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1. CMA Alert Podcast Now Available
Don't have time to read CMA Alert? Now you can listen on the go to the latest news from CMA in a convenient audio podcast. Use the link below to listen to the current issue, or visit http://www.cmanet.org/news/podcasts.asp.
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2. Californians Overwhelmingly Oppose 2% Doctor Tax
A survey released last night by the well respected Public Policy Institute of California (PPIC) shows strong public support for changes in the delivery of health care in California. This support crosses nearly all partisan, ethnic, regional, and gender lines.
Most significantly, both “all adults” and “likely voters” in the state soundly reject the idea of taxing physicians and hospitals to pay for health care reform. The opposition among “likely voters” is by an overwhelming 2 to 1 ratio.
"This clearly takes the tax on doctors off the table in the health care reform debate," says CMA President Anmol Mahal, M.D. "It’s a non-starter for the voters of California, so it should be a non-starter for the legislators and Governor who they trust to fix this broken system.
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Contact: Susan Bassett, 916/444-5532 or sbassett@cmanet.org.
3. Improperly Denied POS Claims to Be Reprocessed by May 30
CMA recently reported in CMA Alert about a system glitch at PacifiCare/United Healthcare (PC/UHC) that caused claims for services provided to patients with “point of service” (POS) plans to be improperly denied. As you know, POS plans allow patients the freedom to pay higher copays and/or deductibles 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 had been fixed and PC/UHC expects to have all improperly denied claims reprocessed by May 30. These claims will be reprocessed (with interest, when appropriate).
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Contact: CMA’s reimbursement help line, 888/401-5911.
4. California Medicare Carrier Will Pay Claims
Submitted on Badly Formatted CMS-1500 Forms
NHIC, California’s Medicare carrier, has informed CMA that it will, despite previous reports to the contrary, be able to process claims submitted on incorrectly formatted CMS-1500 forms while physicians are obtaining corrected forms.
As recently reported in CMA Alert, the Centers for Medicare & Medicaid Services (CMS) earlier this month announced it would 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 other vendors. 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.
The best way to identify badly formatted forms is to look at the upper right-hand corner of the form. If the tip of the red arrow above the vertically stacked word “CARRIER” is touching or close to touching the top edge of the form, then the form is not printed to specifications. There should be approximately a quarter of an inch between the tip of the arrow and the top edge of the paper on properly formatted forms.
Please note that this issue involves the paper claim form only and does not affect the NPI implementation date. 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.
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Contact: CMA's reimbursement help line, 888/401-5911.
5. Medicare Hosts Conference Call on New Quality Reporting Initiative
The Centers for Medicare & Medicaid Services on Tuesday hosted the first in a series of conference calls to help physicians understand and prepare for Medicare’s Physician Quality Reporting Initiative (PQRI). Physicians who were unable to participate in the call can access an on-demand audio replay of the call by calling 888/348-4629 (passcode 549030). The audio replay will be available until April 10. A written transcript of the call is also available at the PQRI website, http://www.cms.hhs.gov/pqri.
The next PQRI conference call will be in early April. Details will be published in CMA Alert as soon as they become available.
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,” will not be part of the formula.
Physicians (and their staff) can also learn more about PQRI at CMA’s 10th Annual Health Care Leadership Academy. Among the academy’s many valuable breakout sessions is “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. This workshop is just one of several Leadership Academy sessions on reimbursement and practice management issues.
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6. Practice Tip: Report Health Plan Abuses
In recent years, CMA-sponsored laws have given state agencies the power to take action against insurers that repeatedly engage in unfair payment practices. It is important, however, that physicians be able to identify these unfair payment practices. Without physician complaints, the regulations will be useless, and abusive health plan behavior will not change.
For help identifying unlawful payment practices, see CMA’s payor abuse action guide, “Payor Abuse Matters.” This guide is available free to members at the members-only website. Nonmembers can purchase the guide for $100 in the CMA Bookstore, CMA Bookstore. Please be aware that when the guide was published, the protections applied only in regard to health plans regulated by the Department of Managed Health Care (DMHC). Since then, a law has been passed granting similar protections to physicians contracted with insurers regulated by the Department of Insurance (DOI).
If you have been subject to unfair payment practices, see CMA ON-CALL document #1051, “Complaints about Managed Care Plans,” for more information on filing complaints with DMHC or DOI.
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Contact: CMA's reimbursement help line, 888/401-5911.
7. Save the Date: Adult Immunization Summit Is 4/30 in Los Angeles
CMA is again sponsoring the California Adult Immunization Summit. This year’s summit, which is presented by the Steering Committee for the California Adult Immunization Coalition, will be on Monday, April 30, in downtown Los Angeles.
The one-day summit brings together a diverse group of stakeholders including physicians, public health officials, members of the media, health plan representatives, and vaccine manufacturers to discuss the lessons learned from this year’s flu season and lay the groundwork for future adult immunization initiatives.
Early-bird registration deadline is April 8. Register by the April 8 early-bird deadline and pay only $50. After April 8, registration is $75. Participants can receive 6.5 CME hours.
Registration information is available at http://www.immunizecaadults.org.
Contact: Patricia Porter, patricia.porter@ucsf.edu.
8. Member Benefit of the Week:
Guaranteed-Issue Term Life Insurance Deadline Is March 31
CMA members, don’t miss your chance to get $50,000 of term life insurance at discounted group rates. This special guaranteed-issue insurance is available only until March 31 to actively practicing physician members under age 60. (“Actively practicing” means working 30 hours per week for at least 90 days prior to the effective date of coverage.) Additional coverage requires a supplemental application and will be medically underwritten.
More information, including an application, is available at http://www.marshaffinity.com or call 800/842-3761.
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. 2088
CMA Alert Podcast Now Available
