August 2014

Official Magazine of FRESNO COUNTY Fresno-Madera Medical Society KERN COUNTY Kern County Medical Society KINGS COUNTY Kings County Medical Society MADERA COUNTY Fresno-Madera Medical Society TULARE COUNTY Tulare County Medical Society

See Inside: “No” on Prop. 46 Campaign Renew Your Medical License Early Small Businesses Receive Extended Deadline for Health Insurance Coverage

Vital Signs

August 2014 • Vo Vol. V ol. 36 No. 8

We Celebrate Excellence – James Strebig, MD CAP member, internal medicine physician, and former President of the Orange County Medical Association.

800-252-7706 www.CAPphysicians.com

SAN DIEGO ORANGE LOS ANGELES PALO ALTO SACRAMENTO

For 35 years, the Cooperative of American Physicians, Inc. (CAP) has provided California’s finest physicians, like internal medicine specialist James Strebig, MD, with superior medical professional liability protection through its Mutual Protection Trust (MPT).

Physician owned and physician governed, CAP rewards excellence with remarkably low rates on medical professional liability coverage – up to 40 percent less than our competitors.

CAP members also enjoy a number of other valuable benefits, including comprehensive risk management programs, best-in-class legal defense, and a 24-hour CAP Cares physician hotline. And MPT is the nation’s only physician-owned medical professional liability provider rated A+ (Superior)

by A.M. Best.

We invite you to join the nearly 12,000 preferred California physicians already enjoying the benefits of CAP membership.

Superior Physicians. Superior Protection.

2 AUGUST 2014 / VITAL SIGNS

Vital Signs Official Publication of Fresno-Madera Medical Society Kings County Medical Society Kern County Medical Society Tulare County Medical Society August 2014 Vol. 36 – Number 8

Contents CMA NEWS ...............................................................................................................................5 NEWS CMA EDUCATION SERIES CALENDAR: August 2014 ..................................................................6 AFFORDABLE HEALTHCARE ACT: Surviving Covered California ....................................................7 HEALTHCARE REFORM ...........................................................................................................9 LEGISLATIVE NEWS: Unprecedented Number of Groups and Organizations Join Forces to Defeat Proposition 46 .....................................................................................10 CODING CORNER: Modifier 22: Reporting and Reimbursement ................................................11

Editor Alan Birnbaum, MD Managing Editor Carol Rau Yrulegui Fresno-Madera Medical Society Editorial Board Virgil M. Airola, MD Hemant Dhingra, MD David N. Hadden, MD Roydon Steinke, MD Kings Representative TBD Kern Representative John L. Digges, MD

CREDIT CARD UPDATE: Physicians Can Avoid High Credit Card Fees.........................................11 CLASSIFIEDS..........................................................................................................................19 FRESNO-MADERA MEDICAL SOCIETY .....................................................................................13 • President’s Message • 2014 Physician Community Service Award Nomination Forms: Lifetime Achievement; Special Project or Service. Nominations due September 8, 2014 • Walk with a Doc • Medical Manager’s Forum KERN COUNTY MEDICAL SOCIETY ..........................................................................................17 • Medical Missionary Journey: Part One TULARE COUNTY MEDICAL SOCIETY ......................................................................................18 • HIPPA and Your Vendors • Walk With A Doc • Upcoming Events

Tulare Representative Francine Hipskind

Vital Signs Subscriptions Subscriptions to Vital Signs are $24 per year. Payment is due in advance. Make checks payable to the Fresno-Madera Medical Society. To subscribe, mail your check and subscription request to: Vital Signs, Fresno-Madera Medical Society, PO Box 28337, Fresno, CA 93729-8337.

Advertising Contact: Display: Annette Paxton, 559-454-9331 apaxton@cvip.net Classified: Carol Rau Yrulegui 559-224-4224, ext. 118 csrau@fmms.org

Cover Photograph: “Yosemite Falls in the Mist”

By Ning Lin, OD, MD Calling all photographers: Please consider submitting one of your photographs for publication in Vital Signs. – Editorial Committee

Vital Signs is published monthly by Fresno-Madera Medical Society. Editorials and opinion pieces accepted for publication do not necessarily reflect the opinion of the Medical Society. All medical societies require authors to disclose any significant conflicts of interest in the text and/or footnotes of submitted materials. Questions regarding content should be directed to 559-224-4224, ext. 118.

AUGUST 2014 / VITAL SIGNS

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You create a brighter future.

We work to protect it.

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most or all of your life’s savings.2

FMMS, KCMS and TCMS are pleased to announce that members now have access to an interactive and educational Long-Term Care evaluation tool to help you make the best decisions for your specific situation. To learn more, visit: www.myltcplan.com/fmms.

Long-Term Care insurance may not be for everyone. But with soaring health

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care costs, insurance restrictions and the need to stretch retirement savings

FRESNO-MADERA MEDICAL SOCIETY

People are living longer these days, but as life expectancies increase, so does the risk of serious health problems that could require long-term care. In fact, at retirement age, 70% of Americans will need long-term care and 35% will enter a nursing home.1 And with the average cost for nursing home care in a private room equating to more than $87,600 per year, that could literally cost

through more years . . . it’s a good idea to seriously consider this valuable coverage while receiving a member premium discount.

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KERN COUNTY MEDICAL SOCIETY TULARE COUNTY MEDICAL SOCIETY

Call 800.616.8759 or visit www.myltcplan.com/fmms.

Department of Health and Human Services, www.longtermcare.gov/the-basics/how-much-care-will-you-need/, viewed April 1, 2014.

Genworth 2013 Cost of Care Survey, March 2013, https://www.genworth.com/corporate/about-genworth/industry-expertise/cost-of-care.html The Long-Term Care Resources Network is only available for residents of the United States. Coverage may vary or may not be available in all states.

1 2

66660 (8/14) Copyright 2014 Mercer LLC. All rights reserved. 777 South Figueroa Street, Los Angeles, CA 90017 800-842-3761 • CMACounty.Insurance.service@mercer.com • www.CountyCMAMemberInsurance.com

CA Ins. Lic. #0G39709 • Mercer Health & Benefits Insurance Services LLC

CMA NEWS PROVIDER ACCESS ISSUES PLAGUE ANTHEM AND BLUE SHIELD AS DMHC BEGINS INVESTIGATION

The Department of Managed Health Care (DMHC) began conducting a “non-routine audit” of Anthem Blue Cross and Blue Shield of California to investigate the accuracy of the plans’ provider directories and identify whether either plan violated any network adequacy laws. According to the DMHC, consumer complaints about access issues for both plans prompted the investigation.

Blue Cross and Blue Shield are the only two exchange plans using narrowed provider networks for their exchange and “mirror” products. The state is looking at whether the networks are too narrow in some counties, making it difficult for enrollees to find participating providers.

A California Medical Association (CMA) survey of California physicians found that there is also widespread confusion about exchange plans contracting amongst providers, with 80 percent of physicians stating they had been confused about their participation status.

Health plans often use intentionally vague or confusing contracting practices, which result in consumer confusion and frustration, as physicians often do not know that they are listed as participating in certain networks.

With roughly 1.4 million Californians newly enrolled in Covered California products since January, it has been difficult for both physicians and patients to identify who is in and who is out of the narrow provider networks.

CMA has urged Covered California to address this and other issues before the next open enrollment period.

As part of the audit, DMHC has hired pmpm Consulting to contact practices to ask about their participation status with the two plans. If contacted by pmpm Consulting, CMA strongly encourages the practice to respond to their questions. This is an investigation into the accuracy of the plan directories and whether the plans have violated any laws, not an investigation of physician practices. DMHC expects to complete its investigation in approximately 60 days. Findings of the survey will be released publicly prior to the next Covered California open enrollment period, which is scheduled for November 15.

Having trouble finding an in-network provider or facility?

Patients who are having trouble finding an in-network physician or facility are encouraged to contact the DMHC Help Center at 888-466-2219 for assistance or for complaints.

We also ask that physicians notify CMA if they are experiencing difficulties finding in-network providers to whom they can refer patients so that we may raise the issue with the plan, Covered California and the appropriate regulator. Contact CMA’s reimbursement helpline at 888- 4015911 or economicservices@cmanet.org.

RENEW EARLY! PHYSICIANS RENEWING LICENSES EXPERIENCING DELAYS

The Medical Board of California is asking physicians who need to renew their medical licenses to do so early due to delays associated with the implementation of a new online licensing and enforcement system. Renewal notices are sent out 90 days in advance of the licensee’s expiration date.

This transition is resulting in disruptions in cashiering and other services and is affecting both online and mail renewals. Currently, the medical board is experiencing delays of 6-8 weeks to update its website and provide physicians with a current wallet license.

If you have not yet submitted your renewal application to the medical board, do not submit it to the P.O. Box listed on the renewal notice, as it may not be processed prior to your expiration date. For faster service, the medical board recommends submitting the renewal application to: Medical Board

of California; 2005 Evergreen Street, Suite 1200; Sacramento, CA 95815 This will allow for expedited processing. Questions should be directed to the medical board at 916-263-2382 or webmaster@mbc.ca.gov.

CMA RELEASES 2014 ANNOTATED MODEL MEDICAL STAFF BYLAWS

The California Medical Association (CMA) has released its 2014 Model Medical Staff Bylaws. These bylaws are the definitive guide for medical staffs, providing details on professional and legal structures to support effective medical staff operations and self-governance.

The model bylaws are fully annotated to provide background information on critical provisions, including explanations of relevant state and federal laws, hospital accreditation standards, and other explanatory information. CMA’s lawyers performed a complete evaluation of the bylaws to ensure they comport with current law and reflect CMA’s positions and policies.

New for 2014: The California Supreme Court has recently decided two cases having a direct effect on medical staffs and hospital-based physicians.

El-Attar v. Hollywood Presbyterian Medical Center addresses the balance of power and responsibilities between hospitals and medical staffs and the individual rights of physicians in peer review. Fahlen v. Sutter Central Valley Hospitals addresses the interplay between peer review and whistleblower protections for physicians. Many other opinions by the intermediate appellate courts (which also establish binding law through the state) were handed down last year having a significant impact on physician and medical staff rights in hospitals. All of these cases, as well as changes to Joint Commission standards and other authorities, are discussed throughout the footnotes to the CMA model bylaws.

The 2014 Model Medical Staff Bylaws are available free to any medical staff with an active membership in CMA’s Organized Medical Staff Section (OMSS). If your medical staff is not already an OMSS member, you can join by completing and submitting the OMSS membership application at www. cmanet.org/omss.

The model bylaws are also available to non-OMSS members for a fee.

For more information, visit CMA’s online resource library.

Contact: CMA member help center, 800-786-4262 or member service@cmanet.org.

PROBLEMS GETTING PAID?

The California Medical Association’s Center for Economic Services provides direct reimbursement assistance to CMA physician members and their office staff.

Reimbursement Help Line: 88-401-5911; or economicservices@ cmanet.org .

When to call CMA? CMA members can call on CMA’s practice management experts for free one-on-one help with contracting, billing, and payment problems. If you answer “yes” to any of the following questions, it might be time to call for help.

• Are your claims not being paid in a timely manner?

• Are you not being paid according to your contract?

• Are your claims being denied after obtaining prior authorization or verifying eligibility?

• Are you receiving unreasonable requests for medical records or untimely requests for refunds?

• Are you having difficulty obtaining fee schedules and/or payment rules?

AUGUST 2014 / VITAL SIGNS

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CMA NEWS

New Career Opportunities Available

2014

EDUCATION SERIES CMA Center for Economic Services Webinars At-A-Glance

KERN

FRESNO

FAMILY MEDICINE FACULTY

FAMILY MEDICINE FACULTY

Clinica Sierra Vista is seeking a Board Certified Family Medicine Physician to serve as faculty for the Rio Bravo Family Medicine Residency Program. Full and part-time teaching positions available!

Make a difference in the lives of new physicians and join our faculty! Inpatient and Obstetrics a plus! Competitive salary offered.

Federal loan forgiveness may be available for qualified applicants.

Clinica Sierra Vista is seeking a Board Certified Family Medicine Physician to serve as faculty for the Sierra Vista Family Medicine Residency Program. Full and part-time teaching positions available!

Make a difference in the lives of new physicians and join our faculty! Inpatient and Obstetrics a plus! Competitive salary offered.

Federal loan forgiveness may be available for qualified applicants.

Interested applicants may contact Clinica Sierra Vista

(661) 979-0812

Most webinars are FREE for CMA members and their staff, $99 for non-members.

A Webinar Invitation for All Physicians and Their Staff The California Medical Association (CMA) offers programs to educate physicians and staff on a range of practice management issues. Space is limited, so register soon.

Workers’ Compensation Advanced Part 1: August 5 • 12:15-1:15pm: Tips and Tricks for Workers’ Compensation Billing

DaisyBill presents this series covers specific advanced topics for those physicians who already treat injured workers. DaisyBill electronically manages thousands of workers’’ comp bills each month. More importantly, we capture granular payment data about these bills.

Using our extensive data analysis these webinars will focus on known strategies that will increase revenue, decrease costs, and get these bills paid quickly. In this webinar, attendees will learn about the most common billing errors to avoid when billing workers’ compensation.

This webinar will review five tips to immediately increase workers’ comp revenue and the new RBRVS billing rules and reimbursements.

Part 2: August 12 • 12:15-1:15pm; Second Bill Review Plus Managing Third Party Billers

You said what

to the Medical Board’s investigator?

Physicians often come to us after they have been interviewed by a Medical Board investigator or after they have already provided a written description of their care.

Did you know that a Medical Board investigator is a sworn peace officer, with a gun, and a badge, and the power to arrest you?

When the Medical Board demands an explanation, seek help immediately. The attorneys at Baker, Manock & Jensen have helped many physicians through the maze that is a Medical Board investigation. We would be honored to help you.

George L. Strasser 5260 North Palm Avenue Fresno, CA 93704 559 432-5400 gstrasser@bakermanock.com www.bakermanock.com

6 AUGUST 2014 / VITAL SIGNS

In this webinar, attendees will learn about five essential components of a compliant Second Bill Review. This webinar will also review easy ways to make sure your third party biller is correctly managing your workers’ comp bills.

Part 3: August 19 • 12:15-1:15pm; Requests for Authorization, Dispensed Pharmaceutical and DMEPOS billing for workers’ comp In this webinar, attendees will learn how to correctly submit Request for Authorizations and how to bill for dispensed pharmaceuticals and DMEPOS.

These webinars are hosted by the California Medical Association. You must register at least one hour prior to the event. Once your registration has been approved, you will be sent an email confirmation with details on how to join the webinar. Questions? Call the CMA Help Line at 800-786-4262.

AFFORDABLE HEALTHCARE ACT

Surviving Covered California Provided by California Medical Association Editor’s Note: Due to a printing error in last month’s Vital Signs, a portion of this article was not printed. This month the article is reprinted in its entirely.

Covered California reports that nearly 1.4 million individuals have enrolled in exchange plans, which significantly surpasses original targets, making it critical that physicians and their staff know what to expect from these products. To help answer some of the more common questions, the California Medical Association (CMA) offers this information to assist physician practices in surviving this major change in health care.

How can I identify whether an exchange patient is in months two or three of the grace period? Enrollees who receive federal premium subsidies to help pay their premiums are entitled to keep their insurance for three months after they have stopped paying their premiums.

Insurance ID cards for exchange enrollees do not indicate whether the enrollee is subsidized. Current enrollment trends, however, predict that 88 percent of those with exchange coverage will be subsidized and receive the three-month grace period. In other words, those with a Covered California logo on the ID card will most likely will have the three-month grace period.

In the first 30 days of the grace period, federal law requires plans to pay for services incurred, but in months two and three of the grace period plans can pend and deny claims. So it will be extremely important that practices verify eligibility on all exchange patients, ideally on the date of service, or as near the time of service as possible. If the patient is in months two or three of the grace period, the health plan should indicate that coverage is inactive or otherwise suspended.

CMA queried Anthem Blue Cross, Blue Shield of California and Health Net, which account for approximately 75 percent of the total Covered California enrollees, on exactly what to look for in eligibility verification to identify patients who are in months two and three of the grace period. They report the following: Plan Name

Grace Period Eligibility Status Indicator (Days 31-90 of grace period)

Anthem Blue Cross Inactive pending investigation Blue Shield of California Pended Health Net Eligibility suspended

Unsubsidized exchange patients and those with a mirror product are not entitled to the 90-day federal grace period, rather they only receive the 30day grace period called for under state law.

What are my options if a patient presents with inactive coverage on account of the grace period? Practices should have policies in place regarding how they will handle patients who are in months two or three of the grace period. Patients should ideally be made aware of this policy in advance. If a patient’s eligibility verification comes back indicating his or her coverage is not active, the practice should treat the situation as they would any other patient who has had a lapse in coverage. For non -emergent services, patients may be given the option to either pay cash at the time of service or reschedule to a later date when their coverage is effective. The office policy should include how patients will be triaged to determine whether their condition is emergent or urgent and the policy should be approved by the physician.

How can I identify the off-exchange, or “mirror,” products that

are sold outside of Covered California but utilize the narrowed exchange provider networks? Practices must review patient ID cards and eligibility information closely to identify whether the practice is in or out of network for that particular plan. Every plan offered in the exchange must also be offered outside of the exchange, using the same provider network. Confusion around these off-exchange products, also called “mirror” products, has resulted in a number of practices unknowingly seeing patients out-of-network for products that use a narrowed exchange provider network, as these ID cards will not have the Covered California logo. The issue is specific to just Anthem Blue Cross and Blue Shield of California, because they are the only two plans offering narrowed networks.

Blue Shield mirror products (bought off of the exchange but utilizing the exchange provider network) will list one of the following product names on the patient ID card: Sample Blue Shield ID Card • Basic PPO/EPO • Enhanced PPO/EPO • Get Covered PPO/EPO • Preferred PPO/EPO • Ultimate PPO/EPO. Anthem Blue Cross mirror products (bought off of the exchange but utilizing the exchange provider network) will list “Pathway” (network name) on the bottom of the card. The product names for mirror products, which appear on the top of the ID card are: • Anthem Core DirectAccess (EPO/PPO) • Anthem Essential DirectAccess (EPO/PPO) • Anthem Essential Guided Access (HMO) • Anthem Preferred DirectAccess (EPO/ PPO) • Anthem Sample Anthem Blue Cross ID Card Premier DirectAccess (EPO/PPO) • Anthem Premier Guided Access (HMO) If you see these product or network names on the Anthem Blue Cross or Blue Shield of California patient ID cards, it indicates the patient only has access to the narrowed exchange network. Again, these are the only two plans currently offering narrowed networks. The other nine plans generally offer their full network to exchange and mirror product patients.

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Covered California Continued from page 7 Given the confusion and varying product/network names, CMA submitted a letter to Peter Lee, Executive Director of Covered California, and the Exchange Board of Directors, recommending Covered California develop new requirements of plans to clearly identify mirror products on patient ID cards, among other things.

What options are available for Covered California/mirror product patients who are having trouble finding in-network providers and/or facilities to provide care?

CMA has received a number of complaints about patient access to care issues, mainly in the narrowed networks offered by Anthem Blue Cross and Blue Shield of California. In fact, in a recent CMA survey of physicians’ experiences with exchange plans, more than half of physician respondents indicated that they have experienced difficulties finding an in-network physician or hospital to which they can refer their Covered California patients.

Patients who are having trouble finding an innetwork physician or facility are encouraged to file a complaint with the Department of Managed Health Care’s Help Center at 888-466-2219.

When calling, patients should indicate they have a Covered California plan and cannot find an in-network physician/facility that is reasonably accessible.

In addition to contacting the health plan, we ask that physicians and practice staff who are experiencing difficulties finding in-network providers notify CMA of the issue so that we may raise it with Covered California and the appropriate regulator. Issues may be submitted to our physician helpline at 888-401-5911 or economicservices@cmanet.org.

Still have questions? Visit CMA’s exchange resource center at www.cmanet.org/exchange. At the resource center, you may download CMA’s comprehensive exchange toolkit, “CMA’s Got You Covered: A Physician’s Guide to Covered California, the state’s health benefit exchange,” as well as a other CMA exchange resources. CMA members and their staff also have FREE access to our reimbursement helpline at 888-401-5911 or economicservices@cmanet.org.

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HEALTHCARE REFORM BROWN SIGNS BILL DELAYING ACA DEADLINE FOR SMALL BUSINESSES

Gov. Jerry Brown (D) signed into law a bill (SB 1446) that will give state businesses with fewer than 50 employees an extra year (2015) to obtain health coverage that complies with Affordable Care Act requirements, the Sacramento Business Journal reports.

The measure takes effect immediately and allows small businesses to renew coverage at any point in the year (Robertson, Sacramento Business Journal, 7/7).

Under the ACA, all health plans must include 10 essential benefits, including hospitalization, prescription drugs, maternity care and mental health treatments (O’Neill, “KPCC News,” KPCC, 7/7).

The law’s employer mandate provision states that any health plans that do not meet all 10 requirements will be canceled at the end of 2014.

SB 1446 was introduced by Sen. Mark DeSaulnier (D-Concord). State Insurance Commissioner Dave Jones (D) and the California Department of Insurance also sponsored the measure.

ANTHEM MISLED MILLIONS ABOUT HEALTH PLAN NETWORKS, LAWSUIT ALLEGES

Last month, Consumer Watchdog filed a class-action lawsuit alleging that Anthem Blue Cross misled “millions” of consumers who enrolled in its health plans about which physicians and hospitals were included in their provider networks, Kaiser Health News reports.

Consumer Watchdog filed the lawsuit on the behalf of all Anthem members who purchased individual coverage through the state health

insurance exchange or directly from the insurer between Oct. 1, 2013, and March 31.

Specifically, the lawsuit alleges that Anthem: • Delayed giving its customers complete information until it was too late for them to switch their coverage choice; • Did not inform its customers that it no longer offered out-of-network coverage in four of state’s largest counties -- Los Angeles, Orange, San Diego and San Francisco; and • Misled or did not inform its customers about which doctors and hospitals were participating in the insurer’s new plans.

As a result of those alleged failures, the lawsuit states that many members received thousands of dollars in unexpected medical bills and were unable to see their preferred physician.

Jerry Flanagan, lead staff attorney at Consumer Watchdog, said Anthem “intentionally misrepresented and concealed the limitations of their plans because it wanted a big market share.”

Anthem’s Response Anthem spokesperson Darrel Ng declined to comment directly on the lawsuit but said Anthem will pay the claims of members who received treatment from falsely listed physicians during the first three months of 2014.

However, he said the insurer would not extend that policy for members who found out after March 31 that their longtime doctors were not included in their plan’s network (Appleby, Kaiser Health News, 7/9).

AUGUST 2014 / VITAL SIGNS

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LEGISLATIVE NEWS

Unprecedented Number of Groups and Organizations Join Forces to Defeat Prop. 46: The Ballot Initiative to Raise the MICRA Cap

When was the last time you saw this mix of a group come together for a cause?

Opponents OF ProP. 46 Coalition List and numbers (as of July 15, 2014): Doctors and Health Groups.................................... 83 Community Clinics & Health Centers........ 960 Hospitals..............................................................................97 County Medical and Dental Societies.............. 53 Medical and Dental Groups..................................115 In addition to the above Health-Related groups and organizations: Labor Unions & Healthcare Trusts Service Employees International Union (SEIU) California International Brotherhood of Boilermakers AFSCME California PEOPLE IBEW Ninth District SEIU United Long Term Care Workers (ULTCW) SEIU-USWW (United Security Workers West) SEIU 1000 Committee of Interns and Residents-SEIU IBEW Local 11 IBEW Local Union 441 IBEW Local Union 477 IBEW Local Union 551 Union of American Physicians and Dentists (AFSCME Local 206) Southern California Pipe Trades Health & Welfare Fund Boilermakers Local 92 Boilermakers Local 1998 Plumbers & Pipefitters Local Union 228 Plumbers & Steamfitters Local Union 398 Plumbers and Pipefitters UA Local Union 442 Plumbers & Pipefitters Local 447 Plumbers, Pipe and Refrigeration Fitters UA Local 246 Sheet Metal, Air, Rail and Transportation Workers (SMART), Sheet Metal Workers’ Local Union No. 104 Southern CA Pipe Trades DC 16 Sprinkler Fitters UA Local 483 Civil Liberties Groups American Civil Liberties Union of California American Civil Liberties Union, Northern California American Civil Liberties Union of Southern California American Civil Liberties Union of San Diego and Imperial Counties 10 AUGUST 2014 / VITAL SIGNS

Education Groups California Teachers Association California School Boards Association California Association of School Business Officials California School-Based Health Alliance Small School Districts’ Association Children’s Groups Children’s Specialty Care Coalition California Children’s Hospital Association Children’s Physicians Medical Group Miller Children’s Hospital Long Beach A New PATH (Parents for Addiction Treatment & Healing) PADRES Contra El Cancer South Bay Children’s Health Center Totally Kids Specialty Healthcare Ethnic Groups Angel City Dental Society Armenian American Medical Society Armenian Dental Society Arab American Dental Association California Black Chamber of Commerce California Hispanic Chambers of Commerce Hispanic Dental Association San Diego Binational Chapter Indian Dental Association Iranian Dental Association Latino Physicians of California Network of Ethnic Physician Organizations Philippine Medical Society of Northern California Sacramento Hispanic Chamber of Commerce Solano County Black Chamber of Commerce Southern CA Filipino Dental Society Professional Liability Carriers The Doctors Company CAP Physicians Insurance Agency, Inc Cooperative of American Physicians NORCAL Mutual Insurance Company California Healthcare Insurance Company, Inc., RRG BETA Healthcare Group Medical Insurance Exchange of California The Mutual RRG, Inc Physicians Reimbursement Fund, RRG Podiatry Insurance Company of America (PICA) Prevail Insurance Management Services The Mutual The Dentists Insurance Company Ophthalmic Mutual Insurance Company Fireman’s Fund Insurance Company

Business & Taxpayer Groups California Chamber of Commerce Bay Area Council Valley Industry & Commerce Association San Diego Regional Chamber of Commerce Southwest California Legislative Council Big Bear Chamber of Commerce Elk Grove Chamber of Commerce Oxnard Chamber of Commerce Placer County Taxpayers Association Torrance Area Chamber of Commerce Santa Clarita Valley Chamber of Commerce Chula Vista Chamber of Commerce Huntington Beach Chamber of Commerce Corona Chamber of Commerce The Chamber of Commerce of the Santa Barbara Region Greater Bakersfield Chamber of Commerce Camarillo Chamber of Commerce Inland Empire Taxpayers Association North Orange County Legislative Alliance Fullerton Chamber of Commerce Los Angeles Area Chamber of Commerce Santee Chamber of Commerce La Canada Flintridge Chamber of Commerce & Community Association Santa Monica Chamber of Commerce California Taxpayer Protection Committee Greater Fresno Area Chamber of Commerce Ventura Chamber of Commerce Seniors AltaMed Health Services Corporation Curry Senior Center Civil Justice California Citizens Against Lawsuit Abuse Civil Justice Association of California Local Governments City of Long Beach California State Association of Counties Excess Insurance Authority

Proponents OF Prop. 46 U.S. Senator Barbara Boxer Consumer Watchdog Consumer Attorneys of California (formerly California Trial Lawyers Association)

CODING CORNER Modifier 22: Reporting and Reimbursement CPR’s “Coding Corner” focuses on coding, compliance, and documentation issues relating specifically to physician billing. This month’s tip comes from G. John Verhovshek, the managing editor for AAPC, a training and credentialing association for the business side of health care.

CPT® modifier 22 increased procedural services allows a provider to gain additional reimbursement for an unusually difficult or time-consuming procedure. To realize that extra payment, your billing staff will have to make a special effort, as well.

Per CPT® Appendix A, modifier 22 may be appended to a CPT® code to indicate that the work performed was “substantially greater than typically required…. ” CPT® does not define a “substantially greater” effort, although some payors do offer guidelines (e.g., the effort and/or time to perform the procedure should be “at least 25 percent greater than usual”). Regardless of payor, you should append modifier 22 infrequently, and for only the most unusual procedures.

Specific circumstances that may call for modifier 22 include: • Intra-operative hemorrhage resulting in a significant amount of increased operative time.

• Emergency situations that require significant effort beyond the normal service. This does not include minor intra-operative complications that sometimes occur.

• Abnormal pathology, anatomy, tumors and/or malformations that directly and significantly interfere with the normal progression of a procedure.

Also, keep in mind these caveats: • Additional time, by itself, does not justify the use of modifier 22.

• Do not use modifier 22 when the existing CPT® code describes the service.

• Do not use modifier 22 to indicate that a specialist (no matter how specialized) performed the service.

• Do not use modifier 22 if the complication is due to the surgeon’s choice of surgical approach.

CPT® guidelines require that provider documentation support “the substantial additional work and the reason for the additional work (i.e., increased intensity, time, technical difficulty of the procedure, severity of patient’s condition, physical and mental effort required).” The provider should explain and identify additional diagnoses, preexisting conditions, or unexpected findings or complicating factors that contributed to the extra time and effort.

Use comparisons to clarify how the procedure differed, using quantifiable criteria. For example: The patient lost 800 cc’s of blood, rather than the usual 100-200 cc’s lost during a procedure of the same type. Time is also quantifiable (e.g., “the surgery took four hours instead of the usual 1½-2 hours”).

Payors may request a full operative report to verify the unusual nature of the coded procedure. Because most claims are now sent electronically, you should include comments in the narrative field, using everyday language, to explain precisely why (and how much) additional effort and/or time were required to complete the procedure, along with the statement, “Request documentation if needed.” If the payer requests the additional details, be prepared to send the full operative note, along with a cover letter (with provider signature) detailing the unusual nature of the procedure.

The Centers for Medicare & Medicaid Services and other payers scrutinize modifier 22 claims, and primary payor claims submitted with a 22 modifier are often subject to a full medical review. If your claim is correctly coded and well supported by documentation, be persistent in pursuing payment.

Lastly, when submitting your claim with modifier 22, you have to ask for additional payment. Payors won’t automatically increase reimbursement. Instead, you should recommend an appropriate fee. For instance, if a surgical procedure takes twice as long due to unusual clinical circumstances, you could ask the payor to increase the intra-operative portion of the payment by 50 percent.

CREDIT CARD UPDATE Physicians Can Avoid High Virtual Credit Card Fees If your practice accepts virtual credit card (VCC)

payments from health plans, you may be losing a significant amount of your contractual payments to high interchange fees. Fortunately, there are steps you can take to stop paying unnecessary charges.

To disburse claims payments, health plans have increasingly shifted from paper checks to electronic payment methods, including payer-issued VCCs. With this method, a health plan sends credit card payment instructions to physicians, who process the payments using standard credit card technology.

This method is beneficial to health plans, but costly for physicians. Health plans often receive cashback incentives from credit card companies for VCC transactions. Meanwhile, VCC payments are subject to transaction and interchange fees, which are born by the physician practice and can run as high as 5 percent per transaction for physician practices.

Here are three helpful steps to minimize fees: Register for electronic funds transfer (EFT) payments. The Health Insurance Portability and Accountability Act (HIPAA) requires all health plans to offer standardized EFT using the Automated Clearinghouse (ACH) Network. Similar to direct deposit, ACH EFT allows health plan payments to be directly paid into a physician’s designated bank account. Each ACH EFT transaction carries only one fee of about 34 cents, far less than the potential 5 percent fee charged to VCC transactions. In order to receive ACH EFT, physicians should request and register for this payment method with payors.

Be aware of restrictions in payment methods when contracting with health plans. Even though HIPAA requires health plans to make EFT payments available upon request, health plans may try to require other payment methods, such as VCC, within their contracts with physicians. Be cognizant of any such restrictions and avoid signing contracts with inflexible payment terms.

Educate your practice staff. If your practice staff processes both patient and health plan payments, make sure they know how to differentiate between patient and health plan credit card payments to avoid authorization of VCC payments from health plans.

The American Medical Association (AMA) EFT toolkit has more information on EFT payment, including a VCC tip sheet, “The effect of health plan virtual credit card payments on physician practices” (free AMA login required) with more information on avoiding high fees.

For more information contact EFT at 888-4015911 or economicservices@cmanet.org.

AUGUST 2014 / VITAL SIGNS

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A former employee sued me for wrongful termination.

You are not alone. Employment-related lawsuits are more common. What many physicians don’t realize is that help is literally a phone call away. FMMS, KCMS and TCMS members have access to a unique blend of risk management services and insurance specifically designed to assist physician groups in addressing these important employment issues. Among the features of the sponsored Employment Practices Liability program are: A Helpline staffed by experienced employment defense attorneys.

Any manager, officer or principal of your practice has access to the Helpline for obtaining advice on handling workplace issues, including internal sexual harassment complaints, discipline and employee terminations.

For more information on these important benefits, and the special FMMS, KCMS and TCMS First-Time Buyers Program, please contact Mercer at: 800-842-3761 or email us at CMACounty.Insurance.service@mercer.com

If a member seeks and follows Helpline advice on an employee termination or demotion which later results in a claim, there is a 50% reduction of the member’s EPLI deductible for that claim.

Free, comprehensive criminal background checks for newly hired and promoted managers/supervisors.

EEO compliance training for managers/supervisors. An internetbased training program, compliant with California law, provides supervisors with sexual harassment training.

Sponsored by: Fresno-Madera Medical Society Kern County Medical Society Tulare County Medical Society

Optional Wage and Hour Defense Coverage. (Subject to additional premium.)

Ask about our First-Time Buyers Program.

65457 (7/14) Copyright 2014 Mercer LLC. All rights reserved. • 777 S. Figueroa St., Los Angeles, CA 90017 www.CountyCMAMemberInsurance.com • CMACounty.Insurance.service@mercer.com 12 AUGUST 2014 / VITAL SIGNS

Mercer Health & Benefits Insurance Services LLC • CA Ins. Lic. #0G39709 • 800-842-3761

Fresno-Madera PRAHALAD JAJODIA, MD

President’s Message IT’S OFFICIAL: NO ON 46 CAMPAIGN

Following last month’s Secretary of State’s assignment of proposition numbers to qualified ballot measures, the MICRA ballot initiative campaign is now officially being referred to as the “ NO on Prop 46” campaign. With a proposition number assigned, the measure is now much more visible to potential voters, meaning that the public will be hearing more from both the THIS IS A proponents and opponents between now and Election Day – November 4, 2014.

PERFECT There is a growing coalition dedicated to defeating this Trial Lawyers’ MICRA lawsuit measure. See page 10 of this issue to see how diverse this coalition is – but most importantly – notice the very limited number of proponents. Talk about special interests! That alone should raise voters’ suspicions on the merits of this proposition.

Voters – and our patients – need to be made aware of this deceptive proposition – that its intent is to put more money (and lawsuits) into the pockets of the trial attorneys. It’s not to curb drug abuse among doctors and other health care professionals.

In fact, the authors of this proposal have been quoted as saying that the drug-testing part was thrown in as the “ultimate sweetener.” This is a perfect example of special interest legislation intended to fool the voters into thinking the measure is about something it is not.

In addition, according to California’s former Legislative Analyst – Prop. 46 will increase health care costs by $9.9 billion annually – approximately $1,000 per year for a family of four.

EXAMPLE OF SPECIAL INTEREST LEGISLATION INTENDED TO FOOL THE VOTERS INTO THINKING THE MEASURE IS ABOUT SOMETHING IT IS NOT.

COMPLAINTS ABOUT ANTHEM AND BLUE SHIELD PROVIDER NETWORKS Are you still hearing complaints from patients about the confusion with Anthem and Blue Shield provider networks? If so – make sure they call the Department of Managed Health Care (DMHC) for assistance and to register their complaints at 888-466-2219.

Due to prior consumer complaints, the DMHC is now conducting a non-routine audit. If they call your office – make sure you or your staff answer their questions.

Post Office Box 28337 Fresno, CA 93729-8337 1040 E. Herndon Ave #101 Fresno, CA 93720 559-224-4224 Fax 559-224-0276 website: www.fmms.org Officers Prahalad Jajodia, MD President A.M. Aminian, MD President-Elect Hemant Dhingra, MD Vice President Ahmad Emami, MD Secretary/Treasurer Ranjit Rajpal, MD Past President Board of Governors Alan Birnbaum, MD S.P. Dhillon, MD William Ebbeling, MD Anna Marie Gonzalez, MD David Hadden, MD Joseph B. Hawkins, MD Sergio Ilic, MD Alan Kelton, MC Constantine Michas, MD Trilok Puniani, MD Khalid Rauf, MD Roydon Steinke, MD CMA Delegates FMMS President Don Gaede, MD Michael Gen, MD Brent Kane, MD Brent Lanier, MD Kevin Luu, MD Andre Minuth, MD Roydon Steinke, MD Toussaint Streat, MD CMA Alternate Delegates FMMS President-Elect Perminder Bhatia, MD Praveen Buddiga, MD Surinder P. Dhillon, MD Trilok Puniani, MD Oscar Sablan, MD CMA Trustee District VI Virgil Airola, MD Staff Sandi Palumbo Executive Director

AUGUST 2014 / VITAL SIGNS

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Fresno-Madera FRESNO-MADERA MEDICAL SOCIETY 2014 PHYSICIAN COMMUNITY SERVICE AWARD

LIFETIME ACHIEVEMENT Dear FMMS member: RECOGNIZE A DESERVING COLLEAGUE! The Medical Society will bestow an award recognizing a physician who has gone beyond the call of duty in providing for the health and welfare of our community's residents during his or her lifetime. All nominees must be FMMS members.

Criteria for this award includes: • Extraordinary service and dedication to patients, the community or to the profession • Uncompensated services performed • High quality of care provided to patients Previous award recipients: Drs. James Caffee, Roger Larson, Gilbert Roth, Robert West, Ronald Smith, Dwight Trowbridge, Lauren Grayson, Harold Hanson, John Murray, Max Millar, Ed Defoe, Thomas Eliason, Fred Cooley, Robert Peters, Jack Schiff, Burton James, Donald Knapp, Sathaporn Vathayanon, Jack Thorburn, Joseph Woo, Steven Parks, John Conrad, Bjorn Nelson, Theodore Steinberg, Malcolm Masten, John Bonner and Kenneth Jue. Nominations from the past three years will be considered. The recipient is selected by the FMMS Historical Committee and approved by the FMMS Board of Governors. The award will be presented at the Medical Society's November 8, 2014 dinner and installation gala.

Please complete and return the form below by SEPTEMBER 8, 2014.

“We make a living by what we get, but we make a life by what we give.”

Winston Churchill

2014 PHYSICIAN “LIFETIME ACHIEVEMENT” AWARD I nominate _____________________________________________________________________________ , MD (Please give specific and detailed examples for your nomination)

________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________

Submitted by:____________________________________________________ Phone: ____________________ RETURN BY SEPT. 8

14 AUGUST 2014 / VITAL SIGNS

Mail to: Fresno-Madera Medical Society Historical Committee P.O. Box 28337 • Fresno CA 93729-8337

or Fax to: 224-0276

Fresno-Madera FRESNO-MADERA MEDICAL SOCIETY 2014 PHYSICIAN COMMUNITY SERVICE AWARD

SPECIAL PROJECT OR SERVICE

Dear FMMS member: RECOGNIZE A DESERVING COLLEAGUE! The Medical Society will bestow an award recognizing a physician who has gone beyond the call of duty to devote his or her time to a one-time or on-going special project or service either locally, statewide, nationally or internationally, that served(s) to promote the welfare and healthcare of the community or the medical profession. All nominees must be FMMS members.

Previous award recipients are: Drs. Marc Lasher, Richard Whitten, Jr., Walter Byerly, Chun. C. Chan, David Pepper, Chun-Wai Chan, Lee Snyder, Women’s Imaging Specialists in Healthcare, Mohammad Arain, John Telles , Joan Voris and Alex Sherriffs.

Nominations from the past three years will be considered. The recipient is selected by the FMMS Historical Committee and approved by the FMMS Board of Governors. The award will be presented at the Medical Society's November 8, 2014 dinner and installation gala.

Please complete and return the form below by SEPTEMBER 8, 2014.

“It is well to give when asked, but it is better to give unasked, through understanding.”

Kahil Gibran

2014 PHYSICIAN “SPECIAL PROJECT OR SERVICE” AWARD I nominate _____________________________________________________________________________ , MD (Please give specific and detailed examples of your nominee’s project or service)

________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________

Submitted by:____________________________________________________ Phone: ____________________ RETURN BY SEPT. 8

Mail to: Fresno-Madera Medical Society Historical Committee P.O. Box 28337 • Fresno CA 93729-8337

or Fax to: 224-0276

AUGUST 2014 / VITAL SIGNS

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Fresno-Madera

m u r o f k r o netw Fresno-Madera Medical Society PHYSICIANS: Looking for ways to: • Add more physical activity to your lifestyle?

• Be a role model and inspiration to your patients and your community?

• Spend more time with your family and friends?

Consider volunteering ONE HOUR every month or two in the Fresno-Madera Medical Society’s: WALK WITH A DOC Program This walking program is risk free and requires no preparation. Physicians just need to: SPEND A SATURDAY MORNING: • Presenting a 2-3-minute presentation on the health benefits of walking from the perspective of your specialty • Leading a 45-50 minute walk around Woodward Park in Fresno or Town & County Park in Madera • Answering potential questions from the walkers Encourage patients to take steps to improve their health

FRESNO: AUGUST 23 & SEPTEMBER 27

Woodward Regional Park Sunset View Shelter Registration 7:15am Walk Event 7:30am-8:30am

MADERA: AUGUST 2 & SEPTEMBER 7

Town & Country Park Pavilion Area Registration 7:15am Walk Event 7:30am-8:30am Ready to Volunteer?

For a schedule of dates and times Call the FMMS office: 559-224-4224x110 or send email to receptionist@fmms.org

Find us on Facebook: Fresno-Madera Medical Society

www.facebook.com/pages/Fresno-MaderaMedical Society/107731015917068

16 AUGUST 2014 / VITAL SIGNS

of the

LUNCH & LEARN for

Fresno-Madera Medical Society Members’ Medical Staff featuring

Update on Covered California: What Your Health Team Needs to Know presented by

Fonda Winslow Provider Educator California Medical Association Foundation Thursday, August 14, 2014 12pm – 1pm Fresno-Madera Medical Society offices 1040 E. Herndon Ave. #101 Discussion to include: • Distinguishing and verifying eligibility • Updated enrollment demographics • Information on the “grace period” for subsidized Covered CA patients • Overview of the ACA law • Health plans’ Network adequacy A light lunch will be available.

No charge to attend, but due to space limitations, no more than two (2) people per office may attend.

Must RSVP by May 20 to: Doreen Chaparro at dchaparro@fmms.org or 559-224-4224x 112.

Kern

Kings Editor’s Note: Due to a printing error in last month’s Vital Signs, this article was not printed. This month the article is reprinted.

GUEST EDITORIAL

2229 Q Street Bakersfield, CA 93301-2900 661-325-9025 Fax 661-328-9372 website: www.kms.org Officers Alpha J. Anders, MD President Michelle S. Quiogue, MD President-Elect Eric J. Boren, MD Secretary Bradford A. Anderson, MD Treasurer Wilbur Suesberry, MD Past President Board of Directors Alberto Acevedo, MD Lawrence N. Cosner, Jr., MD Vipul R. Dev, MD John L. Digges, MD Susan S. Hyun, MD Kristopher L. Lyon, MD Ronald Morton, MD Mark L. Nystrom, MD Edward W. Taylor, III, MD CMA Delegates Jennifer Abraham, MD Vipul Dev, MD John Digges, MD Lawrence N. Cosner, Jr., MD Staff Sandi Palumbo Executive Director Kathy L. Hughes Administrative Assistant

Medical Missionary Journey Thomas R. Larwood, MD with Portia Choi, MD The following article is a remarkable human interest story of Dr. Thomas Larwood’s life. It was first published in Levan Humanities Review, Volume 2, Issue 1 (2014). Over the next few months, we will continue with his story.

PART I Why did I become a medical missionary? My background gives clues. My maternal Grandfather was a Methodist Minister in Iowa and my Mother was a church organist and choir director. It’s too far back to count, but my paternal great, great Grandparents were Presbyterian missionaries to the Nez Perce, a Native American tribe whose territory covered parts of Washington, Oregon, and Idaho. On the way, my great-great-Grandmother, Eliza Hart Spalding, along with Narcissa Whitman became the first two Caucasian women to cross the Rockies.

Many of our family’s activities were church related, as were most of my closest friends. We had several visiting missionaries stay at our home, which helped bring the world to us. The road to becoming an Eagle Scout was a help.

Of the many influences, the simplest answer was in Isaiah, Chapter 6 Verse 8: “Also I heard the voice of the Lord, saying, ‘Whom shall I send, and who will go for us?’ Then said I, ‘Here am I, send me.”

In the ninth grade I decided to become an aeronautical engineer but while a freshman at Fresno State, I became doubtful about spending the rest of my life with numbers, so I talked to my Dad about it. He, a civil engineer and later a teacher, was not given to telling me what to do but rather would ask questions to help me find my own answers. He asked me what I was most interested in. I thought a bit, and then replied, “Science and people.” Then he wondered what that might add up to. The thought of my going into medicine had never seriously crossed my mind but it seemed to fit. The idea stuck and I became a pre-med student, never to look back.

After two years in college, I was drafted in 1944 and spent two years in the Navy Hospital Corps, which made me a better doctor later. Near the time of my discharge from the Navy, I was due to give the sermon at my home church in Fresno for Youth Sunday. On my way from the Oakland Naval Hospital, I stopped by for a brief visit at the Methodist Youth Conference being held at Monte Toyon near Aptos. I was struck that evening by Dr. Day’s talk in which he asked, “Are you going to invest your life or just spend it?” That night I felt that I had been called, so declared to the Methodist Board of Missions, my desire to be a medical missionary. The decision was enhanced by Gordon Seagraves’s book, “Burma Surgeon,” more so when he visited our church. Also by Albert Schweitzer, an accomplished interpreter of Bach on the organ, who became a physician and spent the rest of his life in Africa, with amazing results.

Following my last year of pre-med at UC Berkeley, I attended the U.S.C. School of Medicine. You might say it was a trial run for the future when I went on a Methodist Youth Work Camp in Mexico the summer after the first year of med school. Wally Duncan, a pre-med student from Indiana, who spoke no Spanish, and I walked around the countryside with two Mexican nurses, who spoke no English, giving smallpox vaccinations. My Spanish sure improved!

The rest of the guys were building a new playing field and basketball court at the school, constructing all from local materials with men from the community.

The fiesta that followed was participated in and enjoyed by all! My take-home message was that you do things with people, not for them.

Authors can be reached at trlarwood@bak.rr.com or ssportia@aol.com.

PO Box 1029 Hanford, CA 93230 559-582-0310 Fax 559-582-3581 Officers Jeffrey W. Csiszar, MD President Vacant President-Elect Mario Deguchi, MD Secretary Treasurer Theresa P. Poindexter, MD Past President Board of Directors Bradley Beard, MD James E. Dean, MD Thomas S. Enloe, Jr., MD Ying-Chien Lee, MD Uriel Limjoco, MD Michael MacLein, MD Kenny Mai, MD CMA Delegate Ying-Chien Lee, MD Staff Marilyn Rush Executive Secretary

AUGUST 2014 / VITAL SIGNS

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Tulare Editor’s Note: Due to a printing error in last month’s Vital Signs, this article was not printed. This month the article is reprinted.

HIPAA and Your Vendors

3333 S. Fairway Visalia, CA 93277 559-627-2262 Fax 559-734-0431 website: www.tcmsonline.org Officers Thomas Gray, MD President Monica Manga, MD President-Elect Virinder Bhardwaj, MD Secretary/Treasurer Steve Cantrell, MD Past President Board of Directors Anil K. Patel, MD Carlos Dominguez, MD Pradeep Kamboj, MD Christopher Rodarte, MD Antonio Sanchez, MD Raman Verma, MD CMA Delegates Thomas Daglish, MD Roger Haley, MD John Hipskind, MD CMA Alternate Delegates Robert Allen, MD James Foxe, MD Mark Tetz, MD Sixth District CMA Trustee Ralph Kingsford, MD Staff Francine Hipskind Executive Director Thelma Yeary Executive Assistant Dana Ramos Administrative Assistant

Tim Torian, Torian Group, Inc., www.toriangroup.com

HIPAA’s updates have expanded the requirements of business associates. A “business associate” is a person or entity

that performs certain functions or activities that involve the use or disclosure of protected health information on behalf of, or provides services to, a covered entity. If you have not already addressed this issue, you may need to create or update written agreements with many of your vendors.

Business associate functions and activities include: claims processing or administration; data analysis, processing or administration; utilization review; quality assurance; billing; benefit management; practice management; and re-pricing. Business associate services are: legal; actuarial; accounting; consulting; data aggregation; management; administrative; accreditation; and financial. These are non-employees that create, receive, maintain, or transmit protected health information (PHI). Examples of Business Associates include IT professionals, vendors such as software companies, bookkeepers, accountants, trainers, consultants, and other contractors that have access to the practice’s PHI. Business associates are responsible for their subcontractors, and they must comply with security and breach notification rules. Healthcare providers are liable for the actions of BAs who are agents, but not for those that are independent contractors. Here are some steps to take to assure compliance and limit your exposure: Implement or Update Security Policies and Procedures. A security breach poses the most significant risk for employers and business associates. Most settlements announced by HHS have involved a security breach. Six have resulted in settlements exceeding $1 million. Employers and business associates should implement or update policies and procedures to ensure compliance with the HIPAA Security Rules. It must be in writing. Review the basics and update your documentation. Make sure you are conducting the required risk assessments and addressing the findings in a written plan. Make sure your designated security officer is actually executing your security policies and plan. Consider outsourcing the IT portion of your assessment and corrective action if you don’t have the expertise.

Enter Into or Update Business Associate Agreements. For the first time, business associates are required to enter into business associate agreements with their subcontractors. The business associate agreements may not require significant changes for legal compliance purposes. However it is important to address potential liability for HIPAA violations. A significant number of privacy and security breaches involve a vendor. Do you have the updated Business Associate Agreement on file? Have you verified that the agreement does not disclaim responsibility? Are you confident in your business associates? The Business Associate Agreement must identify if the associate subcontracts with other individuals or groups. For example, if the medical office contracts with an IT professional and the IT professional subcontracts a computer technician and a breach occurs, who is responsible?

When writing or revising associate agreements, there are several critical elements to include: • Insurance – Ask if your business associates carries adequate liability insurance, and whether it covers a security breach.

• Security plan summary – A copy of the technical evaluation goes into the contract - requiring that the BA have adequate security, and be able to provide a written assurance of the security of protected data.

• Incident response – How long does it take the BA to respond? How long does it take them to protect? How long does it take them to remediate? Those types of questions all go into the contract. A 10 or 15 day time limit to disclose a security breach will give you time to do your own assessment and disclosure within the required 60 days.

In some cases you may need to educate those you contract with on these requirements. Covered health plans are not required to update their existing business associate agreements until September 22, 2014.

A sample Business Associate Agreement is provided by the Department of Health and Human Services: www. hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/contractprov.html.

Update or Implement Privacy Policies and Procedures. Employers that have previously implemented HIPAA policies and procedures will need to update them to address regulatory changes. Changes in the last year include the new standard for determining whether a security breach has occurred and new procedures regarding requests for access to PHI in electronic form.

Conduct Training. Employees need to be informed of the changes to HIPAA regulations that are relevant to their job functions. At the same time, employers and business associates can take advantage of the opportunity to provide refresher training.

The core of HIPAA compliance is good security practices. The burden of documentation and good planning are worthwhile considering the alternative. For more information is available at www.toriangroup.com/compliance.

All material presented herein represents the views and information of the respective authors and is considered to be current and reliable. It does not necessarily carry the endorsement of the Tulare County Medical Society and/or its’ officers.

18 AUGUST 2014 / VITAL SIGNS

CLASSIFIEDS

Tulare 2015 Coding Book News

It is that time again to start purchasing

coding books. Order your 2015 editions of CPT, ICD-9, ICD-10, and HCPCS through us. We are offering extraordinary discounted rates and free shipping directly to your office.

Please contact Dana Ramos, Provider Relations to order or obtain more information: 559-734-0393 or dramos@ tkfmc.org.

Tulare County Medical Society presents

Medical Office Salary Survey If you would like to receive one to complete and participate in the confidential results, email: Lydia@tkfmc.org and she will submit a blank survey to you.

If you submit your complete survey by August 22, 2014 you can participate in a drawing for a $100 Vintage Press Gift Certificate.

If questions, please call our office at 559-7340393.

Tulare County Medical Society Upcoming Events TRANSFORM YOUR FRONT DESK Thursday, November 13, 2014 1:00 ro 4:00 p.m.

Focus of training to be for front office staff on the following: • Communication skills • Importance of collecting Co-pays • HIPAA compliance & confidentiality • Short-notice appointments

CHART AUDITING FOR PHYSICIAN SERVICES Join us at the next Walk With A Doc to take a step toward a healthier you!

All you need to do is lace-up a pair of comfortable shoes and join us for some fresh air, fun and fitness.

TULARE Del Lago Park, Tulare, CA Saturday, August 23, 2014 8:00am to 9:00am VISALIA Riverway Sports Park, Visalia, CA Saturday, August 9, 2014 8:00am to 9:00am Who can attend: ANYONE For more information, please contact Tulare County Medical Society at (559) 627-2262

This class is a five-day class.

November 14, 21, Dec. 5, 12, & 15, 2014 9:00 a.m. to 12:00 p.m

CERTIFIED MEDICAL CODER COURSE AND EXAM This class is a five-day class.

November 14, 21, Dec. 5, 12, & 15, 2014 8:30 a.m. to 4:30 p.m. (one hour lunch break)

TCMS FAMILY DAY Sunday, September 14, 2014 McDermott Field House Details will follow by mail on all of the above events. If you have any questions, please feel free to call the Tulare County Medical Society office at 559-734-0393 and ask to speak to Dana Ramos. You may also email her at DRamos@ tkfmc.org .

Members: 3 months/3 lines* free; thereafter $20 for 30 words.

NON-Members: First month/3 lines* $50; Second month/3 lines* $40; Third month/3 lines* $30. *Three lines are approximately 40 to 45 characters per line. Additional words are $1 per word. Contact the Society’s Public Affairs Department, 559-224-4224, Ext. 118.

FRESNO ANNOUNCEMENTS Fresno Gastroenterology welcomes boardcertified physicians Dr. Paul Hanchett and Dr. Vivek Mittal. Referrals appreciated. Call 559323-8200 or Fax: referral to 559-323-9200.

University Psychiatry Clinic: A sliding fee scale clinic operated by the UCSF Fresno Dept. of Psychiatry at CRMC M-F 8am-5pm. Call 559-3200580.

FOR LEASE Medical office. 1000sf, up to 2500 sf at NE corner First/Herndon & NW corner First/Bullard; starting at $1 psf++ by owner. Call 559-824-9966 or 559-930-4297.

Office space at Chestnut/Herndon. Build to suit.

1200 sf. Call 559-287-3279.

PHYSICIAN WANTED .

Spruce Multispecialty Group of Fresno, committed to the private practice of medicine, is recruiting a BE/BC IM, Rheumatology or Pulmonary specialist. Contact Rathin at 559-289-9518 or tharathin@gmail.com.

Gar McIndoe (661) 631-3808 David Williams (661) 631-3816 Jason Alexander (661) 631-3818

MEDICAL OFFICES FOR LEASE 8327 Brimhall – 1,629 rsf.

8327 Brimhall – 2,288 rsf.

Crown Pointe Phase II – 2,000-9,277 rsf.

3115 Latte Lane – 5,637 rsf.

3115 Latte Lane – 2,660-2,925 rsf.

1150-1160 Lerdo Hwy, Shafter 1,766 to 3,793 sf.

9300 Stockdale Hwy. – 3,743 sf.

9330 Stockdale Hwy. – 5,754 rsf.

9900 Stockdale Hwy. – 2,085 sf.

500 Old River Rd. #185 – 3,071 sf.

SUB-LEASE 4100 Truxtun Ave. – Adm. & Billing – 6,613 rsf.

FOR SALE 2019 21st Street – 2,856 sf.

3015 Calloway – 1,465-10,318 sf.

Crown Pointe Phase II – 2,000-9,277 rsf.

AUGUST 2014 / VITAL SIGNS

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VITAL SIGNS Post Office Box 28337 Fresno, California 93729-8337

PRSRT STD U.S. Postage PAID Fresno, CA Permit No. 30

HAVE YOU MOVED? Please notify your medical society of your new address and phone number.

Proud to be endorsed by the Fresno-Madera, Kern, Kings and Tulare County Medical Societies

Our mission begins and ends with you, the policyholder.

That means connecting our members to the highest quality products and services at the lowest responsible cost. Join us as we enter a new phase of our journey and advance with our vibrant new look and expanding offerings.

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