Policy Update - Do you want to improve your AUTONOMY when practicing medicine?  MOASC and ANCO are working on your behalf to support the following bill to improve your ability to treat your patients in PAIN.  AB 369 is a bill this year that would LIMIT INSURANCE COMPANIES ABILITY TO FORCE STEP THERAPY OR FAIL FIRST PROTOCOLS IN THE MANGEMENT OF PAIN.  This bill would specifically do the following:

1) Prohibit a health care service plan or health insurer from requiring that a patient try and fail on more than two pain medications before allowing access to other pain medications prescribed by the physician, as specified;.

2) Authorize the duration of any step therapy or fail first protocol to be determined by the prescribing physician

We need your help for the successful passage of this bill into law.   Please submit stories of your patients' insurance requiring them to try and fail on multiple pharmaceuticals in the management of pain.  These stories may be used for media purposes to bring awareness to this issue and strengthen the chance of successful bill passage into law.

Medi-Cal

- A Federal judge has tentatively blocked Medi-Cal reimbursement cuts to doctors and other providers saying the cuts could cause irreparable harm. Courts have blocked various state budget cuts before. The state is appealing the judge's decision.

-The State Controller last week reported that the state of California will run out of cash by early March if immediate action is not taken to identify $3.3 billion in cash solutions.  To meet this challenge, California will increase borrowing and institute short-term payment delays to universities, counties, and Medi-Cal providers.  Therefore, the Department of Health Care Services (DHCS) will hold payments due to certain Medi-Cal fee-for-service providers on February 27, issuing them instead on March 5.  DHCS will also hold payments on March 12, issuing them on March 19.  For more information about the provider types impacted, please log on to the Medi-Cal website.  DHCS understands that this difficult decision is painful for their valued provider partners, but Medi-Cal, as the state's second largest General Fund expenditure, must be part of the state's budget solution.

-Following are the correct payment hold dates, which reflect the information posted on the Medi-Cal website. 

1) Payments scheduled for a warrant release date of March 1, 2012 (Electronic Funds Transfer [EFT] date of March 5, 2012) will be held until the warrant release date of March 15, 2012 (EFT date of March 19, 2012) and will be paid along with all services normally scheduled for payment that week.

2) Payments scheduled for a warrant release date of March 8, 2012 (EFT date of March 12, 2012) will be held until the warrant release date of March 22, 2012 (EFT date of March 26, 2012) and will be paid along with all services normally scheduled for payment that week.

3) Payments to Medi-Cal non-institutional providers will not be held.

 For more information, please log on to the Medi-Cal website.

Medicare

-Practices are beginning to receive 2012 claims adjusted for unsuccessful 2011 reporting under the Medicare e-prescribing program. Physicians subject to the e-prescribing penalty will see an indicator "LE" on the remittance advice to denote the penalty. The remittance advice should also contain the following Claim Adjustment Reason Code (CARC) and Remittance Advice Remark Code (RARC):

CARC 237 - Legislated/Regulatory Penalty. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT).

RARC N545 - Payment reduced based on status as an unsuccessful e-prescriber per the Electronic Prescribing Incentive Program.

For more information on the 2012 penalty see the MLN Matters article.  

to learn what practices need to know in 2012 to avoid penalties in 2013 and 2014.

-Based on Change Request (CR) 7670, the Claim Status and Claim Status Category Codes for use by Medicare Contractors were updated during the February 2012 meeting of the National Code Maintenance Committee. The code changes were also posted to the Web on or about March 1, 2011. Included in the code lists are specific details, including the date when a code was added, changed or deleted. Medicare Contractors will implement these changes on April 2, 2012.

- The ANCO Board of Directors has elected the following officers (terms): President, Jeffrey Cronk, M.D. (Antioch, 2012-2013); Vice President, Daniel P. Mirda, M.D. (Napa, 2012-2013); Secretary, Bradley Ekstrand, M.D. (San Mateo, 2012); and, Treasurer, Robert L. Robles, M.D. (Pleasant Hill, 2012).  

Innovatix cordially invites healthcare professionals to participate in a jointly offered lunchtime CE teleconference; February 15, 2012 on Medicare and Medicaid Changes: An Update for Health Providers

Presented by:Brad Kile, PhD;   S. Leigh Davitian, JD; Dumbarton Group and Associates

11:00am - 12:00pm Pacific. RSVP by Friday, February 10, 2012. Any questions please contact Shannon at (888) 258-3273 ext. 369 or ssteen@innovatix.com

-Cephalon is voluntarily recalling the below lot of Treanda® 25mg 8ml vials in response to the presence of particulate matter indentified as glass fragments found in a single Treanda 25mg vial. Lot # TB30111; CAT# 909-556; MAT# 5001929; NDC# 63459-0390-08

Please discontinue use of any affected vials and contact GENCO Pharmaceutical Services at 877.319.8965 for questions. If you are impacted by this recall, you will also receive a letter from McKesson Specialty Health. 

-Allos Therapeutics, Inc. proudly sponsors the Allos Support for Assisting Patients

(ASAP) program, a reimbursement support and patient assistance program

designed to help patients and healthcare professionals gain appropriate access to

FOLOTYN® (pralatrexate injection). The ASAP program provides the following

services:

* Verification of Patient-Specific Insurance Benefits

* Pre-Submission Claims Review and Support

* Prior Authorization Assistance

* Coding and Billing Guidance

* Payer Research

* Denied and Underpaid Claims Assistance

* Patient Assistance Program for Qualified Patients

Monday-Friday, 9:00 am-8:00 pm, ET

1-877-ASAP102 (877-272-7102) - phone

1-877-801-0777 - fax

www.getASAPinfo.com