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1. Medicare Payments for Thousands of
Northern California Physicians at Risk
The number of physicians whose Medicare payments are at risk has risen increased dramatically, according to California’s Medicare carrier, NHIC. Affected are Northern California physicians who work for or contract with groups in Northern California and haven’t updated the required 855R form, which reassigns their Medicare payment to their group(s). Until an updated 855R form is filled out and submitted for each of the groups for which a physician bills, that group will not get paid for the physician’s Medicare services after August 1. This impacts groups of all sizes.
Affected physicians must submit updated 855R forms for each of the groups they bill for no later than August 1. (NHIC has pushed back the original June 1 deadline, to August 1.) If the 855R forms are not submitted by the deadline, groups will not get paid for the physicians’ Medicare services after August 1.
NHIC is also reporting having to return many deficient 855R forms that have been submitted without date or signature. Physicians should also make sure that the authorizing agent’s name is the same as is listed on the group’s record. If the authorizing agent has changed, the group will have to update this information with CMS.
CMA strongly urges all physicians who work for groups or contract with groups in Northern California to contact the NHIC hotline at 877/527-6613 to ensure that you have correctly filled out the required 855R form for each of the groups to which you want to reassign your Medicare payments. Physicians who enrolled as Medicare providers prior to 2006 may also need to fill out form 855I.
Groups can help physicians fill out these forms, but the physicians must sign them. To complete the 855R, physicians will need their NPI, the tax ID number for each of the groups to whom they want to assign payments, and the signatures of the groups’ authorizing agents. The authorizing agent’s signature is required.
Click here for more information.
Contact: Frank Navarro, 888/401-5911 or fnavarro@cmanet.org.
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2. Legislative Committees Take First Step Towards Revoking
Medi-Cal Budget Cuts; Resolution Still a Long Way off
On May 30, the full Senate Budget Committee and the Assembly Budget Subcommittee on Health and Human Services met to take action on the Governor’s May budget revision proposals. After months of CMA’s legislative, grassroots, and media advocacy, the Senate and Assembly took steps to stop the 10 percent Medi-Cal reimbursement rate cut scheduled to take effect July 1.
The Assembly subcommittee voted to restore all but $54.2 million of the 10 percent cut, with the major caveat that resources must be available. The $54.2 million was carved out for public hospital funding restoration. The Subcommittee’s action will be considered by the full Assembly Budget Committee in the coming weeks.
The full Senate Budget Committee voted to restore half of the 10 percent cut, effectively making it a 5 percent cut. CMA reminded the committee that Medi-Cal reimbursement rates are cut annually in real terms, as the cost of providing care goes up and rates remain stagnant.
Assuming the full Assembly Committee adopts the subcommittee recommendation, the Medi-Cal reimbursement rate issue will go to conference committee where the Senate and Assembly reconcile any differences before sending a single budget proposal to the Governor for signature.
While we were encouraged that the Senate and Assembly are reconsidering their previous action to slash Medi-Cal rates by 10 percent, the battle is far from over. CMA’s lawsuit to stop the rate cut is still an essential part of the fight. It is unclear how the Senate and Assembly will resolve their difference in restoring the rate cut, whether resources will be available to support the restoration, and whether the Governor will sign a budget that restores the cuts. Even if agreement is eventually reached, it is extremely unlikely that there will be a budget agreement before the rate cuts go into effect July 1.
Click here for more information.
Contact: Lisa Folberg, 916/444-5532 or lfolberg@cmanet.org.
3. U.S. Senate Begins Negotiations on Medicare Payment Cuts
Last week, Senate Finance Committee Chairman Max Baucus (D-MT), released a summary of his draft Medicare legislation, which will be the starting point for more formal negotiations Medicare physician payments. CMA is working vigilantly with our Senators and key House members to get the cuts stopped before the 10 percent cut takes effect July 1. Senate leaders in both parties have reiterated their commitment to stopping the payment cuts.
Specifically, Chairman Baucus is proposing an 18 month bill that will stop the 10 percent sustainable growth rate cut on July 1 and the 5 percent cut on January 1, 2009. It would continue the current 0.5 percent physician payment update through the rest of 2008, with an additional 0.5 percent update for 2009.
Baucus’s proposal would extend the Physicians Quality Reporting Initiative (PQRI) through 2010 with a 2 percent bonus. The proposal also contains a phased incentive for physicians to adopt electronic prescribing, with bonuses being implemented before penalties are applied. The bonuses are cumulative, so that a physician who uses electronic prescribing and participates in PQRI in 2009 could qualify for a 4 percent total bonus.
Many provisions that CMA has opposed are not in the bill, including public disclosure of physician claims data in quality reporting initiatives, mandated use of electronic medical records, or prohibition of physician hospital ownership.
The proposed legislation would be financed primarily by cuts in Medicare Advantage payments which the Administration strongly opposes. Senator Baucus expects to introduce the bill this week. Senate Republicans indicate that they plan to introduce a counter proposal after the Baucus bill is introduced.
The current legislative activity related to Medicare physician payments is focused in the Senate. As you may remember, the House passed the CHAMP Act last July, which would similarly stop the cuts in 2008 and 2009, replacing them instead with 0.5 percent increases in each of those years. It would also update California’s geographic payment localities and prevent any geographic payment reductions for three years.
If the Senate passes its own Medicare legislation, the bills would go to conference committee where House and Senate leaders would resolve any differences between the two pieces of legislation.
Click here for more information.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
4. Appropriations Bill Softens Ban on Physician-Owned
Specialty Hospitals
An amendment to a supplemental war appropriations bill (HR 2642) would allow some physician-owned specialty hospitals to continue to participate in Medicare and Medicaid. The Senate passed the bill by a veto-proof margin (75 to 22) last week. The House is expected to consider the legislation soon.
The legislation originally would have banned participation in Medicare and Medicaid by many current or planned specialty hospitals or required physicians with ownership stakes in the facilities to sell some of their shares. Although the bill still bans any new physician-owned hospitals, the amendment would allow all existing California physician-owned hospitals to continue operating under current conditions. Existing hospitals would not be forced to change their physician ownership patterns and investments. Hospitals would, however, have to meet the disclosure requirements that organized medicine has already accepted. While the legislation does allow for the expansion of existing physician-owned hospitals, most hospitals would have difficulty meeting the expansion requirements.
CMA will continue to oppose any bans or limitations on physician ownership of hospitals. However, compared to previous legislation, the supplemental appropriations bill with these amendments is an enormous improvement thanks to the advocacy of CMA and organized medicine around the country.
Click here for more information.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
5. CMA Asks Blue Shield to Post New Rates Online
As reported in the last issue of CMA Alert, Blue Shield of California recently notified physicians of changes to its standard physician fee schedule set to take effect July 1.
In a letter to Blue Shield on May 22, CMA expressed concern that physicians do not have electronic access to the new fee schedule. Currently, physicians must either call or fax a request to the insurer and wait up to 10 days for a response. CMA has been engaged in productive discussions with Blue Shield about this issue. CMA has asked that Blue Shield post the new rates online so that physicians may access them without delay.
Although CMA is working with Blue Shield to provide online access, you should not wait to begin assessing the impact the changes will have on your practice. To help you, CMA has published a toolkit available free to members at CMA’s members-only website. Included in the toolkit is CMA’s financial impact worksheet, which will help you calculate the impact of the fee schedule changes based on your most commonly billed CPT codes.
We hope to have an update for you very soon. The latest information will be posted here as soon as it becomes available.
Click here for more information.
Contact: Jodi Black, 916/551-2863 or jblack@cmanet.org.
6. CMA Foundation Accepting Noms for Leadership Awards
The CMA Foundation is seeking nominations for the Ethnic Physician Leadership Award; the Robert D. Sparks, M.D. Leadership Achievement Award; and the Adarsh S. Mahal, M.D. Access to Health Care and Disparities Award.
The first award will be presented on October 18 at the Annual National Ethnic Physician Organization Summit in Anaheim. The other awards will be presented at the Foundation’s Annual Leadership Dinner on October 5 in Sacramento. The deadline to submit nominations is June 27, 2008. For eligibility criteria and nomination forms for each award, please visit http://www.thecmafoundation.org.
Contact: Liz Burdick, 916/779-6639 or lburdick@thecmafoundation.org.
7. CMA’s 2008 California Physician’s Legal Handbook Is Here
The 2008 California Physician’s Legal Handbook (CPLH) is now available. CPLH—an annual publication of CMA’s Center for Legal Affairs—answers the legal questions most frequently asked by physicians. CPLH 2008 offers more than 4,500 pages of comprehensive legal information including current laws, regulations, and court decisions related to medical practice in California.
The handbook is available in a 7-volume print format and on CD-ROM. The CD-ROM offers all of the content of the print version, plus many enhancements including fully searchable content, fully searchable content and hyperlinks that let you navigate within the CD-ROM and onto the web, as well as links to Findlaw for information on the cited court cases.
The CD-ROM is priced at $398 for members ($480 for nonmembers), the print version costs $798 ($960 for nonmembers), and the CD-ROM/print combination costs $898 ($1080 for nonmembers). To place an order, visit http://www.cmanet.org/bookstore or call 800/882-1262.
Don’t forget, CMA members can access most of the CPLH content FREE via CMA On-Call, CMA’s online library of medical-legal information, at http://www.cmanet.org/member.
Contact: CMA’s Publications Line, 800/882-1262.
8. Top NPI-Related Claim Errors, And How to Fix Them
Since the May 23 implementation of the National Provider Identifier (NPI) claim submission rules, the Centers for Medicare & Medicaid Services has identified common errors causing a high number of claim rejections.
- Error messages M402, M417, and M419: Legacy Identifier Submitted
- Error messages M379 and M381: EIN/SSN Not Tied to NPI
Click here for information on correcting there errors from NHIC.
Contact: Frank Navarro, 888/401-5911 or fnavarro@cmanet.org.
9. Member Benefit of the Week: 30-50% off Epocrates
CMA members receive 30 percent off one-year subscriptions and 35 percent off two-year subscriptions to any Epocrates product. Students and residents receive 50 percent off all Epocrates products. Group discounts are also available.
Epocrates provides physicians with point-of-care access access (via PDA/smartphone, or online) to up-to-date information on drugs, diseases, and diagnostics. Epocrates allows physicians to make better clinical decisions, saving time and improving quality of care. To receive your discount, log in to the members-only website and follow the links to the Epocrates website.
Click here for more information on your membership benefits.
Contact: CMA’s member service center, 800/786-4CMA or info@cmanet.org.
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