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1. Updated Analysis of PacifiCare Contract Available
After receiving a number of physician complaints, CMA last year analyzed the PacifiCare/United Healthcare physician contract and found that it in many ways is inconsistent with state laws and regulations, including the Knox-Keene Act.
Although PC/UHC has since made a number of changes to the contract, CMA continues to have concerns with some of its provisions.
A detailed analysis of the contract, and its flaws, is available to members at CMA's members-only website. There you will also find objective written analyses of a dozen other major health plan contracts.
CMA reminds physicians that before signing a health plan contract, it is important to know what value that relationship will bring to your practice. Physicians do not have to accept bad contracts or contracts that are not mutually beneficial.
Click here for more information.
Contact: Aileen E. Wetzel, 916/444-5532 or awetzel@cmanet.org.
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2. Academy Workshop Will Help Physicians Prepare
for Medicare Quality Reporting Initiative
To help physicians understand and prepare for Medicare’s Physician Quality Reporting Initiative (PQRI), including the required use of G and CPT-II codes for reporting quality data, CMA has added to its Leadership Academy agenda a new workshop, “Medicare Pay for Performance: What We Know, How to Prepare.” The workshop will be taught by Ron Bangasser, M.D., past president of CMA and one of the leaders of the Integrated Healthcare Association’s P4P Initiative.
The quality reporting initiative, which begins in July, establishes financial incentives – bonus payments of 1.5 percent of total allowed charges for covered Medicare physician services – for physicians who participate in this voluntary program. Initially, performance targets, or actual “pay for performance” (P4P), will not be part of the formula.
This workshop is just one of several Leadership Academy sessions on reimbursement and practice management issues.
CMA’s 10th Annual California Health Care Leadership Academy is April 13-15 at the Monterey Convention Center. Early-bird tuition is $595 for members, $895 for nonmembers. After March 16, tuition is $695 for members, $995 for nonmembers. Attendees can receive up to 14 AMA PRA Category 1 CreditsTM.
Click here for more information or to register.
Contact: Roger Purdy, 916/444-5532 or rpurdy@cmanet.org.
3. Order the 2007 California Physician’s Legal Handbook
Physicians can now order the 2007 California Physician’s Legal Handbook (CPLH). This indispensable manual is published annually by CMA’s Center for Legal Affairs and answers the legal questions most frequently asked by physicians. It can be purchased as a seven-volume, 4,500-page print edition, an interactive CD-ROM, or an online subscription.
The entire handbook has been updated and expanded to reflect new laws and developments in the fast-changing health care delivery system. This edition includes extensive information on Medicare Advantage, including private fee-for-service health plans, and Medicare’s pay-for-performance program. It also contains extensive information on all the HIPAA rules, including specifics on the new National Provider Identifier, and contains practical summaries of state and federal laws, the text of laws where necessary, and useful forms.
The online subscription and CD-ROM offer all of the content of the print version, plus many enhancements, including fully searchable content, interactive forms and sample letters that you can easily customize with your computer’s word-processing program, and hyperlinks that take you to the Internet for more information about cited court cases.
The online subscription and CD-ROM are priced at $399 each and the seven-volume print version costs $799. Visit the CMA bookstore to place your order.
Members can access most of the CPLH content free through ON-CALL, CMA’s online medical-legal information library, at CMA's members-only website. Nonmembers can download ON-CALL documents for $2 per page in the CMA bookstore.
Click here for more information.
Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.
4. CMA Hosts Payor Contracting Seminars
for Physicians and their Office Staff
CMA and county medical societies are cohosting a series of seminars to help physician practices assess payor contracts and prepare for contract negotiations. The next “Taking Charge” seminars are March 15, in San Mateo, and March 31, in San Diego. (Click here for a list of all currently scheduled seminars.)
Attendees will learn how to:
- evaluate current and proposed contracts
- target payors for contract termination, negotiation, or renegotiation
- monitor payor compliance with terms
- determine a payor’s value to their practice
- and more!
Participants will also receive a copy of CMA’s payor contracting toolkits (a $125 value), including “Taking Charge: Steps to Evaluating Relationships and Preparing for Negotiations” and “Managed Care Contracts Deciphered: The Physicians’ Guide to Their Rights and Obligations.”
Click here for more information.
Contact: Gabrielle Fonseca, 916/551-2061 or gfonseca@cmanet.org.
5. Do You Have an NPI Yet?
On May 24, physicians who are covered by HIPAA will be required by federal law to use their new National Provider Identifier (NPI) on claims and other electronic health care transactions. NPIs will replace UPINs and other payor-specific provider identification numbers.
Physicians must also register their NPIs with Medi-Cal by May 23 to ensure that their payments are not interrupted when Medi-Cal transitions from its current provider numbering system to the NPI system. To ease the transition, Medi-Cal will offer a “dual use” period, during which physicians will be encouraged to use both their Medi-Cal provider numbers and their NPIs (if available) on Medi-Cal claim forms. During this transition period, NPI use is encouraged but not required for adjudication. This “dual use” period applies only to Medi-Cal. On May 24, claims submitted to Medicare and private payors will be denied if submitted without an NPI.
Click here for more information, including details on applying for an NPI.
Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.
6. Member Benefit of the Week:
Multimedia HIPAA Training for Physician Office Staff
Did you know that HIPAA requires every new hire in your office to be trained in both privacy and security practices? Is your practice compliant with these HIPAA training requirements? PrivaPlan, CMA’s HIPAA partner, has an affordable, easy-to-use CD-based training module, with online testing.
The training module is the latest in a series of premier compliance resources developed for CMA members by PrivaPlan. The training has been customized for California physicians, to keep them in compliance with both state and federal law. The program includes an online comprehension quiz and a printable certificate of completion.
Existing PrivaPlan subscribers receive a special price of $99 ($70 off the public purchase price of $169). CMA members who are not PrivaPlan subscribers pay $129.
Each HIPAA training CD comes with access for up to three users to take the quiz. Additional user accounts can be purchased at a very low cost. (Call 877/218-7707 for details.)
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. 2085
