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1. CMA Encourages Physicians to Opt-Out of Inadequate Concentra Settlement
Most California physicians recently received a notice about class-action settlement with Concentra, a company that provides PPO networks, medical bill review, and other cost-containment services to insurance companies.
The lawsuit, brought by a Pennsylvania orthopedic medical practice, alleged that Concentra engaged in “silent PPO” activity and used biased repricing methods to unfairly reduce payments to physicians. CMA urges physicians to opt-out of this inadequate settlement agreement, which provides very little real relief to physicians. The deadline to do so is September 12.
The nationwide settlement applies to any physician in the country who has had a workers compensation or auto accident bill repriced by Concentra or one of its subsidiaries. The vast majority of physicians in California are covered by this settlement.
CMA, AMA, and a number of other state medical societies believe the defendants’ promised changes are illusory and inadequate to redress the damages incurred by physicians as a result of defendants’ alleged activities. AMA filed formal objections to this settlement before its preliminary court approval. AMA intends to object again at the formal fairness hearing, currently scheduled for October 19 in Philadelphia.
Click here for more information, including a sample opt-out letter.
Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.
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2. Workers’ Comp Raises Pay for Medical Legal Evaluations by 25%
Effective July 1, physicians who perform medical-legal evaluations for injured
workers will get a 25 percent reimbursement increase. This pay raise was encouraged by CMA and approved by the Division of Worker’s Compensation (DWC) in hopes of increasing the number of qualified physicians interested in performing these evaluations. CMA had told DWC that the previous pay rate was inadequate for physicians performing complex medical-legal evaluations.
The $100 worker’s comp lien filing fee has also been repealed, effective July 1, thanks to the budget deal approved by the Legislature and signed by Gov. Arnold Schwarzenegger last month. The filing fees were established as part of workers’
compensation update enacted in 2003. The fee was intended to reduce the number of liens that are unnecessarily filed by health care providers when reimbursement for their services is not in doubt. In reality, the number of liens filed did not decrease and the extra work involved processing the liens and related filing fees took Division of Workers’ Compensation staff away from other essential duties.
Also taking effect July 1 is an increase to the medical and medical-legal travel mileage reimbursement (to 44.5 cents per mile).
Click here for more information.
Contact: CMA’s Reimbursement Hotline, 888/401-5911.
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3. CDC Recommends New Human Papilloma Virus Vaccine for Preadolescents
The Centers for Disease Control and Prevention’s Advisory Committee on
Immunization Practices (ACIP) is urging that 11- and 12-year-old girls be
routinely vaccinated against human papilloma virus (HPV) the sexually transmitted virus that causes cervical cancer. The committee also said the shots can be administered to girls as young as 9, at the discretion of their physicians.
This recommendation follows the June approval of Gardasil, the first vaccine specifically designed and approved by the Federal Food and Drug Administration (FDA) to prevent cancer in females age 9 to 26. Vaccine proponents believe that the vaccine could dramatically reduce the nearly 4,000 cervical cancer deaths in the United States each year.
With ACIP approval, it is likely that federal officials will also vote to add
the HPV vaccine to the federal Vaccines for Children program, which pays for immunizations for the poor. A CMA-sponsored law also requires California health plans to pay for vaccines covered by the federal vaccine program. Unfortunately, although the FDA approved the shot for females age 9 to 26, is it likely that most payers will only cover the vaccine for 11 to 12 year olds, as would be required by law. The vaccine costs $360 (3 shots at $120 each).
Click here for more information.
Contact: Robin Flagg, 415/882-5110 or rflagg@cmanet.org.
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4. Deadline to Resubmit Aetna Add-On Claims Is Friday, July 14
Don’t miss your opportunity to submit unpaid “add-on” claims to Aetna for adjudication. The deadline to submit claims is tomorrow, July 14.
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 and the physicians who filed compliance disputes continued to push Aetna to retroactively pay the previously denied claims for add-on codes. As a result of the compliance disputes and CMA’s ongoing RICO settlement enforcement, 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 money involved is not insignificant. The 19 physicians and physician groups who filed compliance disputes were paid a combined total of $678,000, with one group receiving over $250,000.
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 from 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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5. Planning to Retire?The CMA Foundation Can Help!
The CMA Foundation’s planned giving program can help you reach your retirement goals, while supporting the foundation’s good works. A planned gift to the foundation can provide you with retirement income and tax benefits, while the actual donation can be deferred for a period of time—often for the lifetime of the donor. The foundation has posted at its website (http://www.calmedfoundation.org) an online calculator that can provide you with charitable deduction calculations for a broad range of planned gifts, including gift annuities and remainder trusts.
Click here for more information.
Contact: Cherie Davis, 916/551-2556 or cdavis@cmanet.org.
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6. Free EHR Assistance for Primary Care Physicians
If you are interested in getting an electronic health record system (EHR) for your practice, but don’t know where to start, consider joining the Doctor’s Office Quality – Information Technology (DOQ-IT) program. DOQ-IT offers assistance—at no cost—to help physicians select, implement, and fully utilize EHRs for improved clinical outcomes. Lumetra is currently accepting applications from primary care physicians who treat adult patients for its next DOQ-IT Program. Space is limited to 20 practices. The deadline to apply is July 26.
The program includes teleconferences, two in-person workshops and EHR vendor fairs, as well as an online community where participants can securely exchange information and share knowledge.
Lumetra is an independent, nonprofit organization dedicated to improving the quality, safety, and integrity of health care. The DOQ-IT program is part of Lumetra’s California Quality Connections initiative, a quality improvement
program for health care providers.
Click here for more information.
Contact: CMA Center For Economic Services, 916/551-2061.
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7. Tomorrow Is Deadline to Reserve Space in CMA’s Commemorative Book
To honor 150 years of “helping physicians help patients,” CMA is producing a commemorative book.
In this CMA anniversary book, we offer you the opportunity to pay tribute to your CMA in the way you see fit. You can honor fellow members, county societies, health leaders, health care achievements, and even your family and friends. This glossy, handsome commemorative book will be distributed to CMA’s members and beyond. Please join us in celebrating this major milestone in our history.
Don’t know anything about graphic design? Don’t worry—we can do it for you. All we need you to provide are the pictures and text that you want to have in your tribute.
Click here for more information.
Contact: 888/231-7451 or advertising@cmanet.org.
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8. 150th Anniversary Trivia: Did You Know?
Did you know that in 1895, at the encouragement of the State Medical Society (now CMA), the California became the second state, after New York, to authorize and pay for distribution of diphtheria antitoxin? (Death rates in Germany had been reduced from 60 to 15 percent after use of the antitoxin.) The state legislature appropriated $6,000 ($125,000 in today’s dollars) to procure, manufacture, and distribute the antitoxin.
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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9. Member Benefit of the Week: Long Term Care Insurance
This week’s featured member benefit is Long-Term Care Insurance. CMA members receive a 5 percent discount on long-term care insurance* purchased through Marsh. The CMA member discount is also available to your staff, spouse, parents, parents-in-law, and grandparents. Purchase a policy for both you and your spouce, and receive an additional discount. And if you’re an applicant in good health, you can save even more!
Marsh can arrange to have a Long Term Care specialist meet with you to discuss your needs. If you have any questions, please contact Marsh at 800/842-3761 or e-mail CMACounty.Insurance@marsh.com.
Click here for more information about the benefits and discounts available to CMA members.
*Underwritten by: Metropolitan Life Insurance Company (rated “A+” by A.M. Best and Company) and John Hancock Life Insurance Company (rated “A++” by A.M. Best and Company).
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No. 2057 
