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1. Physician License Renewal Form No Longer Requires
Social Security Number Because of Potential for Identity Theft
Responding to identity theft concerns, the Department of Consumer Affairs (DCA) will no longer require full Social Security numbers (SSNs) on physicians’ biannual medical license renewal forms. The new form only requires the last four digits of the licensees’ SSNs.
CMA—at the urging of a number of its resident and young physician members—had previously approached the medical board about changing the policy requiring SSNs on license renewals. Despite support from the medical board and other licensing boards, DCA, which processes professional license renewals in California, had initially resisted the change. DCA finally implemented the policy change in part because of the demonstrated real risk of identity theft stemming from the burglary of mail from a medical board office in Sacramento.
Click here for more information.
Contact: Sandra Bressler, 415/882-3377 or sbressler@cmanet.org.
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2. Physicians Are Not Required to Be CPR Certified,
Although Misleading Solicitations Imply Otherwise
CMA has learned that a number of physicians have received a misleading “memo” from the “CPR Update Unit” soliciting business with misleading information. The memo implies that physicians are required by law to be CPR certified and that physicians who already are certified need to take extra courses to maintain their CPR certification to comply with guidelines recently issued by the American Heart Association (AHA). While it is true that AHA did issue new CPR guidelines, which took effect April 1, the law does not require physicians in California to be CPR certified. These memos are nothing more than solicitations from a company that sells CPR renewal certificates online.
Physicians who choose to be CPR certified do not need to do anything extra to maintain their CPR certification. According to AHA, when it comes time for an individual to renew CPR certification, the required and AHA-approved renewal courses will be taught according to the new guidelines.
Click here for more information.
Contact: American Heart Association, 800/242-8721.
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3. CMA Advocacy Works! Aetna Changes Reimbursement Policy,
Recognizes Modifiers 25 and 57 in Certain Situations;
Physicians Urged to Resubmit Previously Denied Claims
Aetna recently announced that it would stop bundling evaluation and management (E&M) codes submitted on the same date of service in two circumstances. Aetna will now pay physicians for problem-oriented evaluation and management (E&M) services provided during a preventive services visit, when billed with modifier 25. Aetna will also reimburse physicians for E&M services when billed with modifier 57, performed on the same day as a decision for major surgery (global, 90-day procedure). These changes are consistent with CPT coding guidelines.
Although these policy changes were announced last year, their implementation was delayed and Aetna’s claims processing systems finally began recognizing E&M Codes with these modifiers effective February 11. Physicians can, however, resubmit previously denied claims for these codes with dates of service on or after August 15, 2005.
The changes were recommended by Aetna’s Physicians Advisory Board, which was created as part of Aetna’s RICO lawsuit settlement. Aetna in 2003 became the first HMO to settle with CMA and more than a dozen other state medical associations in CMA’s RICO lawsuit. Since then, six other HMOs have settled the fraud and racketeering cases. CMA filed the lawsuit six years ago, challenging the rapacious tactics of the for-profit managed care industry. The case allowed physicians to air profound grievances against an industry that has unfairly exploited them for more than a decade.
Modifier 25: This modifier is used when there was a significant, separately identifiable E&M service provided by the same physician on the same day as another procedure or service. For example, you see an Aetna patient for her annual well-woman check-up and during the visit she mentions that she’s been having significant neck pain. You can bill for the well-woman exam and for your E&M services related to the neck pain, with a modifier 25 attached to the latter code. The codes affected by this policy change are 99381-99387, 99391-99397, 99201-99205, and 99211-99215.
Note: Some pending Aetna settlement compliance disputes will likely result in additional payments to physicians for modifier-25-related reasons beyond those described above. The settlement language requires that “if a bill contains a CPT code for performance of an evaluation and management code appended with a modifier 25 and a CPT code for performance of a nonevaluation and management service procedure code, both codes shall be recognized and eligible for payment.”
Modifier 57: This modifier is used on E&M services that resulted in a decision to perform major surgery. For example, an Aetna patient comes in complaining of neck pain. You examine the patient, diagnose a fractured clavicle, and decide that surgery is indicated to treat the closed fracture. You can bill for the examination (with modifier 57) and for the decision for surgery.
Note: Some Aetna settlement compliance disputes are pending that may result in additional payments for modifier 57 claims with dates of service prior to August 15, 2005. The settlement language requires that “no global periods for surgical procedures shall be longer than any period than designated on a national basis by [the Centers for Medicare & Medicaid Services] for such surgical procedures.” CMA believes that this provision entitles physicians to reimbursement for modifier 57 claims that are consistent with Medicare payment rules with dates of service on or after May 21, 2003 (the date the Aetna settlement became final).
Stay tuned to future issues of CMA Alert for more information on RICO settlement enforcement activities.
Click here for more information.
Contact: Frank Navarro, 916/444-5532 or fnavarro@cmanet.org.
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4. CMA’s Innovative Extreme Makeover Project
Will Streamline Physician Practices
 CMA recently received a grant from the Physicians’ Foundation for Health System Excellence to fund its “Extreme Makeover” project. The project will pair 8 solo and small group physician practices with physician leaders and experts in a number of areas, including technology and organizational design. Together, the team will help these practices optimize their administrative work flow.
Through this project, CMA will develop methods to reduce administrative distractions and use technology to improve efficiency your practice’s bottom line. CMA will use the lessons learned from this project to create templates, toolkits, and training materials to benefit physicians nationwide.
Would you like to participate in the Extreme Makeover project and be part of an exciting, innovative project funded by the settlement of CMA’s RICO lawsuit? We’re looking for practices that:
- Are located in the Alameda or Contra Costa counties;
- Submit high volumes of low-dollar claims;
- Contract with third-party payers;
- Can commit their time and that of their staff to
meaningfully participate in the project.
To learn more about this project, come to a town-hall meeting at the Alameda Contra Costa Medical Association, April 25 from 6 to 8 pm.
Click here for more information.
Contact: Nileen Verbeten, 916/444-5532 or nverbeten@cmanet.org.
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5. Highlights from CMA’s 32nd Annual Doctor Day
 More than 500 physicians, medical students, residents, and CMA Alliance members from throughout the state gathered in Sacramento Tuesday for CMA’s annual Legislative Leadership Day. Participants reviewed major legislative issues affecting patients and physicians in California, and heard those topics discussed by separate panels of legislators and political consultants. Many physicians used the afternoon to meet individually with their legislators for frank discussions of state and local health care issues.
 This year’s event focused on informed consent and off-label prescriptions (AB 2856), medical loss ratios (SB 1591), exposing phantom networks (SB 1804), and increasing Medi-Cal provider rates (budget).
Click here for more information on the legislative issues focused on at this year’s event.
Contact: Susan Bassett, 916/444-5532 or sbassett@cmanet.org.
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6. Tomorrow Is Early-Bird Deadline for CMA’s Leadership Academy
The early-bird deadline for CMA’s ninth annual Health Care Leadership Academy is April 7. Sign up by that date and receive $100 off your registration. The conference is May 5–7 at the Renaissance Esmeralda Resort near Palm Springs. A dynamic multidisciplinary faculty will discuss trends affecting your economic future as a physician and teach essential leadership skills.
This year’s conference, “Reengineering Health Care: Meeting Future Expectations Without Breaking the Bank,” will address the challenges of cost, quality, and access to care as “locomotives” of health system reform. Noted economists and leaders from government, business, labor, and health care will present a variety of perspectives on how to avert a “train wreck” and put the system on track toward a viable future.
The academy also features a powerful slate of leadership workshops including:
- Leadership skills for managing change
- Conflict resolution techniques
- Preparing a compelling presentation
- Maximizing committee effectiveness
- Delivering medicine’s (or your organization’s) message to the public
The value of these workshops alone makes the CMA Leadership Academy’s low tuition a bargain. Participants can earn up to 17 hours of Category I CME.
Early-bird registration is $595 for members, $895 for nonmembers. Special discounted rates are available for retired physicians, students, and allied health professionals.
See http://www.cmanet.org/leadership for more information.
Contact: Leadership Academy Hotline, 800/795-2262 or gfonseca@cmanet.org.
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7. CMA Foundation Hosts 4th Annual Golf Classic
 The CMA Foundation will host its fourth annual Golf Classic in conjunction with the CMA Health Care Leadership Academy. This year, the Leadership Academy will be May 5-7 at the Renaissance Esmerelda in Indian Wells. The golf classic will be May 6 at the Golf Resort at Indian Wells, selected last year by Golf Digest as one of its “Best Places to Play.” The style of play is a scramble, with a best ball format. Play begins with a shotgun start at 1 p.m.
Your participation in the golf tournament will help support the foundation’s many valuable public health programs, including appropriate antibiotic use, childhood obesity, diabetes, smoking cessation, and health disparities.
See http://www.cmanet.org/leadership for more information.
Contact: Donna Astrinidis, 916/551-2054 or dastrinidis@cmanet.org.
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8. Pay-for-Performance Summit Is May 18-19 in Las Vegas,
Members Receive $210 Off Registration
CMA members receive $210 off registration for Decision Health’s pay-for-performance summit (P4P), May 18-19 in Las Vegas. The two-day summit, “How Physician Practices Can Succeed with New Reimbursement Programs,” will help physicians understand P4P initiatives and learn how they can compete for P4P quality bonuses. Participants can earn up to 9.25 hours of CME.
Click here for registration information.
Contact: 866/620-5939 or conf@decisionhealth.com.
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 9. Did You Know?
Did you know that in 1857 the California State Medical Society (now CMA) proclaimed the necessity of teaching multiple modern languages in medical schools to accommodate the diverse population of California?
“In no country in the world is there such a national mixture of languages as in this state, and consequently, none in which the necessity is so forcibly suggested,” the committee wrote in its report. It was suggested that speaking second and third languages — German, French and Spanish, in particular — was “almost an essential qualification of a man in medical practice” in California.
CMA is celebrating its 150th birthday! Visit http://www.cmanet.org/150 for other interesting information about CMA history.
Contact: Karen Nikos, 916/444-5532 or knikos@cmanet.org.
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10. CMA Member Benefit of the Week: Reimbursement Help Line
CMA works hard to make sure that physicians get paid fairly. You’ve probably heard about CMA’s economic advocacy efforts, but did you know that physician members can call on CMA’s reimbursement specialists for one-on-one help with contracting, billing, and payment problems? Call CMA’s reimbursement help line at 888/401-5911.
Click here for more information about the benefits and discounts available to CMA members.
Contact: CMA's membership help line, 888/233-2937 or lgodward@cmanet.org.
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No. 2046 
