Job Opportunities |
Top Story: CMA continues to fight attempt to outlaw physician employment of physical therapists
Since 1990, the Physical Therapy Board of California has explicitly determined that the offering of physical therapy services by a corporation, not organized as a professional corporation, was permitted by the Physical Therapy Practice Act. Accordingly, physical therapists have provided physical therapy services as employees of general corporations and professional corporations such as medical corporations for decades.
READ MORE
Also in this issue:
- CMA defends California's landmark medical liability law before appellate court
- Is your practice ready for 5010? This week is National 5010 Testing Week
- Medicare to require revalidation of provider enrollment information
- Tips for avoiding 5 common Medicare claim denials
- CMA hosts emergency room tour and policy lunch for Capitol staffers
- September is Health Care Fraud Prevention and Awareness Month
- Medical students: Please join us for the 6th annual Medical Student Leadership Conference
- Tell us what YOU think: CMA's website now accepts comments
- Webinar (8/24): Legislative Update
- Webinar (8/31): EHR: Meaningful Use
Featured Member Benefit:
Heartland Payment Systems
Members receive exclusive discounts and a three-year rate guarantee on Heartland Payment Systems' suite of financial services, which includes credit card processing, payroll services, check management and real-time health benefits eligibility verification.
READ MORE
ADVERTISEMENT
1. CMA continues to fight attempt to outlaw physician employment of physical therapists
Since 1990, the Physical Therapy Board of California has explicitly determined that the offering of physical therapy services by a corporation, not organized as a professional corporation, was permitted by the Physical Therapy Practice Act. Accordingly, physical therapists have provided physical therapy services as employees of general corporations and professional corporations such as medical corporations for decades. Last November, however, the physical therapy board rescinded its policy in response to a September 2010 Legislative Counsel opinion, which concluded that physical therapists cannot be employed by any professional corporation, except those owned by physical therapists or naturopaths. Based on this interpretation of the law, the physical therapy board concluded physical therapists may no longer be employed by medical, podiatric or chiropractic corporations. The board also declared its intent to commence enforcement of the Legislative Counsel opinion.
The Legislative Counsel opinion upon which the physical therapy board is relying is not legally binding upon either the board or its licensees. The California Medical Association (CMA) believes that any enforcement action against physical therapists who relied in good faith upon the board's historical interpretation of the law allowing employment is unfair and a denial of due process. Such enforcement actions threaten to disrupt the lives of physical therapists who are happily and legally employed by medical corporations. It also threatens to disrupt the care of patients and their continuity of care.
CMA sponsored a bill (AB 783) to clarify ambiguity in the law, so that physical therapists, along with other physician extenders such as psychologists, nurses, physician assistants and podiatrists, can continue to work within the legal boundaries of medical corporations as they have for decades. Unfortunately, the Senate Committee on Business, Professions, and Economic Development chose not to move the bill forward, based on an assumption the physical therapy board would not initiate any enforcement actions based on this issue.
On July 12, 2011, the chair and vice-chair of the Senate committee sent a letter to the physical therapy board, pointing out that there is no legal requirements that would require it to take immediate action and asking them to delay any enforcement action against physical therapists on this issue until a statutory clarification of the law has been made by the Legislature.
However, on July 20, 2011, the physical therapy board sent letters to all physical therapists who have had complaints filed against them for what they refer to as “illegal employment” arrangements based on the Legislative Counsel's opinion. The letter asked all physical therapists who work in medical corporations to respond by September 1 with a plan on how they will comply with the PTBC’s interpretation of the law. The board threatened disciplinary action if this request was ignored.
This letter fully contradicted the Senate committee’s request for the physical therapy board to withhold action. At CMA’s urging, the chair of the committee engaged the Director of the Department of Consumer Affairs and asked for intervention.
At the August 3 meeting of the Physical Therapy Board of California, the director directly requested that the board withhold any disciplinary action and give the Legislature more time to correct the ambiguity in law. The board agreed only to delay the conclusion of their investigations. In other words, it still plans to continue collecting information on those with complaints filed against them; it will just delay acting on any of the information.
This delay will remain in effect until, at the earliest, their next meeting in November. During this delay, CMA, the California Orthopedic Association, and other interested stakeholders will be working on a legislative solution to this ambiguity in state law. Although time is short, CMA will be working tirelessly to prevent the physical therapy board from enforcing the Legislative Counsel's interpretation of the law.
If you or a colleague has received a letter from the board threatening disciplinary action, or if you have any questions regarding these recent events, please feel free to contact CMA for more information.
Contact: Ryan Spencer, (916) 551-2878 or rspencer@cmanet.org.
Have something to say about this story? Post Comment
ADVERTISEMENT
2. CMA defends California's landmark medical liability law before appellate court
Last week, the California Medical Association (CMA) stood in defense of California's successful Medical Injury Compensation Reform Act (MICRA) before the 5th Appellate District Court in Fresno. The court heard oral arguments in Stinnett v. Tam, a case challenging the constitutionality of MICRA's cap on noneconomic damages. The California Hospital Association, the California Dental Association and the American Medical Association also participated in the proceedings.
The original complaint, filed in 2007, concluded with a jury verdict awarding the plaintiff $148,302 for past economic loss, $1,242,093 for future economic loss and $6,000,000 for noneconomic damages, also called "pain and suffering."
In a post-verdict motion, the defendant moved to reduce the noneconomic damages award pursuant to MICRA's $250,000 cap. The plaintiff opposed the motion, arguing that MICRA is unconstitutional, because the medical professional liability insurance crisis of 1975 no longer exists, thereby eliminating the rational basis that originally justified MICRA. The trial court disagreed and granted the defendant's motion. The plaintiff appealed.
Today, MICRA is still working to restrain premium rates in California, while states without liability reform are seeing dramatically higher premiums. Because of MICRA, California has a system that is affordable, pays patients for their full economic and medical losses, and promotes patient safety and improved patient care.
MICRA allows patients with justifiable medical negligence claims to receive the following forms of compensation:
- Unlimited economic damages for past and future medical costs.
- Unlimited damages for lost wages, lifetime earning potential or any other economic losses.
- Unlimited punitive damages.
- Up to $250,000 for noneconomic damages (pain and suffering).
During oral arguments, CMA attorneys told the appellate court that there is a continuing rational basis for MICRA's cap on noneconomic damages, as the broader goal of MICRA—to ensure access to care—is just as relevant today as it was in 1975. CMA noted that the Legislature declared, as recently as 2005, that there was a "growing crisis" in physician supply, and that California needs to continue to attract and retain physicians rather than drive them away.
This case is just the latest in many legal challenges to MICRA that have been funded by trial lawyer groups from across the country.
MICRA's $250,000 cap on noneconomic damages has proven to be an effective way of limiting meritless lawsuits and keeping health care costs lower, but has been targeted by the trial lawyers because it restricts the amount of money they can collect in attorney's fees. MICRA includes a sliding pay scale to control attorney contingency fees, ensuring that more money goes to patients, not lawyers.
Click here for more information.
Contact: Samantha Pellon, (916) 551-2872 or spellon@cmanet.org.
Have something to say about this story? Post Comment
3. Is your practice ready for 5010? This week is National 5010 Testing Week
On January 1, 2012, physicians and others in the health care industry will be required to use the updated 5010 version of the Health Insurance Portability and Accountability Act (HIPAA) transactions standards to conduct electronic transactions such as claims submissions, eligibility verification, claims status, remittance advice, and referral authorizations.
To avoid rejected claims and cash flow interruptions, physicians should prepare for the transition by working with their vendors, clearinghouses, billing services, and payors or upgrade and test their systems and ensure that they are able to successfully implement the new standards prior to the compliance date.
To help practices prepare for the transition, the Centers for Medicare & Medicaid Services (CMS) has announced that Monday, August 22, through Friday, August 26, is National 5010 Testing Week. This is an opportunity for physicians, including their clearinghouse and/or billing service, to test the Version 5010 transactions with the added benefit of real-time help desk support and immediate access to the Medicare Administrative Contractors (MACs). For more information on National 5010 Testing Week, visit the Palmetto website.
CMA has also published a resource sheet, "Are you ready for the transition to HIPAA Version 5010?" The sheet, which includes practice tips for implementation from the American Medical Association and a list of additional resources for physicians, is available free to members in CMA's resource library.
For more information, see CMA medical-legal document #1606, "HIPAA Electronic Transaction Rule," also in the resource library. Medical-legal documents are free to members. Nonmembers can purchase documents for $2 per page.
Contact: CMA reimbursement help line, (888) 401-5911 or mkelly@cmanet.org.
Have something to say about this story? Post Comment
4. Medicare to require revalidation of provider enrollment information
Physicians who enrolled in the Medicare program prior to March 25, 2011, will be required to revalidate their enrollment by March 25, 2013, under new risk screening criteria required by the federal health reform legislation.
The revalidation requirement is necessitated by new screening criteria that were implemented this past March. Newly enrolling and revalidating providers and suppliers will be placed in one of three screening categories representing the level of risk to the Medicare program. The level of risk will determine the degree of screening to be performed when processing the enrollment application.
California's Medicare contractor, Palmetto GBA, will begin notifying physicians via mail of this requirement in September. Suppliers and other providers will also be required to revalidate their enrollment. The notices will contain instructions for the revalidation process.
Palmetto's plan is to first notify physicians and other organizations that are enrolled in Medicare, but do not yet have complete profiles in Medicare's online enrollment system, PECOS (Provider Enrollment, Chain and Ownership System). Other physicians and providers will receive notices over the next 19 months, in an order still to be determined. Upon receipt of the revalidation notice, physicians and organizations will have 60 days to respond. Failure to respond may result in deactivation of your Medicare billing number.
Do not do anything until you get a letter instructing you to revalidate. (This is very important in order to ensure an orderly enrollment process.) Physicians who are making changes (moving, closing practice, etc.) should continue to submit their changes as usual.
Institutional providers will be required to pay an application fee of $505 to enroll or revalidate. This does not apply to physicians or physician groups. Note, however, that physicians or other providers enrolling as suppliers of durable medical equipment, prosthetics, orthotics and supplies must submit the required application fee.
For more information, see the Centers for Medicare & Medicaid Services website.
Contact: CMA reimbursement help line, (888) 401-5911 or economicservices@cmanet.org.
Have something to say about this story? Post Comment
5. Tips for avoiding 5 common Medicare claim denials
California's Medicare contractor, Palmetto GBA, recently conducted a review of claims denied by Palmetto and other Medicare contractors. The review found that 54 percent of the denied claims were due to provider documentation-related technical errors that can easily be avoided. Below are the top five errors and how to avoid them.
Denial Reason #1: No medical records received after requested.
Resolution: When medical records are requested, send the records with a copy of the request within the time frame specified on the request to the right contractor address.
Denial Reason #2: No signature (or illegible signature) on documents and illegible medical records.
Resolution: Progress notes and orders must be legible and signed. If the signature appears illegible, you can create a signature page identifying the usual signature of the physician and attach it to the materials sent. If the signature is missing, the physician can send an attestation stating he or she actually saw the patient on the date of service in question.
Denial Reason #3: No time documented on timed codes.
Resolution: When service time is part of a particular code (e.g., for some therapy, mental health claims, infusions, critical care, etc.), the time must be documented on the chart either in the format of "from X to Y" or total time.
Denial Reason #4: No record of medications given when medication billed on claim.
Resolution: When medications or lab tests are billed, there must be some documentation (or order) to show the medication was administered and the test was wanted or needed.
Denial Reason #5: Incorrect place-of-service on claim and incorrect use of "new patient" versus "established patient."
Resolution: The distinction between a new and an established patient is whether a patient was seen face to face by the provider within the last three years. Since some E/M codes are the same for "office or other outpatient services," the correct place of service must be on the claim and match the documentation.
Remember, your documentation serves as the basis for the services you bill to Medicare. If your documentation does not support the services on the claim, then a payment error exists.
Physicians are encouraged to take the proactive steps below to help reduce the payment error rate and avoid future claim denials:
- Establish an office process and designate one individual responsible for all record requests.
- The response to a request for records should always be reviewed by an individual with clinical experience before submitting it to a Medicare contractor.
- Use a checklist to verify if the progress notes were signed, legible, had the correct patient name and date, had the correct return address, etc.
- Always keep a record of the company and the contact asking for the record and when it is due.
- If documentation is missing, it can be added by the physician (or other individuals with clinical background) before mailing or faxing the material.
Contact: Michele Kelly, (213) 226-0338 or mkelly@cmanet.org.
Have something to say about this story? Post Comment
6. CMA hosts emergency room tour and policy lunch for Capitol staffers
In the Capitol, legislation is often created, debated and implemented in a vacuum. In order to provide some real-world context to the health care debate, CMA invited health care policy staffers from the state Assembly and Senate to experience what it takes to deliver health care in the 21st century.
California Medical Association member Doug Brosnan, M.D., emergency room physician at Sutter-Roseville Hospital, was our host and tour guide. Participants also heard from other physicians, nurses and executive staff about their everyday experience providing emergency care to patients.
After the tour, the Capitol staffers were treated to a health care policy lunch. After policy briefing by Dr. Brosnan, a lively discussion ensued about the barriers that needed to be brought down to ensure that Californians are getting the best access to care. Other topics discussed included California's bar on the corporate practice of medicine, MICRA, physician reimbursement issues, MADDY funds, and Medi-Cal cuts.
The events success was measured in the thankfulness of the staffers for being given an opportunity to ask questions and to engage in a discussion about such a timely and important topic.
Stay tuned for information about our next tour: "What does it take to run a rural clinic in California?"
Contact: Thomas Lawson, (916) 551-2078 or tlawson@cmanet.org.
Have something to say about this story? Post Comment
7. September is Health Care Fraud Prevention and Awareness Month
Fraud committed through medical identity theft now plagues many physician practices in California. The Centers for Medicare & Medicaid Services (CMS), in collaboration with the California Medical Association (CMA), the California Department of Health Care Services, the Office of the Inspector General, the California State Attorney General, and the Senior Medicare Patrol, will host a series of events on medical identify theft and other fraud-related topics in September, Health Care Fraud Prevention and Awareness Month.
The goal of each event is to raise awareness and to educate physicians on how to safeguard and protect their professional and medical identity and their most valuable assets—their medical practice and their patients—from fraud.
Protect Yourself - Protect Your Patients - Protect Your Practice
September 1 (12:00 - 2:00 p.m.)
University of California, Los Angeles
Protect Yourself and Your Medical Identity
September 8 (5:15 - 6:15 p.m.)
University of California Davis, Sacramento Campus
Protect Your Practice and Roadmap for New Physicians Avoiding Medicare and Medicaid Fraud
September 14 (12:00 - 2:00 p.m.)
University of California, San Francisco, Fresno Campus
Protect and Preserve Your Patient Relationships
September 22 (1:00 - 2:00 p.m.)
University of California - Riverside
Protect Your Practice - Monitoring Your Medical Record Documentation
September 27 (12:00 - 2:00pm)
University of California, San Francisco
Events are open to all health care professionals and other interested individuals. CME credits are available.
For more information, visit the Fraud Awarness Month website.
Contact: CaliforniaFraud@cms.hhs.gov.
Have something to say about this story? Post Comment
8. Medical students: Please join us for the 6th annual Medical Student Leadership Conference
Medical students are invited to attend the California Medical Association's (CMA) 6th annual Medical Student Leadership Conference, September 10, 2011, at the University of California, Davis, School of Medicine Education Center in Sacramento.
The one-day conference, "Developing Leaders for a Healthy California," is a great opportunity to learn how physicians can become champions for a healthy California.
This one-day event will examine:
- The implementation and impact of health reform;
- How patient safety can improve patient outcomes;
- How to develop and strengthen CMA chapters on your campus;
- How to get involved or run your own student clinic; and
- Opportunities for medical students to get involved in community service, political action and CMA's policy-setting House of Delegates.
Participants will also take part in a healthy living fair, cosponsored by CMA, Sacramento City Councilman Kevin McCarty, Sacramento School Board member Patrick Kennedy, and Assemblymember Richard Pan, M.D. The community health fair, held at Sacramento's Tahoe Elementary School, will include free health screenings, nutritious food booths, mural painting and a little gardening in the Tahoe Community Garden. The fair is an opportunity to give the Tahoe Park community healthy choices and alternatives for everyday living.
The conference will also offer medical students networking and mentoring opportunities with young physicians.
Online registration is now open.
Contact: Thomas Lawson, (916) 551-2078 or tlawson@cmanet.org.
Have something to say about this story? Post Comment
9. Tell us what YOU think: CMA's website now accepts comments!
The California Medical Association's (CMA) new website is now open for commenting! Have something to say about any of the news stories in this issue? Visit any news story and click on the "comment" link at the end of the page.
Comments are open and visible only to CMA members. You will be required to log in prior to posting a comment (if you haven't activated your new web account yet, do so now).
If you have any questions, please do not hesitate to contact CMA's member help center at (800) 786-4262 or memberservice@cmanet.org.
Have something to say about this story? Post Comment
10. Webinar (8/24): Legislative Update
This webinar will provide physicians and their staff with the latest information on the bills making their way through the state Legislature this year. Topics will include: the state budget, Medi-Cal cuts, health care reform, physician supply, physical therapy and corporate bar.
The one-hour webinar will be presented on August 24, at 12:15 p.m. For more information or to register visit the CMA event calendar.
Have something to say about this story? Post Comment
11. Webinar (8/31): EHR: Meaningful Use
This webinar will guide physician practices through the process of selecting an electronic health record system, including things to consider before you get started. The webinar is intended for practices at the very early stages of considering making the transition to EHR.
The one-hour webinar will be presented twice on August 31, at 12:15 p.m. and again at 6:15 p.m. For more information or to register visit the CMA event calendar.
Have something to say about this story? Post Comment
12. Featured Member Benefit:
Heartland Payment Systems
Members receive exclusive discounts and a three-year rate guarantee on Heartland Payment Systems' suite of financial services, which includes credit card processing, payroll services, check management and real-time health benefits eligibility verification. For more information, click here or call (866) 941-1477.
For more information on these and other member benefits, click here or contact CMA at memberservice@cmanet.org or (800) 786-4262 (4CMA).