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1. Blue Cross Fails to Make New Fee Schedule Available to
Physicians, CMA Urges Insurer to Delay Implementation
CMA is urging Blue Cross of California to delay implementation of fee schedule changes due to take effect June 1, because the insurer has failed to make a full and complete schedule available to physicians. This failure has prevented many physicians from assessing the impact that the fee schedule changes will have on their practices.
CMA believes that Blue Cross is in violation of state law, which requires insurers to fully disclose to contracting physicians their fee schedules and payment rules and to notify physicians in writing 45 days before instituting any changes to fee schedules and payment rules.
When physicians were notified in late February of the impending changes to Blue Cross’s Prudent Buyer Plan physician contract, the insurer promised that the new fee schedule would be available on its website by April 15, 45 days before the effective date of June 1. CMA has recently learned, however, that this information will not be available until June 1, leaving physicians without a reasonable means to evaluate the impact of the contract changes to their practice.
The only option available to physicians is to submit by fax the Request for Prudent Buyer Plan Pricing form. Unfortunately, this form only allows physicians to request 10 codes at a time and also requires the requestor to include a description of each code and modifier, and the physician’s customary charge.
"As a practical matter, it is not reasonable to expect a busy physician practice to fully complete the required fields for all services provided, nor is it reasonable to limit the physician to requesting only 10 codes at a time,” wrote Aileen E. Wetzel, associate director of CMA's Center for Economic Services, in a letter to Blue Cross. CMA is particularly concerned that the insurer has not yet notified physicians that the online fee schedule will not be available until June 1.
CMA also believes Blue Cross is in violation of the RICO settlement agreement, in which it agreed to provide greater notice of policy and procedure changes.
Click here for more information, including a copy of CMA's letter to Blue Cross on this issue.
Contact: CMA’s Reimbursement Help Line, 888/401-5911 or jblack@cmanet.org.
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2. CMA Again Objects to United Healthcare’s
Attempt
to Penalize Physicians for Out-of-Network Referrals
In March, CMA asked state insurance regulators to investigate United Healthcare’s new laboratory policy, which imposes financial penalties on contracted physicians who refer patients to out-of-network laboratories. CMA called the policy illegal and ill-advised, as it interferes with PPO patients’ right to access out-of-network benefits and improperly obstructs the physician-patient relationship.
The policy, which became effective March 1, authorizes the insurer to fine physicians $50, decrease contracted payment rates, and even terminate the contracts of physicians whose patients choose to go to out-of-network labs.
In response to CMA’s objections, the insurer has insisted that the new policy will not influence physicians’ professional medical judgment or prevent patients from choosing an out-of-network lab. United Healthcare has failed to provide any details on how the policy will be enforced and what the process is for appeals.
CMA continues to have serious concerns with the new policy and the chilling effect it is bound to have on patient-physician communications.
Despite United Healthcare’s assertions to the contrary, this ambiguous and onerous policy will create a profound chilling effect on a physician’s willingness to refer to out-of-network labs when medically appropriate, or even to talk openly with patients about their choices,” wrote Jodi Black, associate director of economic services for CMA, in a follow-up letter to United Healthcare. “By not providing any clarity on how the policy will be administered or how penalties will be assessed, United Healthcare gives itself unlimited discretion as to when, how, or against whom it will direct its enforcement efforts.”
CMA also has serious concerns about the adequacy of United Healthcare’s participating laboratory network. CMA has received complaints from physicians, who to comply with the policy, would have to refer their patients to labs more than 50 miles away.
CMA has again urged United Healthcare to rescind this onerous policy and will continue to work with state insurance regulators to resolve the issue.
Click here for more information, including a copy of CMA's letter to United Healthcare on this issue..
Contact: CMA’s Reimbursement Help Line, 888/401-5911 or jblack@cmanet.org.
3. Catherine Hanson, CMA General Counsel, Moves to AMA
Catherine Hanson, JD, who has served CMA as vice president and general counsel for more than 20 years, will be joining the AMA Advocacy team effective July 2. In her new position – Vice President, Private Sector Advocacy and Advocacy Resource Center – Hanson will be responsible for leading AMA’s advocacy for physicians and patients in the private sector and at the state legislative level. She will remain at CMA through July 1.
We will surely miss Catherine’s leadership and counsel at CMA, but we wish her well as she moves to the AMA, where she can extend her advocacy to physicians nationwide,” says CMA President Anmol Mahal, M.D.
Hanson in 1986 started CMA’s in-house legal department with Astrid Meghrigian. During her time at CMA, Hanson built a solid reputation of aggressive advocacy for California physicians and patients. She spearheaded CMA’s involvement in the federal civil RICO lawsuit, which brought $344 million in cash payments and more than $1 billion in prospective relief to physicians in California.
Hanson and her legal staff have filed hundreds of briefs and lawsuits, and have counseled CMA on thousands of issues related to the practice of medicine. She and her legal staff have annually published a veritable bible in health law – the California Physician’s Legal Handbook – which is now a fixture in law libraries everywhere.
“She is a highly effective advocate for physicians and their patients,” says AMA Senior Vice President for Advocacy Richard Deem. “We look forward to the experience, leadership, and vision she brings to the AMA and our partners in the federation.”
4. National Women’s Health Week Is May 13 - 19
In honor of National Women’s Health Week, the CMA Foundation invites you to check out the various toolkits, fact sheets, patient education materials, and provider education resources on women’s health issues available on the foundation website.
The foundation’s most recent women’s health initiative, “Screen Yourself and Vaccinate Your Daughter,” was launched this year to educate physicians and patients about the link between human papillomavirus (HPV) and cervical cancer. The project provides physicians and other health care providers with resources to increase their clinical knowledge, help them communicate more effectively with patients, and broaden their understanding of the cultural health disparities associated with cervical cancer and HPV.
The foundation’s California Osteoporosis Project promotes public awareness of osteoporosis and educates physicians about prevalence, prevention, diagnosis, and treatment of osteoporosis. Materials available on the foundation website include bone health guides, clinical guidelines, patient education materials in Chinese and Spanish, and the Osteoporosis Communications Toolkit.
Click here for more information.
Contact: Elissa Maas, 916/551-2555 or emaas@cmanet.org.
5. Member Benefit of the Week: Health Savings Accounts
CMA offers a health savings account (HSA) program for members, their families, and their office staff. An HSA is a tax-exempt account used to pay for current health care expenses and save money for future expenses.
To open an HSA, you must be covered by a qualified high deductible health plan (HDHP). Since HDHPs generally cost less than traditional health plans, the money you save on monthly premiums can be deposited to your tax-exempt HSA.To help you get started, all new accounts opened in 2007 will be seeded with $20.
CMA has partnered with Marsh Affinity Services and UMB Bank to simplify the HSA process, combining all of the necessary elements into one product.
For more information, visit CMA’s HSA Access Point or call Marsh at 800/842-3761.
Help Us Choose Our New HSA Logo
  
Click here to vote!
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. 2094
