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1. CMA to Kick Off 150th Anniversary Celebration at Site
    of Association’s First Meeting in Old Town Sacramento
CMA was founded in 1856 by a modest group of 100 physicians who gathered in Sacramento’s Pioneer Hall on J Street. Delegates then were concerned with “mutual improvement, a study of the state’s growing health problems and what to do about ‘that everlasting parasite of medicine, quackery.”

Today, 150 years later, we are 35,000 physicians strong and growing. Although we’ve seen a lot of changes in patient care, that basic goal is still thriving today. “Physicians dedicated to the health of Californians.” It’s the slogan on our letterhead and it sums up CMA’s role in the history, the present, and the future of California.

CMA next week will kick off a year long 150th anniversary celebration, with a press conference and historical presentation at the site of the association’s first meeting in what is now Old Town Sacramento. Following the press conference, CMA will host a luncheon at its downtown Sacramento headquarters.

Past and present CMA officers will attend, as will a number of legislators, public health officials, health care VIPs, and CMA and county medical society staff.

Click here for more information.

Contact: CMA Communications, 916/551-2864 or mgrant@cmanet.org.

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2. Retroactive Medicare Claim Adjustments Have Begun
CMA this week learned that California’s Medicare carrier (NHIC) has begun reprocessing Medicare claims paid under the old 2006 fee schedule. As you know, the federal budget package signed by the president on February 9 reversed the 4.4 percent cut to Medicare physician payments that took effect January 1. The Centers for Medicare & Medicaid Services (CMS) instructed carriers to retroactively adjust claims to compensate physicians for the 4.4 percent cut.

Physicians should not resubmit claims. Medicare carriers will automatically make retroactive payments for eligible claims. It may, however, take a few months to reprocess all the claims. The oldest claims will be processed first.

CMS is also offering a second 2006 Medicare participation enrollment period. This second enrollment period will allow physicians to reconsider their decisions in light of the revised 2006 fee schedule, which rolls back the conversion factor to the higher 2005 level.

Physicians have until March 31 to make any changes to their Medicare
participation status. Changes made during this new enrollment period will
be retroactive to January 1.

Click here for more information.

Contact: CMA’s reimbursement help line, 888/401-5911 or fnavarro@cmanet.org.

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3. Appellate Court Upholds Noncontracting Physicians’ Right to Fair Payment
In a significant victory for physicians, the Second District Court of Appeal in Los Angeles recently ruled that noncontracting physicians who provide emergency services to health plan enrollees have the right to balance-bill patients for the reasonable value of their services if a health plan or IPA fails to reimburse them appropriately.

In this case, Prospect Health Source Medical Group v. Northridge Emergency Medical Group, the plaintiff (a capitated IPA) argued that when a physician bills and is paid by an HMO or its contracting intermediary, an “implied contract” has been created whereby the physician is prohibited from balance billing the patient under the Knox-Keene Act.

CMA filed a brief with both the trial and appellate courts in this case, explaining that nowhere in California law are noncontracting physicians required to accept health plans’ discounted payment as payment in full for services provided to its enrollees. CMA stressed that the Knox-Keene Act’s ban on balance billing applies only to contracted physicians and that the law specifically allows balance billing by noncontracting physicians.

The appellate court also ruled that health plans and IPAs have the right to contest in court the reasonableness of a physician’s billed charges, just as physicians have the right to take legal action against health plans that do not fairly reimburse them for emergency services provided to plan enrollees.

Click here for more information.

Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.

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4. Get Your Medical-Legal Questions Answered at CMA ON-CALL;
    Free to Members and Newly Updated for 2006
The 2006 CMA ON-CALL documents have been updated and are now available online. ON-CALL is an online library that contains over 3,000 pages of medical-legal, regulatory, and reimbursement information. The searchable library contains all the information available in the California Physician’s Legal Handbook, an annual publication of CMA’s Center for Legal Affairs.

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 CMA's online bookstore.

If you haven’t taken advantage of this extraordinary resource, spend a few minutes browsing the ON-CALL index, and see what you’ve been missing.

Click here for more information, including step-by-step instructions on how to access the ON-CALL system.

New ON-CALL documents for 2006 include:

Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.

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For previous editions of CMA Alert, visit our news archives.

Prepared by the CMA Communication Center
Katherine Gallia, Editor,
916/551-2074,
Michelle Grant, Publishing Assistant,
916/551-2072,