CalDerm Alerts Archive
Legislative Alert
Last week saw the death of two of the worst bills before the Legislature this year.
AB 2734 (Krekorian). Medical Board License Numbers on All Advertising. This bill would have required all physician advertisements and business cards to include the physician’s Medical Board license number. The definition of “advertisement” was so broad that it would have required the license number on billing statements and appointment reminders. And the bill was very specific – and unreasonable – as to the appearance and placement of the license number. For example, the number had to be proceeded by the phrase “California Medical Board License Number.” And the CMB/license number combination would have to be “in close proximity” to the physician’s name and it had to be the same font size as the physician’s name!!!
CalDerm strongly opposed the bill from the beginning. When the bill came to the Assembly Floor this week, CalDerm was part of an unlikely coalition against the bill -- the CMA, the California Dental Association, the California Chiropractic Association (the advertising requirements also applied to chiropractors and dentists) and, of course, CalDerm.
CalDerm and our allies lobbied much of the Assembly membership on the bill. The result was lopsided vote against it. In the Assembly, it takes 41 votes for a bill to pass. On Thursday night, AB 2734 got just 16 votes.
AB 2841 (Ma). Disposable Cannulas. As introduced, the bill required physicians to provide an outrageous “disclosure” to prospective liposuction patients. The disclosure, which the patient would have to sign, would have stated that the reusable cannula had “been used on other patients” – as if there was something wrong with that. Worse, the mandated disclosure had to include the “number of patients for which the reusable adipose cannula” had been used -- meaning that you would have to track the use of each cannula. Finally, the mandatory disclosure would have included a statement that “an alternative to reusable adipose cannulas may be available for the adipose medical procedure in the form of disposable adipose cannulas.”
The “disclosure” was clearly designed to 1) raise illegitimate doubts about reusable medical instruments and 2) drive prospective patients to demand the disposable product. Not surprisingly, the manufacturer of disposable cannulas hired a high-powered lobbying firm to push the bill through.
CalDerm, working with the CMA and the California Plastic Surgeons, lobbied against the bill when it was heard before the Assembly Business and Professions Committee. After two hearings, the bill simply did not have the votes. The author did get the bill out of committee, but only because of her promise that the bill would be stripped of its contents and turned into a study bill on infections. Earlier in the week, rather than amend the bill with an infection study, the author placed the bill on the “Inactive File” – meaning that the bill is dead.
For more information contact CalDerm at (916) 498-1712 or email to membership@calderm.org
NPI: Use it NOW!
Medicare requires the listing of the provider’s NPI starting on March 1 on all fee-for-service claims. The NPI must be included in the primary provider fields on the claim. Do it, or you will not be paid! If you have been noticing error messages M389 through M392 on your payment reports from Medicare, your claims are being submitted without an NPI in the proper fields of the claim form.
Other Medicare news of importance to dermatology:
- California Medicare has rejected a significant number of
claims for destruction codes (17003, 17110) for the reason of “not
medically necessary”. Such rejections cost Medicare money to process,
and, if repeatedly produced for a single physician, increase that
physician’s likelihood of being audited. You do not want to be the
subject of a focused Medicare audit! Make sure that proper criteria
for billing for a destruction of a benign lesion are met. Usually,
proper coding and chart documentation specifying an irritated
(inflamed) keratosis, or bleeding, or pain will satisfy the coverage
requirements. For further, specific information see:
http://www.medicarenhic.com/cal_prov/policies.shtml
Scroll to “Active LCD Index”, click on “Southern California or Northern California” and then choose “L21835”. This will give you all of the necessary detailed coverage information. - Avoid duplicate claims submission. When a Medicare claim is rejected, the reason for the rejection should be found, corrected, and then the claim should be resubmitted accordingly, for “redetermination” or “reconsideration”. Simply submitting the original claim again, uncorrected, will result in a second (“duplicate”) denial. The duplicate denials cost the system money and, again, when repeatedly done, can lead to a Medicare audit.
For more information contact CalDerm at (916) 498-1712 or email to membership@calderm.org
SB 661 (Maldonado) –
ANATOMIC PATHOLOGY SERVICES
Signed into Law Effective January 1, 2008.
Imagine if you could no longer bill 88305….
That’s what could have happened if CalDerm had not worked diligently to protect the interests of California dermatologists who read their own pathology slides. CalDerm’s work on shaping and defining the fine points of this year’s SB 661 was an ongoing contest with a Pathology Lobby/Sponsor that had initially promised to work in consultation with CalDerm. Without CalDerm’s consultation or consent, however, Pathology on several occasions discretely inserted language into the bill that could have potentially been very damaging to Dermatology. CalDerm’s intense and relentless pressure resulted in this contentious language being removed from the bill. As a direct result of these efforts, California Dermatologists remain able to send their non-Medicare specimens out for slide preparation and bill a global 88305 code for reading them.
SB 661 requires clinical laboratories to directly bill the responsible payer (insurance company or patient) for pathology services only when the referring physician neither reads the slide nor makes a histology slide from the surgical/biopsy specimen. In other words, if a doctor either reads a slide that was prepared for him elsewhere at his delegation and/or processes the surgical specimen/biopsy tissue and makes a slide (regardless of who reads it), that doctor may bill a global 88305 code to all carriers except Medicare – consistent with current CPT rules.
As was the case before SB 661 passed, however, a doctor may still bill a responsible payer (insurance company or patient) for 88305 codes even if that doctor doesn’t make the slide or read it, provided that the doctor gives written notification to the payer (insurance company or patient) that the doctor intends to engage in this practice. Also, dermatologists who read slides may send slides out for second opinions on a case by case basis. The consulting doctor in such cases should bill the payer (insurance company or patient) separately for the consultation/second opinion service.
CalDerm’s efforts on SB 661 should be viewed overall as a success. Nevertheless, the confrontational nature of our negotiations with Pathology during the amending of SB 661 illustrates the subtleties and complexities of the myriad threats to our specialty. The CalDerm Board wishes to thank all its members for the personal and financial support that allows us to continue advancing Dermatology’s interests in the challenging and ever changing California socio-political environment.