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1. CMA Asks Blue Shield to Clarify Fee Schedule Changes
Physicians recently received a letter from Blue Shield of California, notifying them of fee schedule changes that take effect July 1. To ensure physicians have timely access to all of the information necessary to evaluate the impact the proposed changes will have on their practice, CMA has contacted the insurer to request clarification on a number of issues.
Among the questions CMA has asked:
- Can physicians access the fee schedule online?: Included with the letter was a “provider allowance review” form to be used to request reimbursement amounts by CPT code. Unfortunately, the form only allows physicians to list 19 codes at a time and also requires the requestor to include the physician’s customary charge. CMA believes that the administrative hassle of manually listing each code and customary charge, combined with the insurer’s 20-business-day response time, makes this an unnecessarily cumbersome process. CMA is also concerned that the 20-day turnaround would put Blue Shield in violation of state law, which requires insurers to give 45 days’ notice of any material contract changes. CMA has urged Blue Shield to provide physicians with an alternate electronic means of accessing this information.
- What services will be impacted by the “multiple services payment policy”?: The letter also announced Blue Shield’s new multiple services payment policy, which will in some circumstances reduce reimbursement for multiple procedures provided on the same day. According to the letter, the initial service will be covered at 100 percent and the allowance for subsequent services will be “reduced.” CMA has asked Blue Shield to provide physicians with details on the codes affected by this new policy and the amount of the fee reductions.
Stay tuned to future issue of CMA Alert for more details.
Click here for more information.
Contact: CMA’s reimbursement help line, 888/401-5911 or jblack@cmanet.org.
2. Payors Respond to CMA’s NPI Readiness Survey
As you know, the Centers for Medicare & Medicaid Services (CMS) recently announced that Medicare carriers and other payors would be allowed to continue accepting legacy provider identification numbers until May 23, 2008. Following this announcement, CMA surveyed major payors in California to assess their NPI readiness and determine whether or not they would be taking advantage of this grace period.
The results of the survey are available to members at the members-only website.
Payors can take advantage of the 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.
However, 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. Click here for more information.
Contact: CMA’s legal information line, 415/882-5144 or legainfo@cmanet.org.
3. Blue Cross Agrees to Stop Dumping Sick Patients,
But Proposed Settlement Not Adequate, Says CMA
In an attempt to settle a class action patient lawsuit, Blue Cross last week agreed to stop canceling individual health insurance policies unless it has evidence that policyholders intentionally lied on their applications to cover up preexisting medical conditions.
CMA and others are concerned, however, that the agreement does not prevent patients from being hit with huge medical bills or reinstate canceled patients’ insurance coverage. It also fails to address unpaid claims owed to physicians and medical centers. The proposed settlement offer has not yet been approved by the court and the preliminary approval hearing has been put on hold so that these concerns can be considered.
This proposed settlement comes just weeks after CMA joined the class-action consumer lawsuit seeking to stop Blue Cross from engaging in this unfair and illegal business practice.
Blue Cross was also recently fined $1 million by the Department of Managed Health Care (DMHC) for routinely dumping patients after they got sick. DMHC examined 90 randomly selected policy cancelations 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 will continue to fight to make sure that patients are adequately protected and physicians are appropriately reimbursed for services provided in good faith to Blue Cross policyholders.
Click here for more information.
Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.
4. Governor Releases Revised 2007-2008 Budget Proposal
The Schwarzenegger administration this week released its updated 2007-2008 budget proposal. Click here for a summary of the revised budget as it relates to health care.
Contact: CMA’s Center for Government Relations, 916/444-5532 or lfolberg@cmanet.org.
5. Order CMA’s 2007 Model Medical Staff Bylaws
CMA’s 2007 Annotated Model Medical Staff Bylaws are now available. These model medical staff bylaws are the definitive guide for medical staff, providing details on professional and legal structures to support effective medical staff operations. The model bylaws are fully annotated to provide background information on critical provisions, including explanations of relevant state and federal laws, hospital accreditation standards, and other explanatory information.
The bylaws are free to medical staff members of CMA’s Organized Medical Staff Section (OMSS). Nonmember medical staffs and all others pay $300. Place your order online in the CMA Bookstore or by phone at 800/882-1262.
For more information, call the OMSS information line at 415/882-5107, or e-mail medstaffhelp@cmanet.org.
6. Member Benefit of the Week: Free Portfolio Checkup
CMA members get a free portfolio checkup — a $250 value — from CMA’s affinity partner, Mercer Advisors.
Mercer Advisors manages over $3 billion in assets, mostly for doctors. Mercer’s long-term investment strategy is firmly based on academic studies that identify the location of risk and return in capital markets.
Because Mercer Advisors is fee-based rather than commission-based, you can rest assured that its financial experts have your best interests at heart.
Members also get $500 off Mercer’s “Economic Freedom Program,” a comprehensive program that includes financial planning, investment management, and retirement and estate planning.
To schedule your free portfolio checkup, call 800/898-4642.
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. 2095
