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Welcome

The Santa Clara County Medical Association (SCCMA) and Monterey County Medical Society (MCMS) are professional associations representing physicians and their patients in all modes of practice and specialties, including medical students and residents. We are dedicated to improving the quality of and accessibility to our health care system. The SCCMA and MCMS support physicians and patients in numerous ways. We invite you to explore our website and learn how we can help you. If you are not already a member, and you are an MD or DO, please consider joining today. Our strength and influence grows with our increasing membership, so please help do your part for organized medicine today.

EHR - Meaningful Use Criteria

Federal health officials, in late December, released proposed standards for the use and certification of electronic health records. As you know, Medicare and Medi-Cal physicians who demonstrate “meaningful use” of certified electronic health records (EHR) will qualify for incentive payments under the 2009 federal economic stimulus package.
The meaningful use definition proposed by the Centers for Medicare & Medicaid Services (CMS) sets forth the basic guidelines physicians must follow in order to receive Medicare incentive payments. Among other things, it lays out which quality measures physicians will have to report and which functions (computerized physician order entry, for example) physicians will have to use. CMS’s proposal would phase-in meaningful use requirements in three stages between now and 2013.
This definition only applies to Medicare. States will be allowed to create their own definitions. One of CMA’s concerns regarding meaningful use is that this could cause confusion and administrative difficulty for physicians, particularly in a group setting where different physicians may qualify under different programs.
CMS has acknowledged this problem, and has expressed in the proposed rule a strong preference for states’ definitions to be the same or very similar to the federal definition. States that plan to use an alternate definition must get approval from the Federal Secretary of Health and Human Services.
CMA has prepared a summary of the proposed definition and will be submitting comments during the 60-day comment period. The final definition should be released in late February or early March and will become effective 60 days after release.
The Office of the National Coordinator for Health IT (ONCHIT) has released a related set of proposed certification standards for EHR technology. ONCHIT’s interim final rule outlines the technical standards and features that EHR systems must include to receive certification for meaningful use. The EHR certification standards will also be open for comment for 60 days after publication in the Federal Register on January 13. The standards will take effect 30 days after the final rule is published.

To assist members who would like to plan for or implement EMR, the CMA has created an online "Health Information Technology Resource Center," which includes many helpful resources, http://www.cmanet.org/hit/.

Fate of Health Reform Uncertain

The nature and outcome of health reform was thrown into turmoil last month with the election of Massachusetts Republican Scott Brown to fill the Senate seat of the departed Ted Kennedy, longtime liberal lion of the U.S. Senate. Brown is the 41st Republican Senator, depriving Democrats of their filibuster-proof majority.
It is difficult to overstate the impact that this one election has on health reform. Up until now, discussions were taking place entirely between House and Senate Democrats with virtually no Republican involvement. With Brown’s election, Republicans now have the ability to stop the current version of health reform in Congress, unless Democrats pursue one of several unpalatable and unpopular alternatives to avoid the Senate. (For more details, see http://www.cmanet.org/healthreform.)
The ultimate impact of the new paradigm in Washington is as of yet uncertain. While the slowed pace may present an opportunity for CMA to fight for our priority issues, the retrenching may also cost us some of the provisions in the health reform proposals for which we successfully fought. We will know more about the plans of congressional leaders and the Obama Administration in the days to come, as they figure out their response.
Bottom line: any health reform legislation that makes it to the President’s desk will very likely be either markedly scaled down from the House or Senate bills, or a combined proposal.
Regardless of the new direction reform efforts may take, CMA remains committed to expanding meaningful access to care, while preserving and protecting the doctor-patient relationship.

PHISHING SCAM

CDC Sponsored State Vaccination Program for H1N1

CDC has received reports of fraudulent emails (phishing) referencing a CDC sponsored State Vaccination Program for H1N1. The messages request that users create a personal H1N1 (swine flu) Vaccination Profile on the CDC.gov web site.

An example of the phishing email is below:

You have received this e-mail because of the launching of State Vaccination H1N1 Program.

You need to create your personal H1N1 (swine flu) Vaccination Profile on the cc.gov website. The Vaccination is not obligatory, but every person that has reached the of 18 has to have his personal Vaccination Profile on the cdc.gov site. This profile has to be created both for the vaccinated people and the not-vaccinated ones. This profie is used for the regitering system of vaccinated and not-vaccinated people. Create your Personal H1N1 Vaccination Profile using the link:

create personal profile

Users that click on the embedded link in the email are at risk of having malicious code installed on their system. CDC reminds users to take the following steps to reduce the risk of being a victim of a phishing attack:

    •     Do not open or respond to unsolicited email messages.
    •     Do not click links embedded in emails from unknown senders.
    •     Use caution when entering personal information online.
    •     Update anti-virus, spyware, firewall, and anti-spam software regularly.

Holding of Claims for Medicare Services

Jurisdiction 1 Part B

Posted 12-22-09 - From Article Posted on Jurisdiction 1 Part B Website

To the extent possible and in consideration of possible legislative changes, the Centers for Medicare & Medicaid Services (CMS) is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, non-physician practitioners, and other providers of services paid under the Medicare physician fee schedule, beginning January 1, 2010. In this regard, CMS has instructed its contractors to hold claims containing services paid under the Medicare Physician Fee Schedule (MPFS) for the first 10 business days of January (January 1 through January 15) for 2010 dates of service. This should have minimum impact on provider cash flow because, under current law, clean electronic claims are not paid any sooner than 14 calendar days (29 days for paper claims) after the date of receipt. Meanwhile, all claims for services delivered on or before December 31, 2009, will be processed and paid under normal procedures.

After 10 business days, contractors will begin releasing held claims into processing under the fee schedule which implements current law. This, of course, could result in claims being processed with the negative 21.2 percent update. If a new law is enacted which changes the negative update effective January 1, CMS will correctly process claims under the new law and, if necessary, CMS is prepared to automatically reprocess most of those claims, which have already been processed at the lower rate.

Under the Medicare statute, Medicare payments to physicians and other affected providers are based upon the lesser of the actual charge or the MPFS amount. Providers who submit charges that are greater than the negative 2010 MPFS will automatically have their claims reprocessed. Physicians who submit charges that are equal to or less than the 2010 MPFS amount will need to request an adjustment. Submitted charges on claims cannot be altered without a request from the physician/provider.

To the extent possible, providers may hold claims in-house until it becomes clearer as to whether new legislation will be enacted or until cash flow becomes problematic. This will reduce the need for providers to reconcile two payments (i.e., the initial claim and the reprocessed claim), and it will simplify provider billings of beneficiary coinsurance and payment calculations for payers, which are secondary to Medicare.

CMS has extended the 2010 Annual Participation Enrollment Program end date from January 31, 2010, to March 17, 2010- therefore; the enrollment period now runs from November 13, 2009, through March 17, 2010.

The effective date for any Participation status change during the extension, however, remains January 1, 2010, and will be in force for the entire year.

Contractors will accept and process any Participation elections or withdrawals, made during the extended enrollment period that are received or post-marked on or before March 17, 2010.

In addition, be on the alert for more information about other legislative provisions, which may affect you.

Health Information Technology Resource Center

As you know, the 2009 federal economic stimulus package includes $19 billion for health information technology (HIT), the vast majority of which is projected to be directed to physicians to subsidize the purchase and usage of electronic health record (EHR) systems. Beginning in 2011, qualifying Medicare providers can receive up to $44,000 in incentives under the program, while qualifying Medi-Cal providers can receive up to $64,000. However, many of the rules and standards governing the subsidies will not be worked out for several months. Given the current uncertainties, the SCCMA, MCMS, and CMA are recommending that physicians use this window to begin assessing EHR needs, with an eye on what will work best for your specialty, your practice, and your comfort level with technology.

Calendar of Events

Feb

MCMS: MOJO Management Webinar

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Feb

SCCMA: Diversity in Today's Medical Practices

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Mar

MCMS: Retirement, Recruiting, Buying, Selling, & Transitioning Your Practice (PHYSICIANS ONLY)

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Mar

MCMS: What Every Office Manager Should Know About Running a Practice (PRACTICE MANAGERS ONLY)

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Mar

MCMS: What Every Physician Should Know About Running a Practice (PHYSICIANS ONLY)

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Apr

SCCMA: What Every Office Manager Should Know About Running a Practice (PRACTICE MANAGERS ONLY)

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Apr

MCMS: Patient Relations Workshop

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