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1. It's Time to Order Flu Vaccine for Next Season
Physicians can now order flu vaccine for the 2007-2008 flu season. CMA encourages physicians to place their orders early to guarantee that they will receive their supply in time to vaccinate their high-risk patients in the autumn.
Physicians can place orders directly with manufacturers or through their regular pharmaceutical distributor. Some manufacturers sell out quickly, so place your orders as soon as possible.
Click here for ordering information.
It's Not Too Late to Vaccinate!
Physicians are also reminded that flu season usually peaks in February, so there's still time to vaccinate patients this season. Vaccine remains available from some distributors and manufacturers. Find out who has vaccine for sale at AMA's Influenza Vaccine Availability Tracking System website.
Click here for more information.
2. Call for Nominations: 2007-2008 Councils and Committees
CMA depends on the expertise of its members to make smart policy choices. Do you have expertise in medical ethics, professional liability, or other topics related to the practice of medicine? If so, you could serve on one of CMA's councils or committees.
The nomination deadline for the 2007-2008 term is May 25. Nominees must be endorsed by their county medical societies. Contact your county medical society for information on the nomination process.
Click here for more details, including nomination forms.
Contact: Ginnie Yee, 415/882-5170 or gyee@cmanet.org.
3. CMA Comments on Workers' Comp Utilization Review Regs
CMA last week submitted comments to the Division of Workers' Compensation (DWC) on the division's revised medical treatment utilization schedule regulations. The proposed treatment rules, largely based on the American College of Occupational and Environmental Medicine (ACOEM) guidelines, are the result of the Workers' Compensation legislation passed in 2004.
In its comments, CMA again emphasized the need to develop protocols for treating patients with chronic conditions. Even though chronic conditions are the real cost drivers in the workers' comp system, chronic care is not sufficiently addressed in the guidelines under consideration.
CMA urged DWC to change its definition of "functional improvement" so as not to unfairly deny coverage for the treatment of chronic conditions. CMA is concerned that the proposed definition of "functional improvement" could result in the denial of continued care if "significant" improvement is not demonstrated. "'Significant' is a subjective term and sets too high of a standard," wrote CMA CEO Joseph Dunn in the comments. "The goal should be for the patient to show clinical improvement. When a doctor believes a patient is continuing to improve and needs further treatment, that patient should receive it."
CMA also recommended that the medical decisions of the treating physician be presumed correct in cases where the treatment is not specifically addressed by the guidelines. "In instances where there are no guidelines, the proposed system would deny the clinical experience of the treating physician who is uniquely aware of the specific needs of the patient," wrote Mr. Dunn in the comments. "Payers should not be allowed to deny payment for services on the sole basis that the treatment is not addressed by evidence-based guidelines."
CMA expressed strong support for the proposal to establish a Medical Evidence Evaluation Advisory Committee. This committee would be made up of board certified physicians and would advise the division's medical director on matters concerning the medical treatment utilization schedule. CMA has recommended that "board certified" include boards recognized by the American Board of Medical Specialties or the Medical Board of California.
Click here for more information.
Contact: Ronda Paschal, 916-444-5532 or rpaschal@cmanet.org.
4. Resubmission Period for Aetna Modifier 57 Claims Now Open
Aetna is now accepting resubmissions of previously denied claims for E&M services provided on the same day as a decision for surgery with dates of service between January 1, 2005, and February 11, 2006.
Aetna in 2005 announced that it would begin reimbursing physicians for E&M services when billed with modifier 57, performed on the same day as a decision for major surgery (global, 90-day procedure). Implementation of this policy change was delayed and Aetna's claims processing systems finally began recognizing E&M Codes with these modifiers effective February 11, 2006. At that time, Aetna also announced that previously denied claims with dates of service of August 15, 2005, to February 11, 2006, could be resubmitted.
This policy change was recommended by Aetna's Physicians Advisory Board, which was created as part of Aetna's RICO lawsuit settlement. A recently resolved RICO settlement compliance dispute has increased the number of claims eligible for retroactive reconsideration. Previously denied claims with dates of service back to January 1, 2005, can now be resubmitted. The resubmission period is January 1 to April 30, 2007.
Click here for more information.
Contact: CMA's legal information line, 415/882-5144 or legalinfo@cmanet.org.
5. Proposed Regulations Allow Health Plans to Evade
Access-to-Care Requirements
The Department of Managed Health Care (DMHC) recently proposed regulations that would eliminate the requirement that health plans seeking licensure in California demonstrate that they have a sufficient number of contracted physicians to provide enrollees with adequate access to care. CMA believes that the regulations, intended to streamline the health plan licensure process, could negatively impact patients' access to care.
In comments submitted last week to DMHC, CMA reminded the department of the Knox-Keene Act's access-to-care requirements. "The Knox-Keene Act and its implementing regulations contain numerous requirements for enrollee access," wrote Aileen E. Wetzel of CMA's Center for Economic Services in the comments. "Enforcement of these laws is the first step toward achieving access to care by ensuring a sufficient number of physicians are able and willing to participate...so that patients can receive medically necessary services."
Click here for more information, including a copy of CMA's comments.
Contact: Aileen E. Wetzel, 916/444-5532 or awetzel@cmanet.org.
6.Medicare Extends Participation Decision Deadline to Feb.14
President Bush in mid-December signed legislation to stop the 5 percent Medicare sustainable growth rate (SGR) cut that was scheduled to take effect January 1. The legislation will freeze the Medicare conversion factor for physician reimbursement at 2006 levels for one year and will give a 1.5 percent SGR increase to physicians who report on at least three quality measures starting July 1, 2007. The Centers for Medicare & Medicaid Services (CMS) will implement the Medicare physician payment provisions of this law (HR 6111) immediately.
The freeze only applies to the 5 percent SGR cut and will not affect the changes to the work relative value units (RVUs) stemming from Medicare's recently completed five-year review. This means that payment rates for many services will change in 2007.
The new work values will increase spending for E&M services by $4 billion next year. However, federal budget neutrality requirements forced CMS to apply a 5.5 percent reduction to all services. The bottom line: Some physicians will still see net decreases in Medicare payments in 2007, but those decreases will be much smaller than they would have seen without the SGR freeze. And many physicians will see net increases. A chart of the average rate change by specialty is available here.
The new rates have been posted to Medicare carriers' websites and the carriers are now processing claims at the new rates.
CMS has also extended the Medicare participation enrollment period. Physicians who wish to change their Medicare participation status for 2007 have until February 14 to do so. Changes in participation status will be effective January 1, retroactively if necessary, regardless of when the participation decision is made.
Click here for more information.
Contact: CMA's reimbursement help line, 888/501-4911.
7. Save the Date: Legislative Leadership Day, April 24
CMA's 33rd annual Legislative Leadership Conference is Tuesday, April 24, in Sacramento. This is the most important day of the year for physician advocates! A revamped schedule will include more time than ever to meet with your elected officials in the State Assembly and Senate.
Attendees will receive a CMA health policy briefing and a short course on "Lobbying 101," which will train them to become strong physician advocates and prepare them for the legislative meetings later in the day.
Don't miss the opportunity to meet one-on-one with your legislators to discuss important health policy issues that affect the practice of medicine in California.
Contact: Susan Bassett, 916/444-5532 or sbassett@cmanet.org.
8. Member Benefit of the Week: Health Savings Accounts
President Bush recently signed into law a bill that boosts the appeal of health savings accounts (HSAs) by allowing significantly larger annual contributions. An HSA is a tax-exempt account used to pay for current health care expenses and save money for future expenses.
Effective immediately, the maximum annual contribution that can be made to an HSA will be a statutory indexed amount, which in 2007 will be $2,850 for individuals and $5,650 for families, even if your deductible is less than that amount. Previously the maximum contribution was your deductible or the statutory amount, whichever was less.
The law also allows a one-time rollover of funds from flexible spending or health reimbursement accounts.
The new law ensures that the maximum annual contributions can be made to HSAs, regardless of when during the year the account was opened. Previously, contributions were prorated.
CMA offers an HSA program for members, their families, and their office staff. To open an HSA, you must be covered by a qualified high deductible health plan (HDHP). Since HDHPs generally cost less than traditional health plans, the money you save on monthly premiums can be deposited to your tax-exempt HSA. Not all "high deductible" plans qualify; the policy must conform to the HSA design specified by Congress.
CMA has partnered with Marsh Affinity Services and UMB Bank to simplify the HSA process, combining all of the necessary elements into one product. Whether you need a qualified HDHP or just want to open an HSA, you can do it all at CMA's HSA Access Point.
For more information, call Marsh at 800/842-3761. (Marsh and CMA do not provide tax advice. Please consult with your personal advisers on how these changes may affect you.)
Click here for more information on CMA member benefits.
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