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1. Bill Would Allow Medical Board to Reduce Licensing Fees
California Assemblymember Fiona Ma (D, San Francisco) has introduced a bill that will give the Medical Board of California the flexibility to reduce licensing fees when its contingent fund exceeds two months of reserves.
Current law requires the board to maintain a reserve fund that would cover operating costs for approximately two months. A recent audit of the medical board’s financial status found that its reserves increased by $6.3 million, to $18.5 million, in fiscal year 2006-07. This represents 4.3 months of reserves.
The auditor recommended that the board either reduce fees or issue refunds to physicians to lower its contingent fund balance. However, under current law, fees are fixed at $790 and medical board does not have the authority to reduce them without legislative action. This bill (AB 547) would grant the medical board the flexibility to reduce licensing fees when necessary to maintain its fund balance at or near the mandated level.
CMA is working with Assemblymember Ma and the medical board to determine how to best reduce the excessive reserves.
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Contact: Brett Michelin, 916/444-5532 or bmichelin@cmanet.org.
2. United Healthcare Denied 11,900 California Claims in Error
CMA has learned that United Healthcare erroneously denied nearly 12,000 claims from California physicians between October 29 and November 30. A
system glitch caused some claims to be fed through the adjudication platform twice, causing the claims to be denied.
United Healthcare has fixed the problem and affected claims will automatically be reprocessed by the insurer this month. Physicians do not need to appeal or resubmit these claims for reconsideration.
Claims that may have been denied inappropriately as a result of this system issue can be identified by the following remark codes on the Explanation of Benefits (EOB)s.
• Remark Code O9: The number of units reported exceeds the typical frequency per day.
• Remark Code O7: Our records show we have already processed this charge.
• Remark Code O6: Our records show these services have been previously submitted by another physician or other health care professional.
• Remark Code Q9: This procedure code and modifier are the same as or equivalent to another procedure code and modifier shown on this same claim submission or a prior claim submission.
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Contact: CMA’s reimbursement help line, 888/401-5911 or drice@cmanet.org.
3. Medi-Cal Claims with Patient SSNs Will Be Denied Beginning 2/1
Next month, physicians will no longer be allowed to bill Medi-Cal or the Child Health and Disability Prevention Program using patients’ Social Security numbers as identifiers. Starting February 1, physicians will be required to use the Medi-Cal identification number from the patient’s Benefits Identification Card (BIC) or paper ID card. Claims submitted with dates of service on or after February 1 with a patient’s SSN will be denied.
Physicians must also use Medi-Cal identification numbers when verifying eligibility or submitting treatment authorization requests. In an emergency or in the event a Medi-Cal patient does not bring his or her BIC to an appointment, physicians may (with the patient’s permission) use a SSN to verify eligibility via the Medi-Cal Eligibility Verification System.
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Contact: Frank Navarro, 916/551-2046 or fnavarro@cmanet.org.
4. CMA Asks DOI to Pull the Plug on United Healthcare’s
New Notification Protocol
CMA has asked the Department of Insurance to require that United Healthcare rescind its new Advance Notification Protocol. This onerous protocol requires physicians to notify United before admitting patients to the hospital and mandates that if physicians don’t comply, they won’t be paid.
United is calling this “notification” rather than “preauthorization,” but is requiring physicians to provide the exact same information that other insurers require for preauthorization, without a guarantee of payment. In our request to the DOI, CMA set forth several problems with the protocol, including United’s failure to notify physicians in a timely manner of a material change to their contracts, as required by law. CMA believes the protocol is an attempt by the insurer to improperly insert itself into decisions regarding patient treatment.
CMA also believes that it unreasonable to expect a busy physician practice to allocate the time and resources necessary to comply with United’s protocol without a guarantee of payment. In order to be compliant with the protocol and to be eligible for payment, physicians may be forced to divert resources from patient care to administrative tasks.
This protocol is one of a series of policies recently announced by United that CMA believes are unfairly onerous, punitive to physicians, and detrimental to patient care, and that we are seeking to have overturned.
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Contact: Aileen E. Wetzel, 916/551-2037 or awetzel@cmanet.org.
5. Governor Schwarzenegger’s Budget Proposal
Includes Deep Medi-Cal Cuts
Governor Schwarzenegger's proposed 2008-2009 budget would cut $1.1 billion in state funds from Medi-Cal, California's health care program for low-income families. These cuts would cost California an additional $1 billion in additional federal matching funds, resulting in more than $2 billion taken away from health care for California’s low-income families.
“We appreciate the Governor’s budget predicament, but California cannot afford to leave $1 billion in federal dollars on the table when we are facing a budget shortfall,” says CMA President Richard S. Frankenstein, M.D. “It is inconsistent to talk about expanding health care coverage for low-income families at the same time we are cutting Medi-Cal rates.”
CMA vigorously opposes any cuts to the state’s already low Medi-Cal rates. Slashing payments that go towards providing health care to the poor will only exacerbate the health care crisis in California. Fewer Medi-Cal dollars will mean less access to doctors for low-income families, more patients in emergency rooms, and higher health care costs for everyone.
The Medi-Cal reductions are largely the result of a 10 percent provider reimbursement rate cut and elimination of certain “optional” benefits in the Governor’s proposed budget. There were no changes to Medi-Cal eligibility.
Click here for more information. Contact: Lisa Folberg, 916/444-5532 or lfolberg@cmanet.org.
6. CMA Stops Bill to Prohibit Billing
Patients for Emergency Services
CMA has for years been fending off legislative and regulatory attempts to prevent noncontracted physicians from billing patients for emergency services. One such attempt was SB 389, a bill introduced last year by Senator Leland Yee. Last week, Senator Yee pulled the bill in response to CMA’s aggressive advocacy, which convinced many of his Senate colleagues that the bill was a gift to HMOs.
While we have killed this bill, the issue is not yet dead for the 2008 legislative session. Senator Yee has indicated that he will continue to pursue a prohibition on billing for services rendered by hospital-based physicians.
CMA will continue to aggressively oppose any attempts to prohibit so-called “balance billing” that do not also address the key underlying problems of unfair contracts, which result in inadequate physician networks and chronic and pervasive underfunding of emergency care by insurance companies.
Contact: Francisco Silva, 916/444-5532 or fsilva@cmanet.org.
7. Senate Health Reform Hearing Scheduled for January 23
The Senate Health Committee has postponed its hearing to discuss the health reform proposal (AB 1X1) introduced by Assembly Speaker Fabien Nuñez and Governor Arnold Schwarzenegger, as they await the Legislative Analyst’s Office’s analysis of the financing initiative. The hearing is now scheduled for Wednesday, January 23, at 9 a.m. and is expected to last all day.
The $14.4 billion health reform package, passed by the state Assembly last month, would only take effect if voters also approve the financing package, which will likely be placed on the 2008 ballot. The measure would, among other things, raise the state tobacco tax to $1.75 a pack and require employers to dedicate up to 6.5 percent of their payrolls to cover employee health care or pay into a state-run insurance purchasing pool.
CMA continues to work closely with Senate President Pro Tem Don Perata to address the deficiencies of the current proposal and make needed improvements.
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Contact: Dustin Corcoran, 916/444-5532 or dcorcoran@cmanet.org.
8. CMA Foundation Offers New Obesity Prevention Grants
The CMA Foundation’s Obesity Prevention Project has launched a new Physicians for Healthy Communities Mini-Grant Program to support obesity prevention advocacy and outreach programs that enhance the well-being of California’s communities.
Medical students, physicians, and component medical societies can apply for grants of $250 to $1,000.
Applicants must supply a 500-word-maximum statement describing the project or program and how it contributes to the community. Applications should be received in the CMA Foundation offices by the last business day of each month to be considered the first week of the next month.
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Contact: Tiffanie Sherrer, 916/551.2031 or tsherrer@cmanet.org.
9. Member Benefit of the Week: I.C. System Collection Solutions
For 23 years, CMA has partnered with I.C. System to help physicians improve their cash flow with efficient, ethical and cost-effective debt collection solutions.
I.C. System, one of the nation’s largest privately owned collection agencies, employs experienced health care industry professionals who thoroughly understand patient accounting. The personnel at I.C. System receive specialized training to maximize recoveries while maintaining positive patient relationships.
CMA members receive a 10 percent “bonus” on I.C. System products and services. For example, if you sign up for a 50-account package, you get 5 additional accounts at no extra charge. CMA members may also request a FREE guide of collection tips at http://www.icsystem.com/cma.
For a no-obligation quote, contact I.C. System at 800/279-3511 and indicate that you are a CMA member.
Click here for more information on your membership benefits.
Contact: CMA's member service center, 800/786-4CMA (4262) or vsatt@cmanet.org.
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