|
ADVERTISEMENT
1. NPI Enforcement Delay No Excuse for Procrastination
Recognizing a low level of NPI readiness in the health care industry, the Centers for Medicare & Medicaid Services Tuesday announced that it would allow Medicare carriers and other payors to continue accepting legacy provider identification numbers until May 23, 2008. Payors can take advantage ofthis one-year grace period as long as they have a contingency plan in place and are able to demonstrate “good faith efforts” to comply with the regulations.
This does not, however, mean that physicians who don’t yet have their NPIs can continue to procrastinate. Medicare and other payors may at any time after May 23, 2007, decide to stop accepting legacy numbers and to only accept the new NPIs. To avoid disruptions in cash flow, physicians should make sure that they have their NPIs no later than May 23, and have registered them with all payors.
Physicians are required by the Health Insurance Portability and Accountability Act (HIPAA) to get NPIs, which will replace UPINs and other payor-specific provider identification numbers on standard electronic health care transactions.
Applying for an NPI is fairly simple. Physicians can apply online at https://nppes.cms.hhs.gov. If you do not have Internet access, call the NPI Enumerator at 800/465-3203 and request a paper application form.
CMA’s legal department has also written a primer to help physicians with the NPI process. The primer, available through the CMA ON-CALL system, is available free to members at the members-only website. See document #1608, “National Provider Identifiers.” Nonmembers can purchase 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.
2. Quality Matters: Medicare Announces 2007 Quality Measures
The Centers for Medicare & Medicaid Services this week unveiled the 74 performance measures that will be used in its new pay-for-performance program, the Physicians Quality Reporting Initiative (PQRI). The program, 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.
Click here for more information on the 2007 performance measures.
Contact: Sandra Bressler, 415/882-5171 or sbressler@cmanet.org.
3. Blue Cross Fined $1 Million for Illegally
Cancelling Health Insurance Policies
The Department of Managed Health Care (DMHC) recently fined Blue Cross $1 million for routinely violating state law by cancelling individual health insurance coverage after policyholders got sick. This fine comes after CMA in 2005 reported this issue to DMHC and demanded that the department take action.
DMHC examined 90 randomly selected policy cancellations and found that in each case Blue Cross used computer programs to systematically cancel policies without any indication that the policyholders intentionally lied on their applications to cover up preexisting medical conditions — a standard required by state law.
Not only does this practice put patients at risk, both financially and medically, but it also leaves physicians and hospitals holding the bag for services rendered in good faith, often with prior authorization. CMA is working with DMHC to ensure that physicians are appropriately reimbursed for services provided in good faith to Blue Cross policyholders.
CMA is sponsoring a bill (AB 1324) that would confirm that it has long been illegal for insurers to rescind or modify authorization after services are rendered in good faith. This bill would also reaffirm that the law protects patients from retroactive cancellation of health insurance policies.
Insurers maintain that they have the right to cancel a policy, even after approving treatment, if important information is missing or incorrect on an application for coverage — regardless of whether the error was an intentional attempt to deceive.
CMA has petitioned to join a class-action consumer lawsuit already filed that seeks to stop Blue Cross from engaging in this unfair and illegal business practice.
Click here for more information.
Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.
4. Don’t Miss This Year’s Legislative Leadership Conference,
with Keynote Speaker Gov. Arnold Schwarzenegger
Physicians seeking insight into and training on how to affect the political process are encouraged to attend CMA’s 33nd Annual Legislative Leadership Conference — aka “Doctor Day”— Tuesday, April 24, in Sacramento. A revamped schedule will include more time than ever to meet with your elected officials to discuss this year’s legislative issues that could impact the practice of medicine in California.
Attendees will receive a CMA health policy briefing and a short course on “Lobbying 101,” which will train them to become strong physician advocates and prepare them for the legislative meetings later in the day.
Among the legislative issues that will be discussed at this year’s conference:
Physicians’ Right to Fair Payment: CMA’s Council on Legislation last week voted to oppose this bill (SB 389), which would prohibit hospital-based physicians from from seeking payment from patients, except for allowable copayments and deductibles, even if the patients’ HMOs fail to fairly reimburse for services provided to enrollees.
Retroactive Cancellation of Health Insurance: CMA is sponsoring a bill (AB 1324) that would confirm that it has long been illegal for insurers to rescind or modify authorization after services are rendered in good faith. This bill would reaffirm protections for patients from retroactive cancellation of health insurance policies. The bill would also require that physicians be paid for services provided in good faith with prior authorization. (For more information this issue, see “Blue Cross Fined $1 Million for Illegally Cancelling Health Insurance Policies” )
Health Care Reform: As you know, Gov. Schwarzenegger is committed to seeing that comprehensive health care reform is achieved this year. A number of proposals on how to “fix” the system have been submitted by the governor and others. CMA leadership is hopeful and excited about the potential of reforming a long-neglected health care system, yet intensely concerned about some of the proposed solutions.
The governor has accepted CMA’s invitation to give the keynote address at the conference. This will be a unique opportunity for physicians to hear the governor speak about his health care reform proposal. The governor will address the more than 500 physician attendees just prior to their afternoon legislative meetings.
There is no charge to attend this conference, but registration is required.
Click here for more information.
Contact: Marlon Cuellar, 916/444-5532 or mcuellar@cmanet.org.
5. Administrative Delays Continue at United Healthcare;
CMA Again Urges State to Investigate
CMA in February informed state regulators that administrative delays by PacifiCare/ United Healthcare (PC/UHC) were negatively impacting patient access to care. CMA asked the Department of Managed Health Care (DMHC) and the Department of Insurance (DOI) to investigate the situation and determine whether the delays are the result, as CMA suspects, of a significant lack of administrative capacity.
CMA had received a number of complaints from physicians of insurer’s chronic delays processing new contracts and contract terminations. These delays not only have caused patients to be misinformed about physicians’ participation status, but also have resulted in significant administrative hassles for physician offices. Physicians are also reporting that the insurer has failed to load contracted rates correctly and has been unresponsive to their phone calls, letters, and e-mails.
Although CMA has worked with the insurer to resolve individual physician complaints, it does not appear that PC/UHC has made a commitment to eliminating these problems on a systemic level. CMA continues to receive similar complaints from other physicians on a daily basis.
CMA last week reiterated its concerns to DMHC and DOI and strongly urged them to conduct a formal investigation into this matter. Additional details will be published in CMA Alert as they become available.
Click here for more information.
Contact: CMA’s reimbursement help line, 888/401-5911 or awetzel@cmanet.org.
6. There’s Still Time to Register for CMA’s
Leadership Academy, April 13-15 in Monterey
Registrations are still being accepted for the 10th Annual California Health Care Leadership Academy in Monterey on April 13-15. To date, over 350 physicians, practice managersand physician office staff, allied health professionals, and medical executives have registered for the CME-approved conference, which features an outstanding line-up of speakers on topics ranging from patient safety to public health to current health system reform legislation.
This year’s new slate of practice management workshops has drawn broad interest from physicians and their office staff.
For more information, visit http://www.cmanet.org/leadership or call 800/795-2262.
7. Benefit of the Week: 30-35% Off Epocrates
CMA members receive 30 percent off one-year subscriptions and 35 percent off two-year subscriptions to any Epocrates product. Students and residents receive 50 percent off all Epocrates products. Group discounts are also available. Epocrates provides physicians with point-of-care access (via PDA, desktop computer, or the Internet) to up-to-date information on drugs, diseases, and diagnostics. Epocrates allows physicians to make better clinical decisions, saving time and improving quality of care. To receive your discount, log in to the CMA members-only website and follow the links to the Epocrates website.
Click here for more information on your membership benefits.
Contact: CMA’s membership hotline, 888/233-2937 or lgodward@cmanet.org.
|
No. 2089
Audio Podcast
