Archive for the ‘Government’ Category

The Truth About Cell Phones and the Do Not Call Registry

August 16, 2010
Red Phone

Please Do Not Call

Consumers do not need to register cell phone or wireless numbers on the National Do Not Call Registry to be protected from most telemarketing calls to those numbers, despite viral email messages saying otherwise. Consumers may place their cell phone number on the Do Not Call Registry to notify marketers that they don’t want to get unsolicited telemarketing calls, but federal regulations already prohibit most telemarketing targeted to cell phones.       

The truth about cell phones and the Do Not Call Registry is: 

  • The government is not releasing cell phone numbers to telemarketers.
  • There is no deadline for registering a cell phone number on the Do Not Call Registry.
  • Federal Communications Commission (FCC) regulations prohibit telemarketers from using automated dialers to call cell phone numbers.  Automated dialers are standard in the industry, so most telemarketers are barred from calling consumers’ cell phones without their consent.
  • There is only one Do Not Call Registry, operated by the Federal Trade Commission (FTC), with information available at https://donotcall.gov/ . There is no separate registry for cell phones.
  • The Do Not Call Registry accepts registrations from both cell phones and land lines. To register by telephone, call 1-888-382-1222 (TTY: 1-866-290-4236). You must call from the phone number that you want to register. To register online (https://donotcall.gov/), you will have to respond to a confirmation email.
  • If you have registered a mobile or other telephone number already, you don’t need to re-register. Once registered, a telephone number stays on the Do Not Call Registry until the registration is canceled or service for the number is discontinued.

Reprinted on August 9, 2010, courtesy of the Federal Trade Commission. For more information, please visit www.ftc.gov

  

  

  

Medicare Physician Payment Cut – Congress Considering a 3-Year Fix

May 26, 2010

A 21.3% Medicare physician payment cut takes effect on June 1, unless Congress comes up with a solution.  ACOG, the AMA, and other medical groups are pushing for a permanent fix through repeal of the flawed SGR formula for setting payment rates.  But Members of Congress, many of them squeamish about increasing the federal deficit in an election year, are looking at shorter-term alternatives.  This week, Congress takes up a compromise fix:

  • A three-year fix to payment rates.  House and Senate Democratic Leaders agreed to include certain “extenders” in a tax bill, the American Jobs and Closing Tax Loopholes Act of 2010, H.R. 4213.  This compromise would avoid the 21.3% physician payment cut set to kick in on June 1 and instead give doctors a 1.3% boost through the end of the year.  Physicians would then get an additional 1% increase in 2011.  The fix would offer additional increases in 2012 and 2013, based on the growth in Medicare health spending.  This growth would be measured by the target growth rate formula in H.R. 3961, legislation passed by the House in 2009.  The new legislation guarantees that physicians cannot see a cut in years 2012 and 2013. Primary care doctors would see higher payment boosts.

A major drawback to this compromise fix:  in 2014 and beyond, the physician payment system would revert back to current law under the SGR formula, resulting in physician pay cuts as high as 37%.

Had Congress permanently solved the payment problem 4 years ago at a cost of $49 billion, it would have cost less than shorter-term remedies now under consideration.  Last week, the Congressional Budget Office and the staff of the Joint Committee on Taxation issued this estimate that the net cost of the 3-year fix under H.R. 4213 would be $64.6 billion over the years 2010-2015.  

The House Rules Committee is expected to take up these provisions this week, with Senate consideration to follow the House vote.  

Should the 3-year fix not pass, Congress could consider other measures:

  • A five-year, $88.5 billion plan giving physicians scheduled pay increases.  This was popular among some House Democrats but may be less so among moderate Representatives and Senators due to cost.
  • A delay of the 21.3% cut until the end of the year.
  • A one-month delay in the cuts. Congress approved a similar short-term fix in April.

Source: ACOG

Medicare Participation Options for Physicians

May 18, 2010

With Medicare’s 21.2% cut looming, many physicians are frustrated with the whole process. Since 2001, Medicare payments have only increased by 1%, whereas physician costs have risen by 22%!  To help physicians make informed decision on their participation, we have listed the available options about Medicare participation. 

Participation (PAR): PAR physicians agree to take assignment on all Medicare claims, which means they must accept Medicare’s approved amount — 80% paid by the government after the deductible is met, plus a 20% patient co-payment — as payment in full for all covered services for the duration of the calendar year. The deductible for 2010 is $115.50

Medicare provides several incentives for physicians to participate: 

  • The Medicare approved amount for PAR physicians is 5% higher than the Medicare approved amount for non-PAR physicians.
  • Directories of PAR physicians are provided to senior citizen groups and individuals who request them.
  • Carriers provide toll-free claims processing lines to PAR physicians and process their claims more quickly.

Nonparticipation (Non-PAR): Non-PAR physicians can file non-assigned claims for Medicare patients on a case-by case basis in return for fees that are set at 95% of Medicare-approved amounts. But non-PAR physicians can balance-bill patients more than the Medicare approved amount.  Limiting charges for non-PAR physicians are set at 115% of Medicare approved amount for non-PAR physicians.  However, because Medicare approved amounts for non-PAR physicians are 95% of the rates for PAR physicians, the 15% limiting charge is effectively only 9.25% above the PAR-approved amounts for the services. 

Further, Medicare pays the patients directly for services billed by non-PAR physicians. Doctors considering becoming non-PAR for an upcoming calendar year are advised to consider potential collection costs and bad debts when projecting revenue. 

Private contracting: Provisions in the Balanced Budget Act of 1997 give physicians and their Medicare patients the freedom to privately contract to provide health care services outside the Medicare system. Private contracting decisions may not be made on a case-by-case or patient-by-patient basis, however. Once physicians have opted out of Medicare, they cannot submit claims to Medicare for any of their patients for a two-year period. 

To privately contract with a Medicare beneficiary, a physician must enter into a private contract with the patients that meet specific requirements.  In addition to the private contract, the physician must also file an affidavit that meets certain requirements.  To opt out, a physician must file an affidavit that meets the necessary criteria and is received by the carrier at least 30 days before the first day of the next calendar quarter. There is a 90-day period after the effective date of the first opt-out affidavit during which physicians may revoke the opt-out and return to Medicare as if they had never opted out. 

The following is a hypothetical service for which Medicare fee schedule amount is $100:

Payment Arrangement Total Payment Rate Payment Amount from Medicare Payment Amount from Patient
PAR physician  100% Medicare fee schedule = $100  $80 (80%) carrier direct to physician  $20 (20%) paid by patient or supplemental insurance (e.g., Medigap) 
Non-PAR/ assigned claim 95% Medicare fee schedule = $95  $76 (80%) carrier direct to physician  $19 (20%) paid by patient or supplemental insurance (e.g., Medigap) 
Non-PAR/ unassigned claim  Limiting charge/109.25% Medicare fee schedule = $109.25 $0 $76 (80%) paid by carrier to patient+ $19 (20%) paid by patient or supplemental insurance
+ $14.25 balance bill paid by patient

Is your name listed with Medicare?

March 5, 2010

The Centers for Medicare & Medicaid Services (CMS) will delay until January 3, 2011, the implementation of Phase 2 of Change Request (CR). This change is only applicable to Part B claims only.

Phase 2 of these CRs relates to the Medicare enrollment status of physicians and non-physician practitioners who order items or services for Medicare beneficiaries or who refer Medicare beneficiaries to other Medicare providers or suppliers.

Although enrolled in Medicare, many physicians and non-physician practitioners who are eligible to order items or services or refer Medicare beneficiaries to other Medicare providers or suppliers for services do not have current enrollment records in Medicare. A current enrollment record is one that is in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) and also contains the physician/non-physician practitioner’s National Provider Identifier (NPI). Under Phase 2, a physician or non-physician practitioner who orders or refers and who does not have a current enrollment record that contains the NPI will cause the claim submitted by the Part B provider/supplier who furnished the ordered or referred item or service to be rejected.

CMS continues to urge physicians and non-physician practitioners who are enrolled in Medicare but who have not updated their Medicare enrollment record since November 2003 to update their enrollment record now. If these physicians and non-physician practitioners have no changes to their enrollment data, they need to submit an initial enrollment application which will establish a current enrollment record in PECOS.

CMS has made available a file that contains the National Provider Identifier (NPI) and the name (last name, first name) of all physicians and non-physician practitioners who are of a type/specialty that is legally eligible to order and refer in the Medicare program and who have current enrollment records in Medicare (i.e., they have enrollment records in PECOS). This is a .pdf file which, as of January 25, 2010, contains approximately 800,000 records. To download CMS’ file visit: Medicare Provider List (or http://bit.ly/cvaasl).

Healthcare Reform – Letter to the Senate

February 3, 2010

CMA has put together the following sample letter to the Senate for the current Healthcare reform issues that is going to be in effect on March 1, 2010:

Dear Senator:

As a physician and member of the California Medical Association, I am a strong, longtime supporter of health care reform that provides universal access to care for the millions of uninsured and underinsured Californians.

As you know, a critical component of these efforts is a strong Medicare program that ensures seniors have access to doctors. Unfortunately, many communities in California are already reporting that physicians are not accepting new Medicare patients. California is also facing a 37% increase in the number of Californians aged 65 or older in the next few years. At a time we are on the cusp of the baby boomers aging into Medicare, it is more important than ever that we ensure a strong network of Medicare providers to see our nation’s seniors.

In order to protect Medicare and our seniors’ ability to see their doctors, we must do two important things:

1) Repeal the Medicare Sustainable Growth Rate formula that would cut my colleagues and I by 40% in the coming years, and

2) Maintain congressional authority over Medicare, not transfer it to an unelected, unaccountable panel with the power to reduce treatment options.

If Congress doesn’t get these important details right, we will be a nation with more seniors and fewer doctors.

Sincerely,

YOUR NAME HERE

Healthcare Reform – Letter to the House

February 3, 2010

CMA has put together the following sample letter to the House for the current Healthcare reform issues that is going to be in effect on March 1, 2010:

Dear Representative:

As a physician and member of the California Medical Association, I am a strong, longtime supporter of health care reform that provides universal access to care for the millions of uninsured and underinsured Californians.

As you know, a critical component of these efforts is a strong Medicare program that ensures seniors have access to doctors. Unfortunately, many communities in California are already reporting that physicians are not accepting new Medicare patients. California is also facing a 37% increase in the number of Californians aged 65 or older in the next few years. At a time we are on the cusp of the baby boomers aging into Medicare, it is more important than ever that we ensure a strong network of Medicare providers to see our nation’s seniors.

In order to protect Medicare and our seniors’ ability to see their doctors, we must do two important things:

1) Repeal the Medicare Sustainable Growth Rate formula that would cut my colleagues and I by 40% in the coming years, and

2) Maintain congressional authority over Medicare, not transfer it to an unelected, unaccountable panel with the power to reduce treatment options.

I know you have played an important role in ensuring that these two provisions made it into the House legislation. I am writing to thank you for those efforts, and to encourage you to fight to ensure that these critical provisions are in the final health reform legislation.

Sincerely,

YOUR NAME HERE

Major Issues Affecting Physicians

February 3, 2010

There are several important issues being debated on Capitol Hill.  Let your voice be heard.   AMA and CMA also urge all physicians to call their representatives and to get involved.  Among all the issues being debated there are four major issues that will affect physicians’ reimbursement.  We have listed four major action plans and briefly explained each item below:

Four Major Action Plans:

  1. Repeal the Medicare SGR.
  2. Stop the IMAC – Independent Medicare Commission. Return it to Congress.
  3. Oppose the Value Index and the Feedback Program.  They impose arbitrary payment reductions and should be tested under pilot programs.
  4. Increase Medicaid rates to ensure access to physicians.

Brief Explanation of the Four Major Issues:

  1. SGR: The Senate Finance Committee bill does not reform the Medicare Sustainable Growth Rate (SGR) formula.  It stops the SGR cut in 2010 but imposes a 21.2% cut in 2011 with additional cuts in later years. Physician rates lag at least 20% behind their practice costs.  It is time to repeal the SGR once and for all.  Otherwise, Medicare seniors will have an increasingly hard time finding a doctor.
  2. IMAC: The Senate Finance Committee bill establishes an Independent Medicare Commission (IMAC) to adopt policies to rein in Medicare spending.  They are mandated to find $22 billion in savings over 10 years if spending exceeds the CPI.  Congress is the accountable body that should be making important decisions impacting patient access to care.  Physicians face two sets of cuts from both the SGR and the IMAC.  It’s double jeopardy.
  3. Physician Outlier Feedback Program AND the Value Index: The healthcare bill establishes two similar programs that could impose Medicare payment cuts on California physicians.  The Feedback program would reduce payment by 5% for physicians who are “outliers” – utilization is above the 90th percentile of national utilization rates. This could penalize physicians who treat the sickest patients because current risk adjustment methods are not adequate. The Value Index program would reduce payment to physicians in high spending regions.  California has high spending regions in part because we have high practice costs (rents and staff wages) and higher numbers of uninsured, poor, minority patients who have not had good access to medical care and therefore, their conditions are more costly once they reach Medicare age. Both the Physician Outlier Feedback and Value Index programs would depend on claims data that is extremely limited. 
  4. Medicaid Reform:  The Senate bills include major expansions of the Medicaid program to cover low-income families.  Yet families on Medi-Cal in California are already experiencing serious problems finding a doctor because the payment rates are 60% below Medicare rates.  New families signing up for Medicaid will not find a doctor.  31% of CA ER visits are from Medi-Cal patients vs. 18% for the uninsured.  Congress will exacerbate the access problems if they don’t finance increased Medicaid rates. 

Why do we have to deal with Medicare’s cuts for physicians every year?

February 3, 2010

The answer lies in a big budget bill Congress passed in 1997, which introduced something called the “sustainable growth rate” for Medicare. SGR has a complex formula but basically SGR says that the amount Medicare pays doctors for an average Medicare patient cannot grow faster than the economy as a whole.

Total payments to doctors can go up because the number of Medicare beneficiaries rises.  And the average payment per beneficiary can rise along with the economy. But if growth in payments per beneficiary grows more than the economy as a whole, according to SGR you have to lower payments to doctors across the board to keep costs under control.

For the first few years since 1997, everything was fine — the economy was booming, and the increases in payments per beneficiary were no problem as far as the SGR was concerned. But as the economy slowed and healthcare spending skyrocketed early in this decade, finances started to get uncertain and reimbursements were cut in 2002. Every year since then, the SGR has called for more cuts, and every time Congress has stepped in to block the cuts.

Now, according to the SGR, reimbursements should actually be cut by more than 40%! A 40% cut in Medicare reimbursements is never going to happen. So we are stuck with continued short-term interventions until, some day, Congress come up with a whole new system to start the clock running again.


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