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1. New Medicaid Rules Shift $12 Billion
in Health Care Costs to California
At a time when California is already grappling with a $16 billion budget shortfall, the federal government has introduced a plan to reduce the amount of money it gives states for Medicaid and other social services, putting further strain on California’s Medi-Cal program.
This week, the Centers for Medicare & Medicaid Services (CMS) is implementing the first in a series of new Medicaid rules that would shift billions in health care costs to state and local governments. The rules would limit how much states could pay health care providers, ban the use of federal Medicaid money to train doctors, set new limits on Medicaid payments to hospitals and nursing homes operated by state and local governments, and limit Medicaid coverage of rehabilitation services for people with disabilities, including serious mental illnesses. The rules are scheduled to take effect over the next several months.
Some estimates indicate that California alone would lose $12 billion over five years.
One of the rules would ban the use of federal Medicaid funds to help pay for physician training, a use that has been allowed since the program began in 1965. According to Dennis Smith, director of CMS’ Center for Medicaid and State Operations, the Bush administration believes “that paying for graduate medical education is outside the scope of Medicaid’s role, which is to provide care to low-income people.”
Stan Rosenstein, California’s Medicaid director, believes using funds for physician training is justified because “interns and residents provide a tremendous amount of care to Medicaid beneficiaries.”
Governors of both parties have strongly objected to the new rules and have asked Congress to stop implementation of the regulations, which could have a devastating effect on the nation’s health care system. For states already grappling with rising health-care costs, the new rules will force them to consider cutbacks in services, leaving the most vulnerable Americans without access to health care and other vital services.
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Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
2. All Medicare Claims (Including Paper Claims) Must Now Include NPI
Physicians are reminded that as of March 1, all Medicare fee-for-service claims must use an NPI as the primary identifier (i.e., in the billing, pay-to, and rendering fields).
Between March 1 and May 23, 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. May 24 marks the end of the Medicare contingency plan. As of that date, all Medicare claims must be submitted with the NPI as the only identifier.
Physicians should be aware that HIPAA’s “country doctor” (small practices that submit only paper claims) exemption does not exempt physicians from Medicare’s NPI rules. The NPI is required on all Medicare claims, including paper claims.
Test Your Claims Now!
Since January 1, Medicare has been returning claims without matching NPI and Medicare “provider types.” 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. NHIC, California’s Medicare Carrier, is hosting a live interactive webinar on Tuesday, March 25, to assist physicians with the provider enrollment process.
Once you have successfully submitted (and been paid for) claims containing both NPIs and legacy identifiers, it is time to begin testing claims with only your NPI in the primary provider fields. It is important that physicians resolve any NPI rejection issues by May 23 NPI deadline to avoid any cash flow interruptions.
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Contact: Frank Navarro, 916/551-2046 or fnavarro@cmanet.org.
3. 40% of Physicians Have Not Yet Registered their NPI with Medi-Cal
If you are among the 40 percent of physicians who have not yet registered their NPIs with Medi-Cal, your claims will be denied. Medi-Cal claims submitted without registered NPIs will not be paid. To ensure uninterrupted claims payment, physicians are encouraged to register their NPIs as soon as possible.
Physicians can register their NPI with Medi-Cal using the National Provider Identifier Collection (NPIC) tool available on the Medi-Cal website.
Contact: Medi-Cal NPI Helpdesk at 800/541-5555 (select option 16 and then option 18 for NPI registration).
4. Insurers Admit Need for External Review of Policy Cancellations
After more than two years of negative press coverage and unfavorable court and regulatory decisions, two major California health insurance companies last week announced their support for external review of their decisions to rescind or cancel policies. CMA and Assemblymember Hector De La Torre both warned that any external review process must have teeth and pointed to CMA-sponsored AB 1945 as the ideal way to provide oversight of health insurers’ rescission practices. The bill (De La Torre, D-South Gate), would require health insurance companies to seek approval from regulators before canceling a patient’s policy.
In an interview in the Los Angeles Times last week, Health Net CEO Jay Gellert pledged to stop all cancellations until an external review process could be established to approve all cancellations. Blue Cross of California issued a press release over the weekend saying it was “developing an outside third-party review process for all rescission cases.”
If passed into law, the bill also would require regulators to revoke the license or otherwise discipline an insurance company for retroactively canceling a policy. Last year, CMA and De La Torre teamed up to pass AB 1324, which prohibited health insurers from denying payment for treatment which they had already approved.
Blue Cross has taken a series of steps over the past two years to show the public it was policing itself after media exposed its practice of taking away individual policies after the patients submitted claims for treatment. But the problems have continued, most recently with reports in the past two weeks that doctors received letters asking them for information about their patients’ medical histories so that Blue Cross could cancel the policies and not pay the bills.
Outraged at this intrusion into the physician-patient relationship, CMA asked the Department of Managed Health Care to step in and stop the letter. “We’re outraged that they are asking doctors to violate the sacred trust of patients to rat them out for medical information that patients would expect their doctors to handle with the utmost secrecy and confidentiality,” CMA President Richard Frankenstein, M.D., told the Los Angeles Times. Within hours of the story breaking in the media, Blue Cross said it would no longer send out the letter.
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Contact: Ned Wigglesworth, 916/444-5532 or nwigglesworth@cmanet.org.
5. Another United Claims Processing Error:
8,700 California Claims Paid Incorrectly
Less than a month after a claim processing error that resulted in nearly 12,000 inappropriate claim denials, CMA has learned that an additional 8,700 United Healthcare claims were processed incorrectly: some denied, some underpaid, some overpaid. This time, the errors were caused by an outdated list of procedures requiring advance notification.
Affected claims had dates of served of December 21, 2007, to January 16, 2008. Physicians do not need to appeal or resubmit these claims for reconsideration. Affected claims will automatically be reprocessed by the insurer.
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Contact: CMA’s reimbursement help line, 888/401-5911 or drice@cmanet.org.
6. United Healthcare to Retroactively Pay
for Previously Denied Preventive Health Services
Last fall, United Healthcare agreed to begin paying physicians separately for acute care services provided during a preventive medicine visit. The policy change, which took effect December 8, 2007, allows for partial payment (50% of contracted rate) of a problem focused evaluation and management (E&M) service when performed on the same day as a preventive E&M service for the same patient. Previously, United only reimbursed physicians for one of the two procedures. CMA and others in organized medicine have been advocating for a change to this unfair payment policy for years.
Initially, the payment policy applied to claims with dates of October 15, 2007, or later. United recently, however, agreed to pay previously denied claims back to August 27, 2007.
Affected claims will automatically be reprocessed. CMA does, however, encourage physicians to run their own reports and identify affected claims to ensure all claims are paid appropriately.
Contact: CMA’s reimbursement help line, 888/401-5911 or drice@cmanet.org.
7. 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.
8. Benefit of the Week: Reduced Loan Administration Fees
CMA members get reduced loan administration fees from Banc of America Practice Solutions™ (a subsidiary of Bank of America). For more than 20 years, Bank of America has served the needs of physicians by offering financial products and services tailored to meet the needs of the medical community.
The expertise of our financial specialists and the convenience of a simple express application can help you secure equipment and electronic medical record financing in as little as three hours.
Whether you own a practice or are just getting started, Banc of America Practice Solutions™ can provide customized financial solutions for your short- and long-term needs. For more information, call Banc of America Practice Solutions™ at 800/497-6076.
A members-only code is needed to take advantage of this discount. Visit CMA’s members-only website, http://www.cmanet.org/member, or call the member service center at 800/786-4CMA (4262) to get your code.
Click here for more information on your membership benefits.
Contact: CMA’s member service center, 800/786-4CMA or info@cmanet.org.
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