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1. Physicians Beware of Deceptive PPO Solicitations
CMA has learned of a possible scam targeting physicians. Physicians report receiving via fax a request to confirm their participation in Three Rivers Provider Network (TRPN). The deceptive and misleading notice, formatted to mimic a HIPAA compliance document, implies that the physician has treated one or more TRPN patients and that in order to authorize the patients’ eligibility the physician must agree to the terms described in the document.
This is merely an underhanded attempt to get providers to join the TRPN network and agree to accept its discounted rates as payment in full. CMA urges physicians to alert their office staff about this solicitation and to be wary of requests for physician information from unknown payors.
Physicians are advised, before signing any new contract, to review it carefully. Among other things, physicians should ensure that the proposed compensation, including the payor’s payment policies and the rules it uses to adjudicate claims, will be sufficient to maintain the medical practice. Without doing this analysis, you cannot make an informed decision about signing the contract.
To help physicians negotiate and manage complex third-party payor agreements, CMA has published a contracting toolkit, Taking Charge: Steps to Evaluating Relationships and Preparing for Negotiations—A Focus on Payor Contracting. The toolkit is available free to members at the
members-only website. Nonmembers can purchase the toolkit for $100 in the
CMA Bookstore.
Click here for more information, including a copy of the solicitation in question.
Contact: CMA’s reimbursement help line, 888/401-5911 or gfonseca@cmanet.org.
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2. CMA Publishes New Toolkit for Billing and Collections Staff
 CMA has published a new toolkit to train physician office personnel in proper billing and collections procedures. The toolkit, Back to Basics: A Step-by-Step Guide to Maximizing Your Cash Flow, is the third in a series of practice management toolkits designed to help members become more successful in their practices.
Whether you’re new to the field or just want a refresher course, this self-instructional workbook will teach physicians and their office staff how to:
- Gain greater control of the practice’s bottom line
- Increase revenue while decreasing days in A/R
- Identify common pitfalls of the billing and collections process
- Monitor payor compliance with contract terms
- Develop skills to effectively and efficiently manage collections
- Foster positive working relationships
- Discover other practice management resources available to CMA members
The toolkit can be also be used to test existing staff’s knowledge or as an interview tool to test new applicants’ skill level.
CMA members can purchase the toolkit for $49 (nonmembers $149). To order, visit the CMA Bookstore or call 800/882-1262. The two previous toolkits,
Taking Charge: Steps to Evaluating Relationships and Preparing for Negotiations and
Getting Paid: Strategies to Maximize Reimbursement, are also available in the bookstore.
CMA’s Center for Economic Services will be offering “Back to Basics” seminars throughout the state. The next two seminars are May 2 in Ventura (during the PAHCOM annual conference) and May 16 in Riverside/San Bernardino.
If you are interested in attending a Back to Basics seminar in your area, contact your county medical society.
Contact: CMA’s reimbursement help line, 888/401-5911 or gfonseca@cmanet.org.
3. 2007-2008 Council and Committee Nomination Deadline Is May 25
CMA depends on the expertise of its members to make smart policy choices. Do you have expertise in medical ethics, professional liability, or other topics related to the practice of medicine? If so, you could serve on one of CMA's councils or committees.
The nomination deadline for the 2007-2008 term is May 25. Nominees must be endorsed by their county medical societies. Contact your county medical society for information on the nomination process.
Click here for more information, including a nomination form and instructions.
Contact: Ginnie Yee, 415/882-5170 or gyee@cmanet.org.
4. Deadline to Resubmit Modifier 57 Claims to Aetna Is April 30
Aetna is currently accepting resubmissions of previously denied claims for E&M services provided on the same day as a decision for surgery with dates of service between January 1, 2005, and February 11, 2006.
Aetna in 2005 announced that it would begin reimbursing 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). Implementation of this policy change was delayed and Aetna’s claims processing systems finally began recognizing E&M Codes with these modifiers effective February 11, 2006. At that time, Aetna also announced that previously denied claims with dates of service of August 15, 2005, to February 11, 2006, could be resubmitted.
This policy change was recommended by Aetna’s Physicians Advisory Board, which was created as part of Aetna’s RICO lawsuit settlement. A recently resolved RICO settlement compliance dispute has increased the number of claims eligible for retroactive reconsideration. Previously denied claims with dates of service back to January 1, 2005, can be resubmitted. The resubmission deadline is April 30.
Click here for more information.
Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.
5. Don't Miss CMA'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.
Gov. Schwarzenegger 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.
6. CMA President Establishes Endowment to Improve Access,
Reduce Health Care Disparities
CMA President Anmol S. Mahal, M.D., and wife Surjit K. Mahal, M.D., have established an endowment fund to award individuals and organizations making strides to improve access to health care and reduce health care disparities in California.
The Adarsh S. Mahal, M.D., Access to Health Care and Disparities Endowment Fund, administered by the CMA Foundation, was established in honor of Dr. Mahal’s father, one of India’s first fully trained psychiatrists, who spent his career training physicians in a medical specialty that at the time was considered taboo.
“I couldn’t think of naming the award for anyone other than the greatest role model in my life—my father, who did so much to improve access to mental health care in India,” says Dr. Mahal. “Improving access to health care for the most needy is a worthwhile goal, and anyone who works to achieve this goal deserves to be honored and recognized.”
The award will be presented annually at the foundation’s leadership dinner. Stay tuned for more information.
Contact: Carol Lee, 916/551-2562 or clee@cmanet.org.
7. Benefit of the Week: Up to 35% off Professional Publications
CMA members receive up to 35 percent off publications from Decision Health, publisher of newsletters, books, and other materials designed to meet the business and regulatory needs of physicians and their office staff.
Decision Health’s flagship publications include Part B News, Medicare Compliance Alert, and Private Payer News.
For more information on your CMA member discount, call Decision Health at 877/602-3835 or visit http://www.decisionhealth.com/cma.
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. 2090
Audio Podcast
