Volume 5, No. 2
The CSA Board met on September 20 and the primary topic of discussion was SB 228, the Workers' Compensation "reform" bill that passed in the legislature at the 11th hour of the session. Although unsigned as of today, Governor Davis has vowed he will sign the bill.
WORKERS' COMPENSATION REFORM
The good news is that through 2005, the RBRVS will not be used for the Official Medical Fee Schedule (OMFS). The bad news is the current fee schedule will apply, with payment for physician services currently paid above Medicare rates being reduced by 5% overall. The Administrative Director of the Division of Workers' Compensation has the authority to selectively reduce payments further for individual codes if he determines them to be overpaid.
Facility fee payments for ambulatory surgery centers will be paid at 120% of Medicare rates beginning Jan. 1, 2004. In addition, physicians may not refer injured workers to facilities in which they have a financial interest unless (1) the insurer or self-insured employer pre-approves use of the facility after the financial interest has been disclosed or (2) if the patient must travel more than 25 miles or 40 minutes to get comparable care. Many other changes were made in SB 228 and a summary of those provisions can be obtained on the CSA web site www.csahq.org.
The CSA will continue advocating that anesthesia payments should not be reduced and in fact, should be increased. In addition, the CSA will continue to warn legislators and regulators of the access problems that will occur if anesthesia reimbursement is based on a low percentage of Medicare rates. During the legislative session, tying workers' comp payments to 120% of Medicare was considered, a move that would have cut anesthesia payments by about 40%.
MEDICARE WILL ACCEPT HIPAA NON-COMPLIANT ELECTRONIC TRANSACTIONS AFTER OCTOBER 16 COMPLIANCE DEADLINE
The Centers for Medicare & Medicaid Services (CMS) will implement a contingency plan to accept noncompliant electronic transactions after the October 16, 2003, compliance deadline. This plan will ensure continued processing of claims from thousands of providers who will not be able to meet the deadline and otherwise would have had their Medicare claims rejected.
CMS made the decision to implement its contingency plan after reviewing statistics showing unacceptably low numbers of compliant claims being submitted.
MEDI-CAL PAYMENT REDUCTIONS
DHS plans to implement the 5% Medi-Cal cut for services rendered on or after 1/1/04 without touching the anesthesia base units or the conversion factor(s). Claims will be processed as they presently are with 5% deducted from the balance to be paid. This avoids the necessity of adopting changes in regulations and makes it easier to rescind the reduction in the future.
CSA COVERAGE & STIPEND AND REIMBURSEMENT SURVEYS PROCEEDING
The CSA Board approved moving forward with conducting two surveys on behalf of the membership. The coverage and stipend survey will be sent to Anesthesia Department chiefs at all hospitals in California and seeks information on call coverage and administrative responsibilities and their compensation. The reimbursement survey will be sent to CSA delegates and alternate delegates, Board members, group administrators and billing services. Information on payers, contracts, and rates paid will be gathered from a representative geographic sample.
The CSA is complying with FTC requirements to gather sufficient numbers of surveys to ensure that the identity of respondents is protected. Additionally, the data will be aggregated in a way that does not reveal individual respondents, hospitals or other facilities. Members may contact the CSA office at firstname.lastname@example.org to request a survey. We ask that only one survey be submitted by each group, however.
CSA EDUCATIONAL MEETINGS' POPULARITY INCREASES
The already popular Hawaiian seminars in October and January are enjoying near-record registration. The meetings on Kauai from October 20-24 and on Maui January 19-23 feature excellent programs with 20 units of CME.
The CSA/UCSD Annual Meeting and Review Course, May 20-23, 2004, marks the CSA's return to a favorite meeting location, San Diego. The program is available on-line and brochures will be mailed in mid-October.
H. Douglas Roberts, M.D.