Marin Medical Society

MMS News Briefs


November 2014

Download PDF Here

Fall Marin Medicine focuses on medical politics

Featured articles in the fall issue of Marin Medicine include "Medicare in Wonderland," a federal update, a report on Covered California, and the latest on Prop. 46. Other topics are options for preventing suicide, electromagnetic hypersensitivity, a review of Inheritance, and an update on Kentfield Hospital. Published Oct. 20, the magazine is in the mail and viewable as PDF or text online at the MMS website.

Marin County Physician Directory arriving soon

Each MMS member will receive one free copy of the 2014-15 Marin County Physician Directory, which lists practicing physicians in the county. Extra copies are now available for $40 each to nonmember physicians, health care facilities and the general public. Cost of extra copies for MMS members is just $30 each. To order, contact Rachel Pandolfi at 415-924-3891 or, or download the order form here.

The directory provides detailed photographic listings for MMS members, including primary and secondary specialties, board certifications, special medical interest, office address, phone, fax, email and medical training. Listings for nonmembers include primary specialty and phone. The directory also offers complete specialty indexes and an extensive list of local medical resources.

New this year: CMA ON-Call Index, a list of resources included in the online HEALTH LAW LIBRARY, with access to over 5,000 pages of documents and valuable information for physicians and their staff.

Dr. Bretan to receive AMA award

Peter Bretan, MD

The American Medical Association (AMA) will award Peter Bretan, MD, a Sonoma, Marin, and Mendocino County urologist, with the Benjamin Rush Award for Citizenship and Community Service at its November Interim Meeting of the AMA House of Delegates in Dallas, Texas. The award recognizes a physician who has gone above and beyond the professional call of duty to make an outstanding public service contribution to their local community.


* Get the facts at
* Click here to watch the "No on 46" ads.
* Order lab coat cards, "No on 46" buttons, posters, bumper stickers, and brochures in English and Spanish. Click hereto order them now - Free Shipping! (Or download Order Form.)
* Coordinate a meeting with your medical group. We guarantee a speaker! Contact Cynthia Melody at 707-525-4375
* Wear your "No on 46" button.
* Put a "Vote No on 46" yard sign in front of your office and at your home. We have crateloads at SCMA and will deliver. Just call us at 707-525-4375.
* A pull-out poster is available in the fall issue of Sonoma Medicine along with articles, charts, the order form and more.
* Talk with your colleagues, patients, friends, family, neighbors, the checkout person at the store, etc. about Prop 46:Increased costs; Losing your Doctor; Threatening your privacy.


DHCS releases duals project toolkit
The California Department of Health Care Services (DHCS) has published a physician toolkit to help providers and their patients understand the Cal MediConnect duals demonstration project. The toolkit includes an overview and several fact sheets that include how to submit crossover claims to Medi-Cal plans, contracting with Cal MediConnect plans, how crossover claims are processed for Medi-Cal managed care patients, continuity of care, and sample patient letters (for contracted and non-contracted physicians).

State issues report cards for HMOs, PPOs and large medical groups
The California Office of the Patient Advocate yesterday released its 14th annual "California Health Care Quality Report Cards" that rate the state's health plans and medical groups on a four-star scale.

The report cards allow consumers to compare the quality of care that more than 16 million commercially insured consumers receive from the state's 10 largest HMOs, six largest PPOs and more than 200 medical groups. Data used is drawn from 2013 claims data and patient surveys. Users can drill-down online to see specific plan performance on topics of greatest interest to them, such as chronic disease management, pediatric care and mental health care. The report cards are available at the Office of the Patient Advocate's website.

Blue Shield makes positive changes to reimbursement policy for physicians treating out-of-network exchange PPO patients
Blue Shield of California recently announced a two-part reimbursement policy change for contracted providers that do not currently participate in the plan's Individual and Family Plan (IFP) PPO product, otherwise known as its exchange/mirror PPO product. Blue Shield's policy change is in response to provider feedback of difficulties collecting from exchange/mirror patients they have seen out-of-network. The policy change also brings its physician payment rules in line with Blue Shield's facility payment policy for PPO exchange/mirror patients who are seen out of network.

CMA believes the policy change will be positive for physicians and commends Blue Shield for their responsiveness to provider concerns. Click here for more information or contact Blue Shield Provider Information & Enrollment at 800-258-3091.


New rules on prescribing hydrocodone combo products took effect Oct. 6
Medicines containing hydrocodone were reclassified as Schedule II substances, in line with oxycodone and morphine, effective Oct. 6, 2014. As Schedule II drugs, patients will need a new script each time the medication is filled (prescription could be refilled five times). Physicians will not generally be allowed to call, fax or e-mail in a prescription to a pharmacy, instead patients will have to present a written prescription. Click here for more information, or contact: CMA Legal Information Line, 800-786-4262 or

CMS launches Open Payments website
The Centers for Medicare & Medicaid Services (CMS) launched its Open Payments website, which allows consumers to see the financial relationships between drug and medical device manufacturers and physicians as reported under the Physician Payments Sunshine Act. To view Open Payments physician payment dataset, click here.

The data published online contains 4.4 million payments made between Aug.1 and Dec. 31, 2013, valued at nearly $3.5 billion and attributable to 546,000 individual physicians and almost 1,360 teaching hospitals. The database is divided into three categories, general payments, research payments and physicians ownership and investments. CMS plans to publish these reports annually and will include a full 12 months of payment data, beginning in June 2015.

The Sunshine Act requires drug and medical device manufacturers and group purchasing organizations to report their financial interactions with licensed physicians-including consulting fees, travel reimbursements, research grants and other gifts.

Physicians have until Dec. 31 to file disputes for any inaccurate information that should be corrected in the next data release. View instructions for doing so on the AMA's Sunshine Act website.


CMA publishes summary of new 2015 health care laws
The California Legislature had an active year, passing many new laws affecting health care. In particular, there was a strong focus on scope of practice for allied health professionals, prescription drug abuse, public health issues and health care coverage. CMA has published a summary of the most significant new health laws. Click here to read CMA's Significant New California Laws of Interest to Physicians for 2015. Click here to download the PDF of new laws (700 KB).

How much revenue is your practice losing by not working denials?
It's no secret that claim rejections and denials can result in a significant amount of lost revenue. Consider this-a practice submitting 80 claims a day at an average reimbursement rate of $100 per claim should expect to receive $8,000 in daily revenue. If 10 percent of those claims were rejected or denied (eight claims per day at $100 per claim equals $800 per day), and the practice only appealed one out of every 10 rejections or denials ($720 per day loss), the practice could expect to lose as much as $180,720 annually (251 business days at $720 per day in denials or rejections). The numbers are staggering and the loss of income could cover the cost of several full time employees

While it might not be feasible for a solo or small physician group to appeal every single denial or rejection, practices can significantly reduce potential lost revenue by identifying and addressing the three most common reasons for denial or rejection: internal billing error; payor error; or medical necessity denial. Click here for more information.

CPR / CMA Practice Resources
CPR is a free monthly e-bulletin from CMA's practice management experts that focuses on critical payor and health care industry changes and how they directly impact the business of a physician practice. Each issue includes tips on reimbursement and contracting related issues along with information on the latest practice management news. TheOctober issue includes:

> Are you ready for the new prescription drug prior authorization form required on Oct. 1?
> DHCS releases duals project toolkit
> New rules on prescribing hydrocodone combo products take effect Oct. 6
> How much revenue is your practice losing by not working denials?
> DHCS announces additional delays for some ACA Medi-Cal primary care rate increases
> DHCS announces new continuity of care rules for duals demonstration project
> DHCS revises Cal MediConnect "Choice Forms"
> Medi-Cal audits began in September
> Meet your CMA affinity partners: Staples Advantage
> Updated payor profiles now available
> The Coding Corner: Coding office E/M at the highest level: 99215

Click here to learn about how you can sign up for a free CPR subscription, contact CMA with questions about articles, and download a printable version of the newsletter.


MMS members get free classifieds!
MMS members can place free classified ads in News Briefs or Marin Medicine. Cost for nonmember physicians and the general public is $1 per word. To place a classified ad, contact Susan Gumucio at or 707-525-0102.


The Marin Medical Society, a 501(c)(6) nonprofit association, supports local physicians and their efforts to enhance the health of the community. Founded in 1898, MMS is affiliated with the California Medical Association and the American Medical Association. Visit us at

© 2014 MMS, 2901 Cleveland Ave. #202, Santa Rosa, CA 95403