Medicine Cabinet Fall 2011

The Medicine CabinetAutumn QuarterSeptember 2011

SCCMS 2011-2012Board of Governors

Officers:Don Hernandez, MD PresidentJeannine Rodems, MD Pres ElectVickie Winkler, MD SecretaryBrian Brunelli, MD TreasurerJoydip Bhattacharya, DO Past Pres.

Governors:Steven Magee, MD 2009-12John Christensen, MD 2011-12Susan Schaefer, MD 2010-13Kim Schulz, MD 2011-14Jennie Jet, MD 2011-14

CMA Delegates:Jack R. Watson, MD 2011-14Dean Kashino, MD 2010-13Michael Coulson, MD 2010-13Hannah Farquharson, MD 2009-12

CMA Alternates:Nicholas Abidi, MD 2011-14Rosalind Shorenstein, MD 2010-13Jeannine Rodems, MD 2010-13Gordon Lee, MD 2009-12

Health Officer:Poki Namkung, MD,MPH

Ex Officio - At Large:Richard Hencke, MD

District VII CMA Trustees:Jimmy Chung, MDDavid Goldschmid, MDTanya Spirtos, MDMartin L. Fishman, MD

Inside this issue:Membership Social 3Practice Managers Network 4-5Art & Music Show 7HIPAA 5210 Conversion 8-11CMA Webinar - October 12DocBookMD 14Membership News 15Calendar 16

“You’re going to find that many truths we cling to depend greatly on our own point of view.”

- Obi-Wan KenobiThe feedback I get from these quarterly newsletters is interesting. Mostly, the feedback is positive, often laced with well-intended advice: “Don’t go so highbrow,” “You can be a little… um… wordy sometimes; use less words,” or “Show your sense of humor more!” As I take these comments in, reflect, cogitate and try to apply the assistance, I’m left to readjust my muse in hopes of better defining the message. Now, ordinarily, my effort starts with a troubled gaze at a blank screen with a flashing nay scolding cursor reminding me that there is a page to be filled, somehow before the deadline. I peruse the literature hoping for inspiration or try to seek it in conversations we have colleague to colleague. I remember the words of my teachers, in a frustrating attempt to channel their wisdom somehow. Ultimate-ly, I am resigned to a session of chin scratching and finger tapping sitting in a comfy chair, with a glass of local Santa Cruz Mountain Pinot Noir (buy local) at the ready, and then, from some unknown place, a kernel of an idea germinates and takes form.

This time was no exception, furrowed brow included.

It has been a busy quarter on many levels. Local issues, state and national trends, quite a stew to pick through.

And while admiring the glistening legs the swirling gift of Dionysus, it came to me. (Allu-sions from Greek mythology a bit too highbrow maybe?) Anyway, what occurred to me was a subject that, on brief deliberation, is honestly the basis of all we do.

Relationships.

When one distills it down, we are in a relationship-based business. We develop and strength-en relationships with our patients, with the staff and other non-physician professionals that assist us, with each other and with the institutions where we apply our craft. With every technological advance or groundbreaking therapy employed, prior to any computer login happening, before any intensely regulated timeout takes place, or preceding any call to order, there must be, at the start, a relationship.

It is how we ultimately do what we do.

It has ever thus been so. When we think back to our first brushes with education, we may have been inspired by some one to pursue the arduous course that led us to this profes-sion. We grinned into camera lenses, robed in gowns and tasseled caps, embraced by family and friends sharing the communal pride of these people who always knew somehow we could reach our goals. We had classmates and co-residents to commiserate with, and we had instructors or Attendings who guided us and showed us the path. When we were up bleary-eyed at night, it was a kind nurse or pharmacist or radiographic tech who handed us a warm drink and struck up a conversation to help us remember that there was always light at the

A quarterly newsletter of the Santa Cruz County Medical Society

The President’s Cornerby Donaldo Hernandez, M.D.

The Medicine CabinetPresident’s Corner, continued

end of the tunnel. We went on to develop partnerships and referral contacts and co-management associations. The walk continued with Medical Staff appointments and committee assignments and professional associations that opened us up to the ever-confounding world of bureau-cracy in all its confusing glory.

And always, always at the core of it all was our patients. We all have reflective stories about that handful of patients that for whatever reason never stray too far from our memory. We feel and are moved by their collective effect in a very real and individual way.

In today’s world, what has been abundantly clear too me too is all the energy that tries to fractionate us all into groups or overriding categories. Solo versus Small Group versus Large Group practice, Primary Care versus Specially care, Outpatient or Hospital based just to touch on a few. Perhaps it’s really more of a reflection of our nation as a whole. We live in an age of scission. Vegan versus Carni-vore, PETA loyalist versus Fur loving capitalist, Blue State or Red State, Tea Party or Progressive; it feels like people have gotten more deeply imbedded in their silos than ever before, and in some cases, so imbedded they can’t see above their own self imposed ramparts. The effect can be polarizing and feel like there is some unwritten intent on insinuating conflict and division. And there are moments when it appears as though it is the overriding narrative.

There’s a kind of sadness in that for me. In an environ-ment such as this one might loose sight of the fact is that we are all actually members of a larger community, interde-pendent and truly reliant on each other. There is a cer-tain simplicity acknowledging that we are really all in this together and we need one another. Despite the economic downturns or the uncertainty about the future of health-care reform, our real strength comes of relying on each other. We count on the fact that those providers that call Santa Cruz County home, who work and serve here, who live here, play here, and raise families here have a unique understanding of the community at large and the needs that exist here. There is reassurance in knowing that we are all of this place. And as we grow to rely on each other, we come to trust each other. We develop accountability to each other. It is through trust and accountability that we gain the understanding that we need each other to perform our jobs, no one cog more important than another cog in the system that tries to assure health care delivery in this smallest of counties. That which affects one member or

group in our community of professionals can and often does spill over and affects the rest of us. It is the knowl-edge of the global community needs that has to be learned beyond the examination room, the emergency room and the OR. It is learned in sponsoring a Little League team and listening to parents express their concerns. It is learned in donating time to a food bank and wondering where some folks are going to get their next meal. It is reinforced at a back to school night or while giving a talk at a skilled nursing facility. Performing school physicals or walking the sidelines at a football game or working with other provid-ers to coordinate services or address needs can only serve to strengthen that understanding. It’s a knowledge that has enormous and incalculable value.

At times, the value of that knowledge can appear down-graded as larger business entities grapple with the signifi-cance and necessity of that community-based understand-ing while they seek to maintain what they see as financial viability. Frequently, it may appear at first blush to be sound principled business decisions can and often does have a profound effect in unraveling the longstanding in-terdependent functioning of all the composite entities that provide care for a community. An unfortunate but perhaps unavoidable byproduct of some of those decisions is the erosion of trust. And ultimately, the effect of the break-down of trust is counter to what is needed for many busi-ness relationships to succeed.

There is in all likelihood no way to change that or forestall the uncertainty that arises in seeking the truth and trying to maintain stability. Who’s to say how and in what form that future challenges might present themselves. We do know the current economics will reveal issues that we might not have foreseen and from places we could not anticipate. It may require us in the not to distant future to rethink or nimbly restructure our customary practices, or defend core issues that protect our profession. Now more than ever, we need to come together and speak with a clear and reasoned consensus. We cannot evade the responsibility we have to advocate for our profession and for our patients. We need to work towards trust and develop common goals to improve the health of our community. We assuredly have a stake in the outcome as demands external to us collectively will profoundly affect us individually. Lets us see our interdependence as strength and come together to positively influence the health of our fellow citizens, our state and country and ultimately ourselves. We truly are, all in this together.

The Medicine CabinetYou are cordially invited to atten the

Autumn Members Social & Wine Tastingto be held on

Wednesday, November 2, 2011at the

Bargetto Winery3535 North Main Street, Soquel 95073

Wine Tasting & Hors d’oeuvresfrom 6:00—8:00 p.m.

Free to memberswith advance RSVP. Otherwise $20 at the door.

Retired members ($20pp, RSVP req)

Guests & non-members heartily welcomed ($38pp, RSVP req)

RSVP by Thursday, October 27, 2011Call: 479-7226 Email: [email protected] Fax: 479-7223

Name: ______________________________________________________

Name: ______________________________________________________

To charge to VISA or MasterCard, call 479-7226 prior to the event. Checks accepted at the event; make payable to Santa Cruz County Medical Society

Are You a Presenter at a Local Health Care Event?Remember to notify SCCMS

We love to advertise our members and we can help advertise the event by placing it on our web site public calendar. We also get calls from the public asking for information about upcoming health care events; it helps us to have correct, up-to-date information. So, please don’t forget to notify SCCMS about your out-side, public events; just another way that SCCMS supports its members!

The Medicine Cabinet

Certified Medical Coder Course - in Santa CruzBy Practice Management Institute

Dates: Mid January thru February 2012 (exact dates TBD) Meets 1 day per week for 5 weeks

Time: 8:30am—4:30pm

Cost:CMA members’ staff: $649/person (includes course and 5 lunches).

Non-CMA members’s staff: $750/person (includes course and 5 lunches). Why should I or my staff be certified? The cer-tification becomes a currency that validates personal achievement, demonstrates a person’s commitment to the profession, improves employer confidence, and can help guard the practice against fraud and abuse.

This individual plays an integral role in the reimburse-

ment process ensuring that proper documentation guidelines are followed and that codes are submitted to the highest degree of specificity to ensure that the physician receives every dollar entitled for the services rendered.

Caution: This course does NOT teach coding. It is designed to certifie the attendee’s knowledge of cod-ing. More info on course: More info on course: www.pmimd.com/cer tify/cmc/cmc.asp.

Where: Meets in the SCCMS office at 1975 Soquel Dr #215, Santa Cruz. Two blocks south of Dominican Hospital; upstairs, inside the Wells Fargo Bank building.

Register no later than December 21, 2011 by calling 479-7226 or mailing the form on the previous page. Payment due at time of registration.

Register for Certified Medical Coder CourseAttendee Name: _________________________________________________________________________

Attendee Name: _________________________________________________________________________

Physician’s Name: _______________________________________________________________________

Attendee’s work email: __________________________________________________________________

Attendee’s work phone: ____________________________________________________

Cost: $649/person for CMA member’s staffCost $750/person for non-CMA member’s staff Payment by check (enclosed) Payment by VISA or MasterCard, please call 479-7226.

Mail completed form and payment to:SCCMS, 1975 Soquel Dr #215, Santa Cruz CA 95065-1821. ● Questions? Call 479-7226

Practice Managers Network


Practice Management WorkshopsStrategic Planning for 2012

Two FREE workshops for practice/office/billing managers of SCCMS members. Kate Nakfoor will teach attendees the following:

Strategic Plan: How to Create One & WhyWednesday, October 12, 2011 | 8:00-10:30amLearn how to decide on a common vision and goals for the next year. Goals come from ou, the manager, the physician owners, staff, and the organization as a whole.Homework assignment during the month after this worshop is to meet with your staff, physician bosses, departments, etc. and cre-

ate goals for 2012. Bring those goals to the November workshop where the education continues.

Strategic Plan: How to Execute the PlanWednesday, November 9, 2011 | 8:00-10:30am

Learn how to set a plan for 2012 which will help you develop a road map for everyone in the practice to follow in order to achieve the same goals.

RSVP today by calling SCCMS at 479-7226 or emailing [email protected].

Coming in 2012 the Santa Cruz County Med-ical Society will offer a quarterly Leadership series for members’ practice/office/billing managers. By participating in this series you will receive:

Leadership Style Assessment Tool• Skills development in leadership man-•

agement and personal developmentImprove critical and organizational •

thinkingPrepare yourself for increased career op-•

portunities

Make yourself a bigger asset to your • practice owners.

Two of the meet-ings will be held in North county and two will be held in South county.

Contact SCCMS to reserve your seat: Call 479-7226 Email [email protected]

Practice Management Leadership SeriesQuarterly during 2012

Practice Managers Network


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The Medicine CabinetWhat happened to the Art & Music Show?

Well, we are pleased to announce that the 10th Annual Physician Art & Music Show is scheduled for April 17-22, 2012. We are rolling out some new ideas and enhancements for, what we hope will be, a smashing 10th Year Show & Event!

First, let us provide a summary of why we are making some changes to the Show. As you know the Dominican Hospital Foundation (DHF), has been a partner with SCCMS. With the transitioning of the DHF Executive Director (E.D.), their Board and new E.D. found it appropriate to evaluate their participation with the Show. Ultimately, DHF will not continue their sponsor-ship. Additionally, over the last few years the Show generated little net revenue, barely paying expenses for the Show with very little, if anything, left over for the named charitable orga-nizations. In the meantime, leadership and volunteers for the Show has fluxuated greatly resulting in a heavy dependence on SCCMS staff. Seeing these trends, the SCCMS BOG decided it was time to do our own evalaution of the Show.

Enter the CruzMed Foundation, the new 501 (c)(3) philanthropic arm of SCCMS. Currently under organi-zation, funds generated under the foundation will support local scholarships for premed students at UCSC, P.A., nursing and M.A. students at Cabrillo, as well as other outreach projects in our community. The SCCMS Board of Governors agree that we have a wonderful opportunity to bring to our community an enhanced and slightly redesigned Physicians Art & Music Show for it’s 10th Annual under the umbrella of the CruzMed Foundation.

How is the event shaping up? In order to allow for ample planning and execution time, the 10th Annual Show was moved to the spring. As in the past, art will be displayed at the Santa Cruz Art League. There will be an expanded Reception/Benefit Event to be held at a different location (still to be determined), on the 16th or 17th. The evening will include wining and dining, a display of one item from each artists’ col-lection, pieces of art for sale, a silent/live auction, and music from our physician musicians.

What’s next? We need your help! As in the past, we hope that all our local physician artists and muscians will participate by contributing their artist and/or musical talents. We are also seeking volunteers to help with the planning, marketing, and execution of the show and event. If you, your spouse, extended fam-ily or members of your practice can participate in one or more of these capacities, we would love to hear from you. Please contact Donna Odryna at (831) 479-7226 or email her at [email protected]. We will be getting together in the next month to begin planning. First order of business will be new branding ideas for the Show and Event. Bring your love for art and music and your ideas to the table and join the show!


HIPAA 5210 Conversion: Are Your Ready?Physician practices may need to make adjustments to the patient data they collect and report in order to comply with a new HIPAA requirement that takes effect Janu-ary 1, 2012. The new “HIPAA 5010 regulations” impact all health care providers who conduct administrative transactions electronically (including submitting claims, checking eligibility and claims status, or obtaining remit-tance advice and referral authorizations). The regula-tions cover all HIPAA-covered transactions, and there-fore apply to most physician practices, health insurance companies and clearinghouses. The changes primarily impact software vendors and billing clearinghouses, but compliance may require medical practices to change some business processes as well.

The SCCMS is advising members to familiarize them-selves with these regulations and be proactive about making the needed changes to comply. The Centers for Medicare & Medicaid Services (CMS) has advised that the regulations will not be delayed, and failure to comply will result in nonpayment of claims effective January 1, 2012. There are no exemptions for physicians who bill electronically based on specialty, practice size, or any other criteria. The remainder of this article provides background on the HIPAA 5010 regulations and guid-ance for physicians to plan ahead to minimize the risk of payment interruptions in 2012.

Background: HIPAA 5010 standardsPhysician practices who conduct administrative transac-tions electronically (including submitting claims, check-ing eligibility and claims status, or obtaining remittance advice and referral authorizations) are required to meet Health Insurance Portability and Accountability Act (HIPAA) standards to perform such transactions. These standards ensure consistency in the type and format of data required in a given electronic transaction regardless of which billing vendors, clearinghouses or payers are involved.

Currently, electronic transactions utilize the 4010 ver-sion of the HIPAA electronic transaction standards. In 2006, CMS began the process of updating from the 4010 standards, which were originally developed in 2000 (and subsequently revised in 2002), to the “5010 stan-

dards”. The rationale for making the switch is that the 4010 version, just like any other software application, has become outdated. Many technical issues have been found in transactions since 2000 and new business needs have been identified that cannot be accommodated with the 4010 version of the standards. For example, conversion to the 5010 standards is a prerequisite for the conversion from the current ICD-9 diagnostic code set to the new ICD-10 code set, which is mandated for October 1, 2013. The ICD-10 codes have a different format and length than the ICD-9 codes, which cannot be reported in the current 4010 version of the HIPAA transactions, so the upgrade to 5010 needs to be com-pleted before ICD-10 codes can be reported. Work was completed between 2006 and 2007 on a newer version of each transaction, Version 005010, commonly called “5010.” In 2009, the Department of Health and Human Services (HHS) and CMS announced that physicians and other health care providers would be required to use the updated 5010 versions of the HIPAA transaction stan-dards by January 1, 2012.

What is actually changing? Who does it apply to?Physicians and other health care providers are HIPAA “covered entities”, which means they must comply with HIPAA requirements when conducting electronic trans-actions. Therefore, if you currently send and receive HIPAA-covered electronic transactions (including sub-mitting claims, checking eligibility and claims status, or obtaining remittance advice and referral authorizations) and plan to continue doing so, then you will be required to upgrade to the 5010 standards.

The 5010 standards have reporting requirements that differ somewhat from the current standards. These changes may require you to collect additional data or report data in a different format. Some (but not all) examples include: no longer reporting a PO Box in the Billing Provider Address field (PO Box addresses for payment purposes will now be reported in the Pay-to Address field); reporting a 9-digit ZIP code in the Billing Provider and Service Facility Location address fields; reporting a patient with a unique health plan member ID as the subscriber; and, only reporting minutes rather than units of anesthesia time. You should consult your

The Medicine Cabinetbilling service, clearinghouse and payers to determine what changes will apply to your practice.

Is there any flexibility on the January 1, 2012, com-pliance deadline?CMS has advised that these regulations will not be de-layed. The necessary software and system changes need to be in place by the compliance date in order for you to continue sending and receiving HIPAA electronic trans-actions. Failure to comply will result in nonpayment of claims effective January 1, 2012. Any 4010 transactions sent on or after January 1, 2012 will be rejected as non-compliant and will not be processed.

You may begin using the 5010 standards in advance of January 1, 2012, to test the system and minimize the chances of billing interruptions. You can begin to use the 5010 transactions if you are ready and mutually agree to this with your clearinghouses or payers. Using the transactions before the deadline will give you the ability to see that transactions are working smoothly and are continuing to be processed. If any issues are identified, you can resolve them before the compliance deadline.

If you will not be ready by the compliance deadline, you will need to talk to your payers, clearinghouses, and billing service to determine what actions you can take to continue to have your transactions processed and receive payments.

What do physicians have to do to comply?The biggest concern for physician practices will be complete implementation and full functionality of the 5010 transactions at or before the compliance deadline of January 1, 2012. Not all of the 5010 changes are IT changes and some will impact your business functions.

To avoid rejected claims and cash flow interruptions, physicians should work with their vendors, clearing-houses, billing services, and payers to upgrade and test their systems to ensure that they are able to successfully implement the new standards prior to the compliance date. The American Medical Association (AMA) has developed several resources to assist physicians make the transition to 5010, including the following checklist:

1) Talk to your current practice management system vendor. Be sure to ask the following questions:

a) Will you be upgrading my current system to ac-commodate the 5010 transactions?b) Can my current system accommodate both the data collection and transaction conduction for 5010?c) Will there be a charge for the upgrade?d) When will the upgrades be available?e) When will the installation to my system be com-pleted?f) What resources to you have to help us covert to 5010 before January 1?

2) Talk to your clearinghouses or billing service, and health insurance payers. Ask the following questions:

a) Will you be upgrading your systems to accom-modate the 5010 transactions?b) Will you be increasing your fees for the 5010 transactions?c) When will your upgrades be completed?d) When can I send test transactions to you to test that the system will work?e) Will I need to re-negotiate my provider contract or electronic data interchange (EDI) agreement based on the move to the 5010 transactions?f) What resources to you have to help us covert to 5010 before January 1?

3) Identify changes to data reporting requirements. Questions to consider are:

a) Can we identify the data reporting changes for the various transactions we use?b) Can we find resources to assist us in identifying the data reporting changes?c) What is the cost of the resources we need?d) Should we use a consultant to assist us in identi-fying the data reporting changes?e) What is the cost of hiring a consultant?f) Which of this new data can be stored in our cur-rent system?g) Which of this data relies on the system upgrade in order to store it?

4) Identify potential changes to billing and EMR sys-tems, existing practice work flow and business

Continued on next page

The Medicine Cabinetprocesses. Questions to consider are:

a) Do we need to make any system upgrades? What is the cost?b) Do we currently collect this data?c) If not, how will we capture the data?d) What added costs will result from new data collection methods, e.g. longer appointment times, revising existing forms?e) What work flow processes do we need to change or add to capture the new data?f) What are the costs of the newly revised work flow processes?

5) Identify staff training needs. Questions to ask include:

a) Who should be trained on the transaction chang-es?b) How long will it take to train the staff on the changes?c) Will there be “downtime” during the training?d) Should we use a consultant to conduct the train-ing and if so, what is the cost of a consultant?e) What resources do we need for the training and to support staff after training?f) What is the cost of purchasing or creating the training resources?g) When should training be completed?

6) Test with your trading partners, e.g. payers and clearinghouses. Questions to consider about testing:

a) What transactions should I test?b) Which trading partners should I test with? Test the 5010 transactions with your payers through the channels you use today to send and receive transac-tions. Specifically test with the payers and clearing-houses that make up your highest volume and/or highest dollar amount of claims.c) When should I begin testing? Talk to your bill-ing service, clearinghouses, and payers about the processes they will be using for testing. Follow their procedures and make certain that your testing is completed.d) Will the testing be truly test data or will it use live production data?e) Does everything work? Work with your vendor to fix any issues identified during testing and re-test with your billing service, clearinghouses, and payers.

7) Budget for implementation costs, including expens-es for system changes, resource materials, consultants and training.

a) Do we have a backup plan? A major concern is the potential for disruptions in transactions pro-cessing after January 1, 2012. Physicians should develop a “back-up plan” or safety net to address what they will do if their transactions do not work and they do not receive payments.

Where can I find more information?A broad group of health care industry stakeholders (including the AMA) are coordinating their efforts to support a smooth and timely transition to the 5010 transactions and have developed free archived webi-nars that are available for viewing at GetReady5010.org. These webinars will focus on testing the 5010 HIPAA electronic administrative transactions and feature speak-ers from the Centers for Medicare & Medicaid Services (CMS), and provider and payer organizations.

In addition, there are numerous online resources avail-able from the AMA, CMS, and the GetReady5010.org websites:

American Medical Association website on “Version 5010 Electronic Administrative Transactions” (http://www.ama-assn.org/ama/pub/physician-resources/solu-tions-managing-your-practice/coding-billing-insurance/hipaahealth-insurance-portability-accountability-act/transaction-code-set-standards/version-5010-electronic.page ). The AMA’s website includes:

5010 FAQs•

AMA’s archived webinar, “5010 and ICD-10: What • They Are and How to Prepare for Them”

“5010 Checklist” that lists activities to guide physi-• cians through their implementation of the Version 5010 HIPAA transactions

“5010 Project Plan Template – Helping Practices • Prepare for the New HIPAA Standards”

“7 Steps Practices Can Take Now to Prepare for • 5010”

5010 Fact Sheet Series•

Links to additional resources•

The Medicine CabinetCenters for Medicare & Medicaid Services (CMS) website (http://www.cms.gov/Versions5010andD0/ ). The CMS website includes:

Preparing for the Electronic Data Interchange • (EDI) Standards: The Transition to Version 5010 and D.0

New Health Care Electronic Transactions Stan-• dards Versions 5010, D.0, and 3.0

Transition to Versions 5010 and D.0: Checklist for • Level I Testing Activities

Transition to Versions 5010 and D.0: Provider Ac-• tion Checklist for a Smooth Transition

GetReady5010 website (http://getready5010.org).

An education effort supported by the AMA and • other health care industry stakeholders to support a smooth and timely transition to the 5010 transactions

Includes physician resources, as well as free webi-• nars and materials on testing of 5010 transactions

If you have questions or need assistance obtaining additional information, please contact the SCCMS at 479-7226 or by email at [email protected].

Sidebar: 5 Action Steps Your Practice Can Take Nowfrom the AMA

The following are five simple actions you can take now to start getting ready for the 5010 conversion. Please note: These are not all of the 5010 data reporting changes; you should check with your clearinghouses and billing ven-dors to determine the full scope of changes that apply to your practice.

Action 1: Is your practice reporting the appropriate Type 2 (organizational) National Provider Identi-fier (NPI) number for the Billing Provider on all electronic claim submissions? In 5010, you must bill all payers the same way using your lowest “level” Type 2 NPI for the Billing Provider. (For example, if your practice has an NPI at the practice level and you have a lab facility under the practice that received a separate NPI, then when billing for the lab services, you will be required to report the lab’s NPI. The lab’s NPI will need to be reported the same way to all of your payers.) If you are not doing this today, work with your payers now on

making the changes to report your Billing Provider NPI correctly for 5010.

Action 2: Is your practice using the 9-digit ZIP code in the Billing Provider and Service Facility Location address fields in your electronic claim submissions? In 5010, the 9-digit ZIP code is required in these two address fields. Begin using the 9-digit ZIP code today in these locations in preparation for the 5010 requirements.

Action 3: Is your practice currently reporting a PO Box in the Billing Provider address field of elec-tronic claim submissions? PO Boxes are not permitted in the Billing Provider Address field in the 5010 claim transaction. The Billing Provider Address must be the street address or physical location of the Billing Provider. If you wish to have payments delivered to a PO Box or different address from the Billing Provider street address, report this address in the Pay-to Address field. If you will be changing the address you report today in the Billing Provider Address field, you should contact your payers about updating your enrollment information. Many pay-ers use the address in their provider files to validate the physician, so they may pend or reject your claims if you begin submitting a different address in your claim. You may also need to update your information in the National Plan & Provider Enumeration System (NPPES) (https://nppes.cms.hhs.gov/NPPES/Welcome.do).

Action 4: Is your practice currently submitting elec-tronic claim submissions that accurately balance at the line level? This will be a requirement in 5010, so begin making the claim balance at the line level. Payers will also be required to ensure the electronic remittance advice accurately balances at the line level.

Action 5: Do you receive paper explanations of benefits? If not, now is the time to consider moving to electronic remittance advices. Use of the electronic transaction is more efficient and cost-effective for physi-cian practices. In preparation for the electronic remittance advice transaction, become acquainted with the HIPAA mandated Claim Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs) that are used in the transactions. To access the current HIPAA CARC and RARCs, visit www.ama-assn.org/go/claims-assistant to access a complimentary look-up tool or visit www.wpc-edi.com and select “Code Lists.”SCCMS thanks the staff at Alameda-Contra Costa Medical Asso-ciation for allowing us to use this article.


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800-842-3761 • [email protected] • www.MarshAffinity.com • CA InS. LIC. #0633005


October 2011

Oct 5 “Providing �xtraordinary Customer Service” – 12:15 – 1:15pmWebinar: Debra Phairas of Practice and Liability Consultants will help practices break through the limits of

ordinary communication, outdated work habits and improve overall customer service and personal

fulfillment.

Oct 5 “What �very Physician Needs to ,now About Their Practice”Seminar: CMA’s Frank Navarro will teach physicians and their staff how to control costs, maintain

quality staff and improve patient experiences to help ensure the success of the practice. Hosted by

Butte Glenn Medical Society. Call (530) 342-4296 for information and registration.

Oct 6 “Basic �state Planning” – 12:15 – 1:15pmWebinar: Attorney Mark Drobny of Drobny Law Offices, Inc. will lead this informative discussion.

Oct 11 “What Would Happen to My Practice if I Were to Die” – 12:15 – 1:15pmWebinar: Attorney Mark Drobny of Drobny Law Offices, Inc. will lead this informative discussion.

Oct 12 “ICD-10” – 12:15 – 1:15pm & 6:15 – 7:15pmWebinar: Practice Management Institute's Linda D'Spain will help you to master the next generation of

coding! Prepare now for ICD-10 transition which will make more than 200,000 diagnosis codes effective in

2013.

Oct 18 “HIPAA 5010 Transaction and ICD-10” – 12:15 – 1:15pmWebinar: David Ginsberg of PrivaPlan will cover the key requirements for 5010 and ICD10 for CMA

practices. Special focus will be given to ensuring your practice management and clearinghouse

vendors are ready, how you can determine what you may need to do with your key payers or local

IPAs and also steps you should take to minimize any cash flow impact in January.

Oct 19 “�OB Analysis: Successful Claims Appeal” – 12:15 – 1:15pmWebinar: There’s a healthy chance that some of your insurance claims will be denied or your

reimbursement will be whittled down to where you say “ouch”. Scrutinizing your explanation of benefits

or remittance advance is a key to successful claims appeal. Led by Mary Jean Sage of Sage Associates.

Oct 26 “,ey Financial Eatios to Increase Profitability” – 12:15 – 1:15pm & 6:15 – 7:15pm Webinar: Debra Phairas of Practice and Liability Consultants will teach critical skills in analyzing the

practice profit/loss statement for overhead expense ratios, accounts receivable ratios, staffing ratios

and how to access specialty comparison norms for benchmarking.


DocBookMD is a smartphone platform designed by physicians for physicians, that provides an exclusive HIPAA-com-pliant professsional network to connect , communicate and collaborate with your colleauges. As physicians, we always look for ways to manage our hectic profes-sional schedules. DocBookMD will help you save time and prevent delays at Point-of-Care.

*DocBookMD is in partnership with your County Medical Society to supply this amazing app FREE and help you provide the best care and service to your patients.

DocBookMD gives you...On-Demand Messaging

Send instant HIPAA-compliant • messages

Set message priority - Get a 5 min, • 15 min, or normal response time

Multi-Media CollaborationSend high resolution images, e.g. •

of X-rays, EKGs or wounds.Fast Look up of Physicians

A directory of your county medical • society colleagues.

Use on Multiple DevicesSwitch easily and seamlessly between •

up to 2 devices: iPhone, iPad or iPod touch, or Android

Quick Pharmacy Search

GET STARTED It’s easy as 1 2 3!

First, contact SCCMS for our County Medical • Society ID number. Call 479-7226 or email [email protected].

Then download DocBookMD from the iTunes • App Store or the Android Market.

Open the app on your phone to begin the regis-• tration process. This is when you will need the ID number.

Start using DocBookMD to connect, communi-• cate and collaborate!


Membership News

Edgar A. Gamboa, M.D.Surgery, Traumatic Surgery160 Green Valley Rd #210Freedom CA 95019P: 724-7874 F: 724-7869

Holly B. Moore, M.D.Internal Medicine*Palo Alto Medical Foundation Santa Cruz2025 Soquel AveSanta Cruz CA 95062P: 458-5597 F: 423-6410

Margaret “Peggy” Moore, M.D.OB/GYNPalo Alto Medical Foundation Santa Cruz7600 Old Dominion CtAptos CA 95003P: 458-6200 F: 458-6204

New/Rejoin Members

Medical Suite for LeaseOn the Dominican Hospital Campus

1595 Soquel Drive, Suite 340738 square feet ● $2200/month

Complete, small professional office with wait-ing area, business section, two exam rooms, consultation, and a handicap accessible bath-room.

Principals and agents welcome to apply to Marcus Kwan, MD of MRKMD at:

the above address by mail* 831-471-0618 by message phone* e-mail to: [email protected] *

Details of lease and any agent compensation to be negotiated.

2011 SCCMSCalendar of Events

The Santa Cruz County Medical SocietyMission Statement

We pledge to advocate for theprofessional practice of medicine,

excellent patient care, public healthand the education and well being of

patients and physicians.

We believe that the patient-physicianrelationship is vital in the healing process;

the continual improvement of this relationshipwill be our guide.

Address: 1975 Soquel Dr #215 Santa Cruz CA 95065

Phone: (831) 479-7226

Fax: (831) 479-7223

Email: [email protected]

Staff: Donna Odryna Executive Director

Mary Champlin Office Manager Member Services Coordinator

Oct 12 Practice Management workshopOct 15-17 CMA House of DelegatesOct 17 CMA dues invoices mailed

Nov 2 Membership Social eventNov 9 Practice Management workshopNov 15 Board of Governors meetingNov 24 Thanksgiving holiday

Dec 8 Medicine Cabinet submission deadlineDec 14 Practice Managers Network; regular meetingDec 22-Jan 1 SCCMS Office closed

HAPPY HOLIDAYS EVERYONE!

Medicine Cabinet Fall 2011

Documents

Transcript of Medicine Cabinet Fall 2011