2015 hardship exception to avoid penalties in 2016.  Physicians are encouraged to apply even if they are uncertain whether they will meet the program requirements this year. Doing so will not preclude physicians from receiving an incentive if they do meet meaningful use requirements, but applying can serve as a safety net in staving off a penalty.

ACTION

Physicians who wish to apply for an exception under the “extreme and uncontrollable circumstances” category need to do the following:

  1. Go to the CMS website and download an application.
  2. Complete the application and check box 2.2.d in order to avoid a penalty under the meaningful use program.
  3. Submit the application.  The deadlines for submitting applications for hardship exceptions are:

For Eligible Physicians: July 1, 2016

 

BACKGROUND

New rules released in 2015 stated that eligible professionals must attest that they met the requirements for meaningful use stage 2 for a period of 90 consecutive days during calendar year 2015. However, the Centers for Medicare and Medicaid Services (CMS) did not publish the updated regulations for stage 2 meaningful use until October 16, 2015. As a result, eligible professionals were not informed of the revised program requirements until fewer than the 90 required days remained in the calendar year.

FOR MORE INFORMATION

 

For more information on the electronic health record (EHR) incentive program, see the CMS tipsheet, "EHR Incentive Programs for Eligible Professionals: What You Need to Know for 2015."

 



RCMA/CMA Works with CMS to Mitigate Medicare ICD-10 Disruptions

With implementation of the ICD-10 code set just around the corner, many physicians have been understandably wary about the transition and the potential for payment disruptions and claims processing errors that could interfere with patient care. Fortunately, the RCMA/CMA – working closely with the American Medical Association (AMA) and other medical associations – has secured provisions that will ease this transition, particularly for physicians in practices with limited resources.

Thanks to RCMA/CMA advocacy, the Centers for Medicare & Medicaid Services (CMS) recently announced that it will provide a one-year grace period during which it will allow for flexibility in the Medicare claims payment, auditing and quality reporting processes as the medical community gains experience using the new ICD-10 code set. The ICD-10 implementation date of October 1, 2015, has not changed.

The changes announced include: Claim denials: Medicare review contractors will not deny claims based solely on the specificity of the ICD-10 diagnosis code as long as a valid code from the right family of codes is used. Moreover, physicians will not be subject to audits as a result of ICD-10 coding mistakes during the grace period.

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 communication center: CMS will set up a communication center to monitor the implementation of ICD-10 in an effort to quickly identify and resolve issues related to the transition. As part of the center, CMS will have an ICD-10 ombudsman to help receive and triage physician and provider issues.

Medicare Eligible Professionals: Take Action by July 1 to Avoid 2016 Medicare Payment Adjustment

Payment adjustments for eligible professionals that did not successfully participate in the Medicare EHR Incentive Program in 2014 will begin on January 1, 2016. Medicare eligible professionals can avoid the 2016 payment adjustment by taking action by July 1 and applying for a 2016 hardship exception.

The hardship exception applications and instructions for an individual and for multiple Medicare eligible professionals are available on the EHR Incentive Programs website, and outline the specific types of circumstances that CMS considers to be barriers to achieving meaningful use, and how to apply.

To file a hardship exception, you must:

  • Show proof of a circumstance beyond your control.
  • Explicitly outline how the circumstance significantly impaired your ability to meet meaningful use.

Supporting documentation must also be provided for certain hardship exception categories. CMS will review applications to determine whether or not a hardship exception should be granted.

You do not need to submit a hardship application if you:

  • are a newly practicing eligible professional
  • are hospital-based: a provider is considered hospital-based if he or she provides more than 90% of their covered professional services in either an inpatient (Place of Service 21) or emergency department (Place of Service 23), and certain observation services using Place of Service 22; or
  • Eligible professionals with certain PECOS specialties (05-Anesthesiology, 22-Pathology, 30-Diagnostic Radiology, 36-Nuclear Medicine, 94-Interventional Radiology)

CMS will use Medicare data to determine your eligibility to be automatically granted a hardship exception.

Apply by July 1
As a reminder, the application must be submitted electronically or postmarked no later than 11:59 p.m. ET on July 1, 2015 to be considered.

If approved, the exception is valid for the 2016 payment adjustment only. If you intend to claim a hardship exception for a subsequent payment adjustment year, a new application must be submitted for the appropriate year.

In addition, providers who are not considered eligible professionals under the Medicare program are not subject to payment adjustments and do not need to submit an application. Those types of providers include:

  • Medicaid only
  • No claims to Medicare
  • Hospital-based
Want more information about the EHR Incentive Programs?
Visit the EHR Incentive Programs website for the latest news and updates on the programs.

It's Finally Over! The Medicare SGR is Dead!

LAST NIGHT THE SENATE APPROVED H.R. 2: THE MEDICARE SGR REFORM AND THE CHILDREN’S HEALTH INSURANCE REAUTHORIZATION ACT WHICH REPEALS MEDICARE’S SUSTAINABLE GROWTH RATE FORMULA, HOURS BEFORE DOUBLE-DIGIT PAYMENT CUTS TO PHYSICIANS WERE SET TO TAKE EFFECT. THE BILL HAS BEEN SENT TO THE WHITE HOUSE WHERE PRESIDENT OBAMA IS EXPECTED TO SIGN IT INTO LAW.

After a decade of battling, the U.S. Senate, in a whopping vote of 92-8, passed H.R. 2, the monumental, bipartisan Medicare SGR Payment Reform and Children’s Health Insurance Program (CHIP) Reauthorization Act. Both California Senators Feinstein and Boxer voted in the affirmative. Two weeks earlier, the U.S. House of Representatives adopted the legislation in a landslide vote of 392-37. This was a rare, bipartisan achievement in a deeply divided Congress. RCMA, CMA, AMA and more than 780 state and national physician organizations supported the bill. In 2013, the policy was jointly developed on a bipartisan basis by the three House and Senate health committees. This year, U.S. House of Representatives Speaker John Boehner (R-OH) and Minority Leader Nancy Pelosi (D-CA) are credited with negotiating the final budget offsets to fund the SGR bill.

RCMA/CMA extends a sincere thank you to all physicians for the extraordinary campaign this last decade to end the SGR. We have kept up the fight these last two years to hold Congress’ feet to the fire to develop a comprehensive bill to reform Medicare physician payments. The unity within organized medicine finally put this over the finish line. Moreover, 52 out of 54 Members of the California Congressional delegation voted to support physicians. This is an incredible achievement in one of the most dysfunctional Congresses in history.

PLEASE BE SURE TO CONTACT YOUR REPRESENTATIVE AND
THE CALIFORNIA SENATORS TO THANK THEM FOR THEIR SUPPORT!

While H.R. 2 is far from perfect, it represents a significant improvement over the current Medicare program which mandates penalties up to 13% in the coming years with no opportunities for payment updates or bonuses. This bill consolidates the burdensome reporting programs and reinstates significant bonus payments. 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 physicians and patients instead of government bureaucrats. And it mandates physician involvement in defining and developing quality measures. Moreover, once the costly SGR is repealed, it will be much easier for physicians to work with Congress to make improvements to the payment system (such as increasing the annual update) at a lesser cost. The enormous cost of the SGR has been a barrier to making any improvements.

Note that Medicare should begin processing claims today for services provided in April at the rates that were effective before the 21 percent cut was scheduled to take effect. Under the provisions of H.R. 2, the fee schedule conversion factor will be increased by 0.5 percent on July 1, 2015, and by another 0.5 percent on January 1, 2016.

Riverside County Public Health Ready For Meaningful Use Stage 2

Download Letter

Dear Health Care Provider:

The County of Riverside Department of Public Health (DOPH) is committed to the improvement of our health information systems and to ensuring our local providers and medical facilities attain meaningful use certification as defined by the Health Information Technology for Economic and Clinical Health (HITECH) Act. As part of this process, this letter is to inform you that DOPH is declaring readiness for Meaningful Use Stage 2 (hereafter MUS2). Incentive payments you may receive or will receive under meaningful use may be affected if you or your facility is not able to meet the requirements for MUS2, including the public health integration objectives. In addition, your Medicare payments may be adversely adjusted in 2015 if you are not a meaningful user of electronic health record (EHR) technology, which include MUS2 requirements.

DOPH has partnered with the Inland Empire Health Information Exchange (IEHIE) to facilitate health care facilities’ compliance with the public health integration requirements of MUS2. DOPH believes that IEHIE is a vital part of improving coordinated care in the Inland Empire and encourages all health care facilities to join. The use of the IEHIE is not required to attain MUS2 requirements, but is strongly encouraged, and may greatly reduce the implementation cost and effort required for your facility to be compliant with MUS2. For more information on joining the IEHIE, please visit www.iehie.org

MUS2 has five public health objectives, three of which in the County of Riverside rest with DOPH. Eligible professionals (EPs) must meet the core public health objective of immunization reporting, and must meet three of six “menu set” requirements, two of which are public health objectives. Critical access hospitals (CAHs) must meet three core public health objectives, namely immunization reporting, reportable lab results/electronic lab reporting, and syndromic surveillance. Even if the IEHIE transmits this information on your behalf, you alone are responsible for ensuring the objectives are met. Please note that if your facility covers or operates in multiple jurisdictions, you may be responsible for different implementation requirements in jurisdictions outside of the County of Riverside. The five objectives are implemented for the County of Riverside as follows:

1.  Electronic immunization reporting is to be done to the California Immunization Registry (CAIR), Region 8. Your facility or medical office is responsible for the registration and onboarding process with CAIR if you are not already registered. You may submit this information yourself from your own EHR system; contact the CAIR Gateway for technical requirements. DOPH cannot offer technical support for implementation. If you are a “live” member of the IEHIE, this information is submitted to CAIR for you; self-registration is still required. Registration for all submitters, including IEHIE members, is through the CDPH Health Information Exchange Portal. 

This objective is a Stage 2 core requirement for both EPs and CAHs. For more information, visit http://cairweb.org/cair-regions/ 

2.  Electronic laboratory reporting of reportable results is to be done to the California Reportable Disease Information Exchange (CalREDIE-ELR). Your facility is responsible for the registration and onboarding process with CalREDIE-ELR if you are not already registered. You may submit this information yourself from your own ELR system; contact CalREDIE for technical requirements. This process is distinct from the CalREDIE Provider Portal. Enrollment for the Provider Portal is a separate process, does not meet this meaningful use requirement, and must go through DOPH. DOPH cannot offer technical support for implementation. If you are a “live” member of the IEHIE, this information is submitted to CalREDIE for you; self-registration is still required. Registration for all submitters, including IEHIE members, is through the CDPH Health Information Exchange Portal.

Please note that this requirement is specific to electronic laboratory reporting of reportable results under title 17 §2505 et seq. if your health care facility or medical office is not participating in reporting title 17 reportable conditions through the calredie provider portal, reporting must still occur via confidential morbidity report. the calredie provider portal and reporting of title 17 conditions is distinct from calredie-elr. also, under all circumstances, doph still must receive telephone notification on conditions designated as “report immediately by telephone.

This objective is a Stage 2 core requirement for CAHs only. For more information, visit http://www.cdph.ca.gov/data/information/tech/Pages/CALREDIE.aspx

 3.  Syndromic surveillance reporting is to be done to CDC BioSense. You must first register an operational relationship with our BioSense Data Steward, Rick Lopez (rilopez@rivcocha.org), to ensure that data you transmit is available to DOPH for review. Only emergency departments may apply at this time; non-EDs and provider offices must select another menu set option (see https://questions.cms.gov/faq.php?faqId=2903). Non-EDs cannot onboard with BioSense currently, but this may change in the future. This statement is not a waiver from this requirement.

Once you have established an operational relationship with DOPH, you may then transmit data to BioSense from your own EHR. Unlike other Meaningful Use information, this data is de-identified. Although DOPH will assist you with constructing this relationship, it cannot offer technical support for actual implementation. If you are a “live” member of the IEHIE, this information is submitted to BioSense for you; self-registration is still required. Certain aspects of county syndromic surveillance will still be maintained in the ReddiNet system, but use of ReddiNet by itself does not meet MUS2 objectives. Registration for this objective is not through the CDPH HIE Portal. All submitters, including IEHIE members, must register with the DOPH Data Steward directly.

This objective is a Stage 2 core requirement for CAHs. For more information, visit http://www.cdc.gov/biosense/ and http://biosenseredesign.org/

4.  Cancer reporting is not operated by DOPH. The California Cancer Registry (CCR) is operated by the California Department of Public Health (CDPH), not by the County of Riverside Department of Public Health. If you select this menu set option, you must specifically contact CCR. DOPH does not monitor CCR’s readiness status and cannot offer technical support for implementation; it is expected that CCR will be ready to receive electronic reporting by January 1st, 2014. As of this letter, there is currently no interface between the IEHIE and the CCR. Regardless of whether you select this option, you are still mandated to report certain cancer diagnoses to the CCR in general. This objective is a Stage 2 menu set option for EPs only. For more information, visit http://www.ccrcal.org 

5.  DOPH does not currently operate specialized disease registries. This may change in the future. DOPH will provide advance notification of any specialized disease registry we plan to operate and how to integrate with them. This does not change any existing reporting requirements to other state or federal disease registries which may still apply. This objective is a Stage 2 menu set option for EPs only. 

Although DOPH does not offer technical support for implementation, we do wish to ensure that all providers and facilities in the county are able to comply. We are working with both the IEHIE and the Riverside County Medical Association (RCMA) to make this possible. The Department is available for questions regarding public health meaningful use requirements and I may be reached by telephone personally at (951) 358-7036 or by E-mail at ckaiser@rivcocha.org

I look forward to our cooperatively improving the health of all county residents through the superior technical interaction and care coordination meaningful use will make possible. 

 Sincerely, 

Cameron Kaiser, M.D.
Public Health Officer



Noridian EDI: Early On-Boarding

In preparation for the cutover from Palmetto GBA, Noridian is offering “early boarding” to ensure physician offices are transitioned without any interruption in your business.

For more information about early boarding please go to www.edissweb.com.



Legislation To Repeal SGR Unveiled


The Energy and Commerce Committee Republicans unveiled draft legislation that would repeal the sustainable growth rate (SGR) formula and replace it with a new system for determining Medicare physician payments. Building off a framework released this spring; the legislation would eliminate the SGR and replace it with a modified fee-for-service system with an emphasis on improving quality and outcomes through performance measures, while also providing means for physicians to participate in alternative payment models.


The Role of Clearinghouses in the ICD-10 Transition

Practices preparing for the October 1, 2014, ICD-10 deadline are looking for resources and organizations that can help them make a smooth transition. It is important to know that while clearinghouses can help, they cannot provide the same level of support for the ICD-10 transition as they did for the Version 5010 upgrade. ICD-10 describes a medical diagnosis or hospital inpatient procedure and must be selected by the provider or a resource designated by the provider as their coder, and is based on clinical documentation.
During the change from Version 4010 to Version 5010, clearinghouses provided support to many providers by converting claims from Version 4010 to Version 5010 format. For ICD-10, clearinghouses can help by:

• Identifying problems that lead to claims being rejected
• Providing guidance about how to fix a rejected claim (e.g., the provider needs to include more or different data)

Clearinghouses cannot, however, help you identify which ICD-10 codes to use unless they offer coding services. Because ICD-10 codes are more specific, and one ICD-9 code may have several corresponding ICD-10 codes, selecting the appropriate ICD-10 code requires medical knowledge and familiarity with the specific clinical event.
While some clearinghouses may offer third-party billing/coding services, many do not. And even third-party billers cannot translate ICD-9 to ICD-10 codes unless they also have the detailed clinical documentation required to select the correct ICD-10 code.
As you prepare for the October 1, 2014, ICD-10 deadline, clearinghouses are a good resource for testing that your ICD-10 claims can be processed—and for identifying and helping to remedy any problems with your test ICD-10 claims.

Keep Up to Date on ICD-10
Visit the CMS ICD-10 website for the latest news and resources to help you prepare for the October 1, 2014, deadline. Sign up for CMS ICD-10 Industry Email Updates and follow us on Twitter.


Medicare reimbursement for physicians will be cut by 2 percent on April 1

With no solution on the horizon to the budgetary woes in Congress, physicians should prepare for a 2 percent reduction in reimbursement from the Medicare program beginning on April 1.

The 2 percent Medicare “sequestration” cuts are part of the $1.2 trillion in cuts required by the Sequestration Transparency Act, part of a deal worked out to end last year’s debt-ceiling crisis. Under the act, across-the-board cuts will be triggered if Congress fails to come to an agreement on how to reduce the federal deficit. The cuts are evenly split between defense spending and discretionary domestic spending. Medicaid is exempt from the cuts.

The mandatory Medicare cuts will result in a savings of $11 billion in 2013.

The biggest of the sequestration cuts will hit the Department of Defense, which will lose almost $55 billion. Education will lose 100 percent of the $38 billion in annual grants it gives to states. Total cuts for 2013 will be $109 billion.

Although it is possible that Congress will eventually come to an agreement and reverse some of these cuts, physicians should prepare for the possibility of a 2 percent cut to their Medicare claims.

The California Medical Association (CMA) is vigorously fighting the Medicare cuts. CMA leaders were in Washington, D.C., mid-February urging the California Congressional delegation to stop these cuts. We will keep fighting.

While implementation is scheduled for April 1, 2013, the actual impact may not be felt for several weeks, while Centers for Medicare & Medicaid Services implements the necessary changes.

For more information, see “Sequestration FAQ: How will the cuts affect California physicians?” This FAQ, available in CMA’s online resource library at www.cmanet.org/resource-library, answers the most commonly asked questions about the sequestration cuts as they relate to health care. This document will be regularly updated as additional details become available.

Contact: CMA’s reimbursement helpline, (888) 401-5911 or economicservices@cmanet.org.


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