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1. Early-Bird Deadline for CMA’s Leadership Academy Is March 16;
Register by Friday and Save $100
Don’t procrastinate any longer. The early-bird registration deadline for CMA’s 10th Annual California Health Care Leadership Academy is Friday, March 16. Register now and save $100 off tuition to this premier event, April 13-15 in beautiful Monterey. Attendees can earn up to 14 CME hours.
Since its inception in 1997, the Leadership Academy has emerged as one of the most important health policy and leadership development meetings on the West Coast. With the quality of content, the stature of the faculty, and the number of CME hours offered, CMA’s Leadership Academy rivals conferences that cost twice as much to attend.
This year’s conference will present information on the current and future practice of medicine — information that is not just theoretical, but also of practical value. The latter emphasis is reinforced by the introduction of practice management workshops aimed at improving the efficiency — and the bottom line — of your medical practice. These powerful workshops were designed for physicians, office managers, administrators, and billing and collections personnel.
This year’s academy also offers expanded social and networking activities, including a cocktail reception at the Monterey Bay Aquarium.
To register, visit http://www.cmanet.org/leadership or call 800/795-2262.
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2. CMA Calls United Healthcare’s New Lab Policy Illegal and
Ill-Advised; Policy Financially Penalizes Physicians for
Out-of-Network Referrals
CMA recently learned that PacifiCare/United Healthcare’s new laboratory policy imposes financial penalties on contracted physicians who refer patients to out-of-network laboratories. CMA this week demanded that state health insurance regulators halt the implementation of this policy, saying it illegally interferes with PPO patients’ right to access out-of-network benefits and improperly obstructs the physician-patient relationship.
The policy, which became effective March 1, authorizes the insurer to fine physicians $50, decrease contracted payment rates, and even terminate the contracts of physicians whose patients choose to go to out-of-network labs. Although PacifiCare United Healthcare (PC/UHC) has advised CMA that physicians will not be penalized without warning, CMA vigorously opposes any health plan attempt to interfere with the physician-patient relationship.
In letters to PC/UHC, the Department of Insurance, and the Department of Managed Health Care, CMA emphasized that PPO policies by their nature include the element of patient choice and as such, physicians must not be penalized when patients exercise their right to select a laboratory of their choice.
“Patients have the right to decide where to receive health care services, without having to worry that their physicians are being fined or otherwise penalized for their choices. This right is particularly acute for patients who pay premiums for nonexclusive PPO benefits,” wrote CMA chief legal counsel Catherine Hanson. “And physicians have the right to speak freely with their patients about their health care choices, without having to worry that they will be fined or otherwise penalized should their patients choose an out-of-network option.”
Physicians should also be aware that effective January 1, LabCorp is PC/UHC’s sole national laboratory services provider. To locate a participating lab in your area, use United Healthcare’s Lab Locator. Physicians may request an exception by calling 877/842-3210.
CMA will continue to work with PC/UHC’s liaison team to resolve this issue.
Click here for more information, including copies of CMA’s letters.
Contact: CMA’s reimbursement help line, 888/401-5911 or jblack@cmanet.org.
3. Claims Submitted on New CMS-1500s May Be Returned;
Formatting Error Delays Switch to New Forms
The Centers for Medicare & Medicaid Services (CMS) recently announced it will continue accepting the old CMS-1500 claim forms past the April 1 deadline because of formatting errors in some of the new forms being distributed by the Government Printing Office and others. The form was recently updated to accommodate the mandated National Provider Identifiers (NPIs).
Medicare contractors have been instructed to continue accepting the old form until future notice. The current target date is June 1.
Physicians should be aware that claims submitted on improperly formatted forms will be returned.
Click here for more information, including how to find out if your forms are formatted properly.
Contact: CMA’s reimbursement help line, 888/401-5911.
4. POS Claims Denied Because of System Glitch;
Improperly Denied Claims Will Be Reprocessed
CMA recently received a number of calls from physicians whose claims for services provided to patients with “point of service” (POS) plans were being improperly denied by PacifiCare/United Healthcare (PC/UHC). As you know, POS plans allow patients the freedom to pay a higher copays and/or deductible if they want to see specialists outside their medical groups/IPAs. The insurer had been denying such claims, saying that the responsibility for payment lay with the patients’ medical groups/IPAs. Claims submitted to the patients’ medical groups/IPAs were also denied, because the patient went “out of network.” CMA brought this problem to the attention of PC/UHC’s liaison team, and it was determined that a system glitch was causing the denials. As of March 5, the glitch has been fixed and PC/UHC is working to identify all improperly denied claims. These claims will be reprocessed (with interest, when appropriate).
It is not yet clear how long it will take for the claims to be identified and reprocessed. More details will be published in CMA Alert when they become available.
Click here for more information.
Contact: CMA’s reimbursement help line, 888/401-5911.
5. Governor Signs Executive Order to Accelerate
Adoption of Health IT in California
Governor Schwarzenegger signed an executive order Wednesday to accelerate California’s efforts to adopt health information technology. The order also calls for statewide quality reporting standards, increased transparency of cost and quality data, and more accountability in public and private health care delivery systems. This order builds on the governor’s health care reform proposal released in January.
CMA supports the adoption of health IT whenever possible and has been at the forefront for many years promoting IT standards and use among doctors and other health care providers. CMA is opposed, however, to unfunded mandates. Many small practices and practices operating in poor and rural areas cannot afford some technologies and, in some cases, don’t have high-speed Internet access. Without financial assistance, the governor’s mandate would be an undue burden for these doctors who are already, in many cases, providing free or underfunded care to the poor and disadvantaged.
Click here for more information.
6. Member Benefit of the Week: Retirement Planning Strategy
Last year, CMA’s Board of Trustees endorsed Professionals’ Retirement Strategy (PRS) as a new partner for retirement planning. PRS is offering a series of in-person educational programs to introduce physicians to its “California Physicians Retirement Strategy” (CPRS) product, which enables physicians to secure competitive loan financing based upon the value of their practice. The loan proceeds can provide supplemental retirement income.
To find out when PRS is coming to your area, visit http://www.prsplan.com.
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. 2086
