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1. California Delays Enforcement of Federal Medicaid Citizenship Rule
This story has been removed at request of the California Department of Health Services (DHS). Stay tuned for a notice from DHS on this subject. Notice should be posted here Friday afternoon/evening.
In the meantime, you can find out more about the federal Medicaid ctizenship rule by clicking here.
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2. Don’t Wait Until the Last Minute to Get Your National Provider ID
In less than a year, physicians who are covered by HIPAA will be required to use their new National Provider Identifier (NPI) on claims and other electronic health care transactions. All physicians who bill Medicare—even if not covered by HIPAA—must also obtain and begin using NPIs by the May 2007 deadline. NPIs will replace UPINs and other payer-specific provider identification numbers.
Beginning May 24, 2007, Medicare providers and physicians covered by HIPAA will have their claims denied if they do not have NPIs. This is not an idle threat. Physicians will have had two full years to get their NPIs.
Physicians are strongly urged to apply for NPIs immediately, if they haven’t already done so. Because many health care providers are expected to wait until the last minute to apply for their NPIs, there will likely be a backlog of applications in months leading up to the deadline. To make sure you get your NPI on time, you should submit your application as soon as possible.
Applying for an NPI is fairly simple. Physicians can apply online at https://nppes.cms.hhs.gov. If you do not have Internet access, call the NPI Enumerator at 800/465-3203 and request a paper application form. (Physician groups and incorporated physician practices of all sizes will likely need to apply for more than one NPI. More information is available in CMA’s NPI toolkit. See details below.)
While applying for an NPI is straightforward, making sure your billing systems and vendors are ready for the transition is a more complicated process, one that requires some preparation and internal assessment. CMA’s HIPAA partner, PrivaPlan, has developed an inexpensive CD-ROM toolkit to help physicians navigate the process.
If you haven’t investigated it, you should give it a look. The toolkit will help physicians understand their NPI “readiness” and the impact the NPI may have on their practices. It also provides form letters and surveys to send to your major system vendors, clearinghouses, and health plans, to determine their NPI readiness.
CMA members can purchase the toolkit for $99. CMA members who have purchased PrivaPlan’s other HIPAA toolkits pay $79. Nonmembers pay $129. Order the toolkit by calling 877/218-7707.
Click here for more information.
Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.
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3. CMS Announces Medicare Payment Delay
Physicians should be aware Medicare will not pay any claims for the last nine days of the federal fiscal year (September 22-30, 2006). This one-time payment hold—mandated by the Deficit Reduction Act of 2006—will defer $1.3 billion in FY 2006 claims to the FY 2007 budget.
Held claims will be paid on October 2. No interest or late-payment penalty will be paid to physicians or other health care providers whose payments are delayed by this one-time hold. Physicians with large numbers of Medicare patients should prepare now for this cash flow interruption.
Click here for more information.
Contact: Reimbursement Help Line, 888/401-5911.
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4. CMA Leaders Visit D.C. to Advocate for Key Federal Health Care Issues
A CMA delegation was in Washington this month imploring federal lawmakers and Administration officials to fix the Medicare physician reimbursement problem. The CMA delegation of physicians and staff met with dozens of Members of Congress and key officials from the White House and the Centers for Medicare & Medicaid Services (CMS).
CMA continues to advocate for a long-term fix for the flawed sustainable growth rate (SGR) formula, which allows total Medicare spending on physician services to grow at the rate of the gross domestic product (GDP), but actually penalizes physicians in part because the cost of physician services rises more rapidly than the GDP. The SGR formula also does not adequately account for the increase in beneficiaries or the cost and complexity of new medical procedures.
CMA believes the SGR formula should be scrapped immediately, and that Congress should direct the Medicare Payment Advisory Commission (MedPAC) to spend the next two years coming up with a fair and more effective physician payment formula for implementation by 2009. In the meantime, CMA urges Congress to follow the recommendations of MedPAC, an independent federal commission established in 1997 to advise Congress on Medicare issues. MedPAC has recommended a 2.8 percent increase in physician payment for 2007.
CMA leaders also urged CMS officials to fix Medicare’s geographic payment inequities. The Medicare fee schedule adjusts payments for physicians based on their geographic practice cost differences (i.e., rent, supplies, staff). However, physicians in 32 states and 175 counties are paid 5 to 14 percent less than their Medicare-assigned geographic cost factors. The reason? These counties are placed inappropriately by Medicare in geographic payment localities with counties that have lower practice costs. Medicare could reassign these counties, but federal budget neutrality laws would result in 4 to 6 percent rate reductions forrural physicians. CMA is seeking legislation that would help these underpaid counties while protecting rural counties from a cut.
CMA also lobbied to protect graduate medical education funding for pediatricians and disadvantaged minority students and participated in a roundtable discussion with House Democratic leadership to discuss CMA’s strategies for achieving universal health care coverage. The roundtable was sponsored by California Representative Xavier Becerra (D-Los Angeles).
Click here for more information.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
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5. Deadline to Submit Aetna ‘Add-On’ Claims Is July 14
Physicians have until July 14 to submit unpaid “add-on” claims to Aetna for adjudication.
As reported previously in Alert, Aetna had been denying claims with add-on codes for CAD mammography (CPT codes 76082 and 76083) and myocardial perfusion testing (CPT codes 78478 and 78480), in violation of its RICO settlement agreement. Some physicians even stopped filing claims because Aetna was not paying them. A number of physicians filed RICO settlement compliance disputes and, as a result, in 2005 Aetna began paying for these add-on codes.
CMA continued to push Aetna to retroactively pay the previously denied claims for add-on codes. As a result of CMA’s repeated complaints, Aetna agreed in April to retroactively pay claims with add-on codes for CAD mammography and myocardial perfusion testing with dates of service on or after January 1, 2004.
The process for resubmitting previously denied claims is described on Aetna’s provider website. Click on “Add-On Code Claims Payment” in the “Features” section in the lower right corner of the top web page. Physicians should submit new claims following standard billing procedures.
More details are available by calling Aetna’s provider service center (888/632-3862 for PPO plans or 800/624-0756 for HMO plans). Have your tax ID number available when you call.
Click here for more information.
Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.
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6. CMA Seeks Historic Health Care Photographs
CMA is producing a commemorative 150th anniversary book that will be distributed to all members this fall. Physicians are invited to submit photographs that illustrate the theme, “150 years of helping physicians help patients.” If your photograph is selected for publication, you will receive a photo credit and five copies of the commemorative book. Photographs not selected for publication will be posted at CMA’s 150th-anniversary website, http://www.cmanet.org/150.
Please e-mail high-resolution scans to kgallia@cmanet.org or send prints to CMA’s Center for Communication at 1201 J Street, Suite 200, Sacramento, CA 94814.
Photographs will be treated with care and returned to their owners after they are scanned.
Click here for more information.
Contact: Katherine Gallia, 916/551-2074 or kgallia@cmanet.org.
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7.
 150th Anniversary Trivia: Did You Know?
Did you know that in 1857, San Francisco physician Dr. Elias. S. Cooper, CMA’s second president and founder of Stanford University School of Medicine, performed the California’s first successful cesarean section? The case also resulted in the state’s first medical malpractice lawsuit, even though the surgery was a success. The lawsuit was encouraged by the physician who assisted Dr. Cooper in the surgery because he did not get credit for the monumental event.
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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8. Member Benefit of the Week: Mercury Auto Insurance
CMA members receive 10 percent off auto insurance from Mercury Insurance. Even without the member discount, Mercury’s rates are some of the lowest around. California drivers report saving an average of $505 a year when they switched to Mercury. Imagine what you can save with your CMA member discount!
Call Mercury Insurance at 866/602-5259 for more information.
Click here for more information about the benefits and discounts available to CMA members.
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No. 2054 
