1. UnitedHealthcare Cutting Physician Fees
Without Notice or Opportunity to Terminate
CMA has asked the Department of Insurance to force UnitedHealthcare to comply with state law, which requires insurance companies to give contracted physicians 45 days notice of any material changes to their contracts. Currently, United makes significant changes to contracts – namely its fee schedules – under the guise of “routine maintenance”, without notifying physicians or giving them the opportunity to cancel their contracts.
United’s “progressive fee schedules” are developed using third party data (such as Medicare’s relative value units). According to United, “routine maintenance” occurs when it “mechanically incorporates revised information created by a third party that is the source for a portion of the fee schedule.” CMA has learned that payments for some CPT codes were reduced by up to 9.5 percent as a result of United’s most recent fee schedule revision.
Affected physicians were not given prior notice of these fee reductions, nor were they given the opportunity to terminate as required by California law. Over 50 percent of physicians contracted with United Healthcare in California are on these so-called progressive fee schedules.
CMA has requested that DOI declare these contract provisions void, unlawful, and unenforceable.
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Contact: Aileen E. Wetzel, 916/444-5532 or awetzel@cmanet.org.
2. Senate Finance Committee Working
on Legislation to Stop Medicare Cuts
The U.S. Senate Finance Committee is currently developing legislation that would stop the 15 percent Medicare physician payment cuts scheduled over the next two years, and instead extend the current .5 percent increase through the end of 2008 and a give doctors a 1.1 percent pay raise in 2009.
President Bush continues to threaten to veto any Medicare physician payment package that is financed by equalizing Medicare Advantage health plan rates with physician fee-for-service rates. Currently, Medicare Advantage plans receive an average of 12 to 20 percent more than fee-for-service physicians for providing the same services to Medicare beneficiaries. Bringing plan rates in line with fee-for-service physician rates could save over $50 billion.
Because of the urgency of this legislation and the President’s veto threat, the Senate package will likely be financed by increasing the cuts in 2010. Senate leaders have said that they will work with the new Administration to fix the physician payment formula before then.
The Senate Medicare package may also include demonstration projects on primary care medical homes, comparative effectiveness, and a potential mandate on e-prescribing. The Senate is also considering a payment increase for primary care services. Senate leaders hope to vote on the package as early as mid-May.
Congressman Pete Stark, Chair of the House Ways and Means Subcommittee and one of the most powerful voices in Congress on Medicare policy, has also vowed that he will fight to include a geographic payment fix in the final Medicare payment package.
Stay tuned for more information.
Contact: Elizabeth McNeil, 916/444-5532 or emcneil@cmanet.org.
3. New Medicare Contractor’s “Early Boarding” Program Opens 5/1
The Centers for Medicare & Medicaid Services (CMS) recently named Palmetto, GBA, the new Medicare contractor for Jurisdiction 1, which includes California. Although the final cutover to the new carrier doesn’t happen until September 2, Palmetto’s “early boarding” program begins May 1 and will allow current electronic claim submitters to familiarize themselves with the new system. CMA encourages physicians to take advantage of this opportunity and avoid the last minute rush and unnecessary payment delays.
During the early boarding program, Medicare claims will continue to be paid by the current Medicare contractor, NHIC. Claims submitted to Palmetto will be forwarded to NHIC for processing. Thus, when submitting claims to Palmetto during the early boarding program, you should continue to use NHIC’s contractor number.
The early boarding program is open only to physicians who currently submit electronic claims, either directly or via a clearinghouse. To participate, you must first complete Palmetto’s EDI application, which is available at the Palmetto website, http://www.palmettogba.com/j1. Physicians should also contact their clearinghouses to ensure that they are prepared for the transition.
If you currently receive payments electronically, you will also have to complete a new EFT authorization before the final cutover on September 2. We encourage you to do so as soon as possible to ensure that your payments are not interrupted. EFT authorization forms are also available at the Palmetto website.
If you need assistance, Palmetto’s Technology Support Center is available to answer EDI-related questions Monday - Friday, 8 a.m. to 5 p.m., Pacific Time at 866/749-4301. Questions can also be submitted via e-mail to medicare.edi@PalmettoGBA.com.
CMA continues to work closely with high-level contacts at Palmetto and CMS to ensure a smooth transition.
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Contact: Frank Navarro, 916/551-2046 or fnavarro@cmanet.org.
4. Most California Physicians Eligible for New Blues Settlement
Another settlement has been reached in the racketeering lawsuit against the Blue Cross/Blue Shield Association, which alleges that the insurers’ payment practices defrauded physicians out of payments for patient care. Most California physicians will be eligible for this latest settlement, which was reached with Capital Blue Cross, Capital Advantage Insurance Company, and Keystone Health Plan Central.
The class includes all physicians who billed any of the Blues companies or their contracted intermediaries (capitated medical groups, IPAs, etc.) for services provided between January 1, 1996, and March 12, 2008. Most California physicians will only be entitled to one settlement share. Physicians who treated even one patient from any of the settling health plans will receive 10 shares.
The deadline to submit a claim is June 30. Physicians do not have to provide documentation for individual claims. If you wish to opt out of the settlement, you must do so by May 30.
The case, Rick Love, M.D. v. Blue Cross Blue Shield Association, was filed in May 2003 in federal district court in Miami. The suit accused the insurers of a pattern and practice of denying and delaying care, including intentionally programming computer billing databases to automatically downcode physician claims. The suit was filed under the federal civil racketeering (RICO) statutes. Although CMA is not a plaintiff in the suit, the suit affects all physicians because of its class-action status.
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Contact: CMA's reimbursement help line, 888/401-5911 or drice@cmanet.org.
5. U.S. House Committee Passes Bill that Would
Block Federal Medicaid Cuts, Bush Threatens Veto
The U.S. House of Representatives has passed a bill (HR 5613) to delay implementation of a series of new Medicaid rules that would shift billions in health care costs to state and local governments. The rules, proposed by the Bush administration, would limit how much states could pay health care providers, ban the use of federal Medicaid money to train doctors, set new limits on Medicaid payments to hospitals and nursing homes operated by state and local governments, and limit Medicaid coverage of rehabilitation services for people with disabilities, including serious mental illnesses. Some estimates indicate that California alone would lose $12 billion over five years.
Governors of both parties strongly objected to the new rules and asked Congress to stop implementation of the regulations, which could have a devastating effect on the nation’s health care system. For states already grappling with rising health-care costs, the new rules would force them to consider cutbacks in services, leaving the most vulnerable Americans without access to health care and other vital services.
President Bush has threatened to veto the legislation. The bill passed by veto-proof margin of 349 - 62 in the House, but it is unclear whether the Senate will also pass the measure with a two-thirds margin.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
6. CMA Kills Psychologists Prescribing Bill
A CMA-opposed bill (insert bill number here) that would have allowed psychologists to prescribe psychotropic drugs was soundly defeated when it died in committee for lack of motion.
While CMA understands the importance of the psychologist’s role in mental health, psychologists are trained to assess behavioral and cognitive problems. Without the training necessary to discern physical problems from purely behavioral ones, important treatable conditions could very likely be overlooked and go untreated. Additionally, all prescription medications have side-effects and can be dangerous in the hands of those with inadequate training.
CMA is also fending off an attempt to expand the scope of practice of optometrists. The bill (SB 1406), which would allow optometrists to diagnose and treat diseases of the visual system, and even perform minor surgeries, has been gutted. The bill’s author has, however, indicated that he intends to introduce new language on this issue in this legislative session.
More information on these and other bills of interest to physicians is available at http://www.cmanet.org/news/hotlist.asp.
Contact: Jodi Hicks, 916/444-5532 or jhicks@cmanet.org.
7. Hundreds of Doctors March on Capitol to Protest Medi-Cal Cuts
More than 350 physicians from throughout California marched on the Capitol last Tuesday to protest 10 percent cuts to the state’s Medi-Cal program, which funds health care for California’s low-income patients.
Doctors wearing white coats walked from the Sacramento Convention Center to the capitol carrying a 16-foot wide, red and blue banner that read: “Medi-Cal Cuts Cost ALL Californians.” The march was part of the CMA’s 34th Annual Legislative Leadership Conference, which was attended by more than 500 physicians, medical students, residents, and medical executives from throughout the state. Local television news outlets in LA, San Francisco, and the Central Valley covered the march, as did two statewide radio news programs.
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Contact: Jennifer Williams, 916/444-5532 or jwilliams2@cmanet.org.
8. There Is Still Time to Register for CMA’s
11th Annual Health Care Leadership Academy
There’s still time to register for CMA’s 11th Annual California Health Care Leadership Academy, May 2 - 4 at the Grand Californian Hotel in Anaheim.
This year’s keynote speakers are Congressman Pete Stark, Chair of the House Ways and Means Subcommittee and one of the most powerful voices in Congress on Medicare policy, and Arnold Relman, Editor-in-Chief Emeritus of the New England Journal of Medicine. Program topics include economic profiling of physicians, the future of organized medical staffs, and the impact of Wal-Mart’s aggressive retail health clinic strategy. A variety of practice management workshops also will be offered to help medical practices weather the economic downturn and improve their bottom line.
The academy has been approved for 19 hours of Category 1 CME for physicians and nurses and 6.25 hours of CLE for attorneys.
To register, visit http://www.cmanet.org/leadership.
Contact: Academy Hotline, 800/795-2262 or rpurdy@cmanet.org.
9. Member Benefit of the Week: 6% off athenaCollector
CMA members receive 6 percent off athenaCollector, athenahealth’s unique web-based billing and practice management service. athenaCollector combines software, a continually updated database of payer rules and a state-of-the-art billing, collections and service center.
If you would like more information about athenaCollector, check out athenahealth’s webinar at http://www.cmanet.org/benefits/practice_management.asp. Participants will learn how athenahealth can help them improve and optimize performance and reverse the negative trends impacting physician practices today. For more details, call 866/817-5739 or visit http://www.athenahealth.com/cma.
Click here for more information on your membership benefits.
Contact: CMA’s member service center, 800/786-4CMA or info@cmanet.org.
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