|
ADVERTISEMENT
1. California Legislature Approves 10% Medi-Cal Rate Cut
Both houses of the California Legislature on Friday approved an emergency spending plan that will cut Medi-Cal provider rates by 10 percent, effective July 1, 2008. CMA believes that these cuts, rushed through the legislative process with little opportunity for public comment, are shortsighted and will have a devastating effect on California’s already fragile health care system.
“These cuts will not only leave millions of Californians stranded with reduced or no access to their critical health care needs, but could break the back of a health care system which is already under serious strain,” says CMA President Richard Frankenstein, M.D. “Medi-Cal patients will be forced into Emergency Rooms for their primary care, driving up costs and compromising access to emergency services for all Californians. These cuts aren’t fair or humane, and don’t even make economic sense. Legislators need to give more consideration than a hearing or two to the impact these cuts will have on all Californians.”
The Medi-Cal program is seriously underfunded already, with only about half of physicians in the state taking Medi-Cal patients. Many cannot afford to take any new patients because reimbursements don’t cover the cost of care. Under current Medi-Cal rates, a primary care office visit goes for $20, for example, which doesn’t cover the cost of a physician’s time, overhead or other expenses. Current Medi-Cal rates are some of the lowest in the nation, and are, on average, 60 percent of Medicare and less than 50 percent of commercial health plan rates.
Slashing payments for health care in California also leaves matching federal dollars on the table. California receives $1 in federal matching funds for every Medi-Cal dollar spent. The $544 million billion in state cuts would drain a total of $1.1 billion from Medi-Cal.
The likely effects of these proposed cuts was highlighted last week in Los Angeles, where county health officials announced the proposed closure of all but one of the county’s dozen clinics. The county also plans to reduce services at six outpatient health centers. Patients have few options, particularly since Los Angeles County has lost nine hospital emergency departments since 2000.
At Santa Rosa Memorial Hospital in Sonoma County, the county’s only inpatient psychiatric care unit announced Wednesday it will close, partly because of financial difficulties incurred after a county mental health facility closed last year. The hospital is also closing acute care and skilled-nursing facilities.
These closures epitomize the effect the cuts will have statewide, with more closures of clinics and other facilities dependent on Medi-Cal dollars.
Click here for more information.
Contact: Lisa Folberg, 916/444-5689 or lfolberg@cmanet.org.
2. CDC Announces Hib Vaccine Shortage; California Department of Health Issues Special Immunization Schedule for Children
Because of a nationwide shortage of the Haemophilus influenzae type b (Hib) vaccine, the Centers for Disease Control & Prevention (CDC) have issued abbreviated Hib vaccine recommendations, temporarily suspending the booster vaccine dose for most children.
California’s school immunization law requires that children receive a series of vaccinations, including Hib, before entry to schools, child care centers, or family child care homes. To allow uninterrupted admission to child care facilities in California, the California Department of Public Health (CDPH) Immunization Branch has issued a Special Immunization Schedule that temporarily amends the Hib vaccine requirements for children in California.
Click here for more information.
Contact: Teresa Kline, 916/444-5532 or tkline@cmanet.org.
3. Medicare Claims Must Contain NPI Effective March 1
Physicians are reminded that effective March 1, 2008, all Medicare fee-for-service claims must use an NPI as the primary identifier (i.e., in the billing, pay-to, and rendering fields).
You may continue to submit NPI/legacy pairs in these fields or submit only your NPI. Claims containing only a legacy identifier in the primary fields will be rejected or returned as unprocessable.
Stay tuned to CMA Alert for additional information about the end of Medicare’s NPI contingency plan, scheduled for May 23, 2008.
Click here for more information.
Contact: Frank Navarro, 916/551-2046 or fnavarro@cmanet.org.
4. Are You Having Medicare NPI Problems?
Medicare Carrier Hosting Provider Enrollment Webinar
California’s Medicare Carrier is hosting a live interactive webinar on Tuesday, March 25, to assist physicians with the provider enrollment process.
As you may know, changes in the Medicare enrollment process over the years have caused some differences between the NPI and Medicare identification number assignment process. This may require some physicians to complete a new Medicare enrollment form so that their NPI and Medicare “provider types” match.
Particularly affected are solo incorporated practices. Solo incorporated practices are required to obtain both an organizational NPI and an individual NPI. If you have two NPIs but only one Medicare provider number, a new CMS 855 application may be necessary.
It is important that physicians resolve any mismatch issues before the May 23 NPI deadline.
These webinars fill up fast, so register today to reserve your spot. NIHC has set aside 150 spots exclusively for CMA members. Members can preregister today, before registration is opened to the general public.
For more information and to register, click here.
Contact: CMA’s reimbursement help line, 888/401-5911 or drice@cmanet.org.
5. Read Before You Sign: Health Management Network Solicitation
It’s not uncommon for physician offices to receive solicitations from out of state PPO networks. One such PPO solicitation from Nevada-based Health Management Network (HMN) was recently brought to CMA’s attention.
The HMN agreement is in many ways inconsistent with California law. For example, California law requires PPOs to pay claims within 30 days. The HMN agreement allows 60 days. HMN also requires physicians to file appeals within 60 days. This means that physician offices must be aware of this quick turnaround and able to comply with the requirement.
Before joining any network, particularly one that is leased or rented by other payors, you should carefully review the contract, including the list of payors that would have access to the discounted rates. Physicians should ensure that the proposed compensation, including the payor’s payment policies and the rules it uses to adjudicate claims, will be sufficient to maintain a medical practice. Without doing this analysis, you cannot make an informed decision about signing the contract.
To help physicians negotiate and manage complex third-party payor agreements, CMA has published a contracting toolkit, “Taking Charge: Steps to Evaluating Relationships and Preparing for Negotiations—A Focus on Payor Contracting.” The toolkit is available free to members at the members-only website. Nonmembers can purchase the toolkit for $100 in the CMA bookstore.
CMA has also published a “Silent PPO Action Guide,” which contains an overview of physician discount contracts and discusses the laws that regulate PPO network leasing. The guide is available through CMA ON-CALL (document #1907). ON-CALL documents are available free to members at CMA’s members-only website. Nonmembers can purchase ON-CALL documents for $2 per page in the CMA bookstore.
Click here for more information.
Contact: CMA’s reimbursement help line, 888/401-5911 or drice@cmanet.org.
6. Leadership Academy Registration Now Open
Registration is now open for CMA’s 11th Annual California Health Care Leadership Academy, May 2 – 4 at Disney’s Grand Californian Hotel in Anaheim.
This year’s conference, “Future Scan 2008,” will focus on trends and developments affecting the future of health care in California and beyond. Among the featured speakers are:
- Congressman Pete Stark, Chair of the House Ways and Means Subcommittee and one of the most powerful voices in Congress on Medicare policy;
- Kim Belshe, Secretary of the California Health and Human Services Agency;
- Arnold Relman, Editor-in-Chief Emeritus of the New England Journal of Medicine; and
- Ronald Galloway, the director of “Why Wal-Mart Works and Why That Makes Some People Crazy,” who will address Wal-Mart’s plan to become the “number one health care company in America.”
The Academy also will feature a slate of dynamic practice management and leadership skills workshops.
Conference brochures have been mailed to all CMA members. The program agenda can also be viewed on the Academy website.
Register online at http://www.cmanet.org/leadership or by calling 800/795-2262 between the hours of 8:30 am and 4:30 pm.
Contact: Roger Purdy, 916/444-5532 or rpurdy@cmanet.org.
7. Correction: Legislative Leadership Day Is April 15
CMA’s 34th annual Legislative Leadership Conference is Tuesday, April 15, in Sacramento. This is the most important day of the year for physician advocates!
This is a unique event for California physicians and is free of charge to all CMA members. 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 elected officials in the State Assembly and Senate to discuss important health policy issues that affect the practice of medicine in California.
Contact: Jennifer Williams, 916/444-5532 or jwilliams2@cmanet.org.
8. Member Benefit of the Week: 6% off Web-Based
Practice Management from athenahealth
CMA members receive 6 percent off athenaCollector, athenahealth’s unique web-based practice management service, which integrates web-based practice management, EMR software, and back office processing specialists into a single service.
athenahealth helps physicians get paid quickly, correctly, and with minimal hassle: On average, practices that use athenahealth get paid 30 percent faster and see a 5 to 10 percent increase in collections.
To find out more about athenaCollector, CMA and athenahealth are cohosting an online interactive seminar for CMA members and their colleagues. The 1-hour seminar is Thursday, February 28, at 12:15 pm.
Participants will find out more about this valuable member benefit and learn how to athenahealth can help them improve and optimize performance, and reverse the negative trends impacting physician practices today. There will also be a live Q&A session, so you can get your questions answered immediately.
Visit http://www.cmanet.org/calendar for more information and to register.
Click here for more information on your membership benefits.
Contact: CMA’s member service center, 800/786-4CMA or info@cmanet.org.
| 
No. 2126
