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1. Caution Urged When Completing Blue Cross
‘Transparency Initiative’ Questionnaire
Many physicians recently received a letter from Blue Cross, requesting completion of the plan’s “Transparency Initiative” questionnaire. The initiative, according to Blue Cross, is intended to help patients research their health care options and evaluate the quality of care offered by hospitals and physicians. Participation is voluntary and the information collected will be posted on the Blue Cross “Provider Finder” website.
Physicians should be aware that the questionnaire asks for their CAQH, UPIN, NPI, and DEA numbers. Blue Cross has assured CMA that these numbers are for internal use only and will not be shared with patients.
CMA is concerned, however, particularly about the request for DEA numbers. The Drug Enforcement Agency discourages the use or disclosure of DEA numbers for purposes other than verifying authorization to prescribe controlled substances, as unnecessary disclosure of this sensitive data increases the risk of prescription fraud and drug abuse. For more information, see CMA ON-CALL document #0515, “Drug Prescribing: Unauthorized.” ON-CALL documents are free to members at the members-only website. Nonmembers can purchase ON-CALL documents for $2 per page in the CMA bookstore.
CMA also urges physicians to think carefully about releasing their NPI, UPIN, or CAQH numbers to anyone, including insurance carriers, unless there is a demonstrated need for them to have access to this information. While this data is required on claims and other paperwork, it is superfluous to this questionnaire. Physicians who wish to complete the questionnaire can leave these fields blank.
Click here for more information.
Contact: CMA’s reimbursement help line, 888/401-5911.
2. Don’t Forget: New Law Requires Mercury-Free
Vaccines for Children and Pregnant Women
Physicians are reminded that it is now against California law to administer mercury-containing vaccines—including inactivated influenza vaccine from multidose vials—to pregnant women and children younger than 3 years old. Multidose vials of flu vaccine are made with thimerosal, a mercury-containing preservative.
Only influenza vaccine from single-dose syringes or vials with trace levels (less than 0.5 micrograms of mercury per 0.5-milliliter dose for pregnant women, less than .25 micrograms per 0.5-milliliter dose for small children) or no mercury may be given to pregnant women and children under 3.
Physicians need to consider this law, which took effect in July 2006, when ordering influenza vaccine for next season. Prebooking has already begun with some influenza vaccine manufacturers.
Click here for more information.
Contact: Sandra Bressler, 415/882-5171 or sbressler@cmanet.org.
3. Quality Matters: 2007 Health Plan Performance Data Collection Has Begun
Since 1994, many of California’s major health plans have collaborated with employers, physicians, and other health care providers to gather standardized health plan performance data as part of the California Cooperative Healthcare Reporting Initiative (CCHRI).
CCHRI promotes collaboration instead of competition in data collection and reporting, ensuring that consumers have the uniform information they need to compare the performance of health plans. CCHRI also makes efforts to streamline the data collection process, reducing the administrative burden on physicians, health plans, and other CCHRI participants.
The 2007 HEDIS (Health Plan Employer Data and Information Set) data collection began this month. Individual physician data requests began in mid-January. Medical group data requests will begin in mid-February. Physicians who receive requests for patient records are encouraged to respond as soon as possible to avoid multiple follow-up requests for the same records.
Physicians should be aware that HEDIS data collection is permitted under the HIPAA privacy rule. HEDIS data collection continues to be governed by the Confidentiality of Medical Information Act (CMIA). This act authorizes disclosure of records to health plans and their agents without express patient consent for the purpose of measuring the level and quality of care. Please note that special rules still apply to records involving inpatient or outpatient psychotherapy, HIV test results, substance abuse, or developmental disabilities. For more information, see CMA ON-CALL document #1110, “Access by Third Parties to Sensitive Information.”
ON-CALL documents are free to members at the members-only website. Nonmembers can purchase ON-CALL documents for $2 per page in the CMA bookstore.
Health plans will reimburse physicians for HEDIS data submissions. The level of reimbursement varies depending on the physicians’ health plan contracts.
Click here for more information.
Contact: Sandra Bressler, 415/882-5171 or sbressler@cmanet.org.
4. Applications Available for 2007 Steven M. Thompson
Loan Repayment Program; Deadline Is March 24
Applications are now available for the 2007 Steven M. Thompson Physician Corps Loan Repayment Program. Physicians selected for the program, which was created under a CMA-sponsored law in 2002, will receive medical school loan repayment grants of up to $105,000 in exchange for a three-year service commitment in a medically underserved area of the state.
The program is open to newly licensed physicians who commit to serve a minimum of three years in the approved geographic areas, which include official “health professionals shortage areas” (HPSAs) and federally qualified “health center look-alikes,” community health centers, migrant health centers, and public housing centers. Last year, loan recipients worked in a variety of underserved areas throughout the state, from community clinics in downtown Los Angeles to farmworker health clinics in the Central Valley to rural health facilities in Northern California.
The law requires that most participants be selected from the specialty areas of family practice, internal medicine, pediatrics, and obstetrics/gynecology. Up to 20 percent of the participants may be selected from other specialties.
Applications are due by March 24 and can be downloaded here.
CMA is still seeking a permanent funding source for this very important program. Unfortunately, the Schwarzenegger administration’s proposed 2007-2008 budget does not include new funding for this program.
Please consider supporting this worthy program with a tax-deductible donation. To make a donation, download the donation form on the next page, or contact the Health Professions Education Foundation at 800/773-1669. You will also have the opportunity to support the program with a voluntary donation during the medical license renewal process.
Click here for more information.
Contact: Susan Bassett, 916/444-5532 or sbassett@cmanet.org.
5. Practice Tip: Submit Claims Electronically
To get paid faster, file your claims electronically. An electronic claim submitted to Medicare, for example, will generally be paid within 17 days. If the same claim were filed on paper, you would not expect payment for at least 30 days. Filing electronically not only increases your chances of getting paid quickly, but also allows practices to better monitor the payor’s receipt of claims via the confirmation/exception report.
Click here for more information.
Contact: CMA’s reimbursement help line, 888/401-5911.
6. CMA Foundation Hosts Fifth Annual Golf Classic in Carmel
The CMA Foundation is hosting its fifth annual Golf Classic in conjunction with CMA’s Health Care Leadership Academy, which is April 13-15 in Monterey.
The golf classic will be Saturday, April 14, in nearby Carmel, at the Rancho Cañada Golf Club. The style of play is a scramble, with a best ball format. Play begins with a shotgun start at 1:30 p.m.
Your participation in the golf tournament will help support the foundation’s many valuable public health programs, including appropriate antibiotic use, childhood obesity, diabetes, and health disparities.
Click here for more information.
Contact: Donna Astrinidis, 916/551-2054 or dastrinidis@cmanet.org.
7. Deadline to Opt Out of Blue Cross Workers’ Comp Networks Is January 21
Physicians should be aware that even though Blue Cross has an “all products” clause in its Prudent Buyer contract, the plan agreed as part of its RICO settlement with CMA that it would not require physicians to participate in its Workers’ Compensation networks. Physicians who do not wish to participate in these networks can opt out by notifying Blue Cross in writing by January 21. Physicians who opt out will still be free to negotiate separate contracts with Blue Cross to provide workers’ comp services.
Click here for more information.
Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.
8. Member Benefit of the Week: Free Portfolio Checkup
CMA members get a free portfolio checkup — a $250 value — from CMA’s affinity partner, Mercer Advisors.
Mercer Advisors manages over $3 billion in assets, most of it for health care practitioners like you. Because Mercer is fee-based rather than commission-based, you can rest assured that Mercer’s financial experts have your best interests at heart.
Members also get $500 off Mercer’s “Economic Freedom Program,” a comprehensive program that includes financial planning, investment management, and retirement and estate planning.
To schedule your free portfolio checkup, call 800/898-4642.
Click here for more information on your membership benefits.
Contact: CMA’s membership hotline, 888/233-2937 or lgodward@cmanet.org.
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No. 2078
