Movement on Bills to Expand Scope of Practice
Sen. Ed Hernandez, Chair of the Senate Health Committee had introduced three bills to expand the scope of practice for Nurse Practitioners, pharmacists and optometrists. His motivation is to make available a wider range of health care professionals in advance of ACA rollout and the coverage of a larger number of uninsured.
This week two of the bills dealing with NPs and pharmacists are moving to final consideration in the Assembly after substantial amendments and a move to neutrality by the CMA. The NP proposal would not allow totally independent practice but allow a broader scope when an NP works within a hospital or clinic in a collaborative role with a physician. The pharmacist bill allows higher credentialed pharmacists to order and interpret lab tests for drug therapy monitoring and an expanded role in providing vaccinations.
The third bill dealing with optometrists was not taken up in the Assembly this week and is now on a two year track.
Possible MICRA Proposals to Change Damage Cap
As the Legislature enters its final month of session for the year there are rumors that the Consumer Attorneys of Ca. may amend a bill to raise the current MICRA cap on non-economic damages. No bill has surfaced yet and the chances of passage seem unlikely due to the ongoing efforts of the coalition to preserve MICRA. The trial attorneys have indicated that they will seek a ballot initiative to raise the cap on a future statewide ballot. The initiative would be required to go into circulation and obtain about 800,000 signatures to get the required number for qualification. It is early on in that process and we will keep you informed on any progress.
Palmetto Announces Fix to Inappropriate Denials of Some AP Claims
We had informed you before that some pathology groups were receiving denials on outpatient AP claims where the patient was determined to have received services in a hospital setting on the same day. Some groups would see denials and could not figure out how the patient was hospitalized the same day a specimen was obtained in a physician office. Palmetto and CMS were alerted to the issue and Palmetto announced yesterday that the system fix would occur on 1/1/14. We have included the notice below. In the meantime you should continue to appeal those types of denials.
Revision to the Common Working File (CWF) Edit for Technical Component (TC) of Pathology Services Occurring on the Same Day as an Outpatient Hospital Visit.
Effective for the TC of pathology claims processed on and after January 1, 2014, the CWF shall incorporate additional bypass criteria to edit 729F to allow the TC of a pathology claim when there is a claim in history from the ordering/referring physician for the same DOS as the TC of the pathology and the ordering/referring physician's claim has a non-hospital place of service. Please share with appropriate staff.