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1. CMA Publishes Blue Cross of California Survival Kit
As previously reported in CMA Alert, Blue Cross of California recently notified physicians of changes to its Prudent Buyer fee schedule. According to a notice mailed to physicians, payment levels for many codes have been modified, some increased and some decreased. Physicians are urged to calculate the impact of these changes on their practices before the fee schedule takes effect August 6. You should also be aware that you have the right to terminate an agreement if any “material change” to the contract terms is not beneficial to your practice.
CMA has published a Blue Cross of California Survival Kit to help you assess the impact fee schedule changes will have on your practice based on your most commonly billed CPT codes. The tool kit answers frequently asked questions and discusses the options for physicians who determine that the new contract terms would negatively impact their practices.
The new fee schedule will be implemented on August 6. It was originally scheduled to take effect June 1, but the insurer was forced to delay implementation after the Department of Managed Health Care received hundreds of complaints from CMA physicians about Blue Cross’s failure to provide physicians with timely access to the new rates.
The Blue Cross of California Survival Kit is available free to CMA members at the members-only website.
Click here for more information.
Contact: CMA's Reimbursement Help Line, 888/401-5911 or gfonseca@cmanet.org.
2. Democrats’ Health Reform Plan Passes Senate Health Committee
Legislative Democrats advanced their health care reform plan last week, when the Senate Health Committee approved AB 8 by a partisan vote of 7 to 4. The bill would provide health care for millions of uninsured Californians and require employers to dedicate at least 7.5 percent of their payrolls to cover employee health care or pay into a state-run insurance purchasing pool.
AB 8 is backed by both Assembly Speaker Fabian Núñez and Senate President Pro Tem Don Perata as a joint Democratic health care reform plan.
The bill would also expand eligibility for Medi-Cal and Healthy Families and contains various insurance market reforms, including a requirement that insurers provide guaranteed-issue health insurance for individuals and spend at least 85 percent of premium dollars on health care. Currently, a number of major insurers in California spend less than 80 percent of premiums on patient care, with the rest going towards administrative costs and profits.
While CMA is supportive of the general framework of the proposal, there are a number of issues we will fight to resolve.
The bill expands coverage for the Medi-Cal and Healthy Families programs, but does not increase the state’s dismally low Medi-Cal physician payment rates. This plan cannot work without a Medi-Cal rate increase. We will also fight to strike the pay-for-performance provisions and make sure that insurers maintain adequate physician networks. CMA will insist on other amendments to ensure that access to care (not just coverage) is considered in any reform plan.
Click here for more information, including a detailed summary of this bill.
Contact: Lisa Folberg, 916/444-5532 or lfolberg@cmanet.org.
3. CMS Proposes Cuts to Geographic Payments
for Many California Counties
The Centers for Medicare & Medicaid Services (CMS) recently proposed changes to its geographic payments. Under the proposed formula, many California counties would see significant “geographic adjustment factor” (GAF) reductions over the next two years. Most major urban centers around the country would see geographic payment reductions as well. These cuts would be in addition to the 9.9 percent across-the-board cuts mandated by the broken sustainable growth rate formula.
CMA is particularly concerned that physicians in the northern Bay Area will see GAF reductions of 4 to 9 percent.
The GAF adjusts payment rates so that physicians are reimbursed based on what it actually costs to provide care in their particular geographic region. CMA has requested from CMS the geographic practice expense data it used to calculate the proposed GAF changes so that the association can verify the agency’s calculations.
The CMS proposal also sets forth three options for updating California’s payment localities. Counties are also grouped into Medicare payment “localities,” theoretically with other counties with similar practice costs. Because the payment localities have not been updated in 10 years, many recently urbanized counties remain inappropriately grouped into payment localities along with lower-cost (mostly rural) counties.
The three proposals reassign underpaid counties into new or more appropriate localities so that they can be reimbursed based on more accurate geographic practice costs.
Unfortunately, because federal law requires changes in the Medicare program to be budget neutral, all three options would require some localities to suffer additional payment cuts to offset the increases for the most severely underpaid counties.
CMA does not support any of these options in their current form. CMA policy requires the association to advocate for a solution that does not substantially penalize physicians remaining in the affected localities.
CMA is sponsoring a bill (HR 2428) that would require CMS to move any county whose county GAF exceeds its locality GAF by 5 percent to its own locality and be reimbursed at the geographically appropriate rate. The bill would require CMS to update the payment localities every three years using the 5 percent threshold. The legislation would also protect the physicians in counties remaining in original payment localities by establishing a geographic payment floor at current levels.
Click here for more information, including a summary of the CMS proposals.
Contact: Elizabeth McNeil, 415/882-3376 or ecmneil@cmanet.org
4. Tell Your Congressional Representatives
to Support Medicare Payment Reform
CMA is once again leading the fight to protect access to care and develop real plans for Medicare reform. CMA needs your help to make it happen. Contact your Congressional representative and ask to protect access to care by:
- Reauthorizing the State Children's Health Insurance Program (SCHIP). SCHIP has provided health insurance to hundreds of thousands of California's uninsured children for a decade. Urge your representatives to reauthorize this very important program at 250 percent of federal poverty level (the current California coverage level).
- Stopping the Medicare SGR Payment Cut. Urge Congress to protect access to physicians for California seniors by stopping the proposed 9.9 percent payment cut and instead instituting payment increases for two to three years or until a long-term alternative to the SGR payment system can be crafted.
- Updating the Medicare Geographic Payment Localities. A CMA-sponsored bill (HR 2482) making its way through Congress would fix the inequitable and outdated Medicare geographic payments. If your members of Congress are authors or sponsors of the bill, please thank them for supporting this long-overdue fix. If your representatives have not yet signed on, please urge them to do so immediately!
Funding Sources: The cost to continue SCHIP, stop the 10 percent Medicare physician pay cut, and institute a payment update for 2 years is at least $80 billion. Tell your members of Congress that these reforms should be paid for by increasing the tobacco tax and equalizing Medicare Advantage health plan rates with fee-for-service rates. Currently, Medicare Advantage plans receive on average 12 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 as much as $30 billion.
Call AMA's grassroots hotline at 800/833-6354, enter your zip code when prompted, and you will be automatically connected with your representative.
Click here for more information.
Contact: Susan Bassett, 916/444-5532 or sbassett@cmanet.org.
5. Help CMA Make a Difference; Become a Key Contact
CMA, the voice of California physicians, relies on the involvement of physicians like you to communicate the physician vision of medical care to lawmakers, and to the regulators who determine how medicine is practiced in California.
Personal contact with elected representatives makes a big difference — sometimes all the difference — in how votes are cast in Sacramento and in Washington. When you sign on as a legislative key contact, you will receive e-mailed “action alerts” from CMA when a key issue is breaking.
The alerts will provide background information and talking points, and will ask you to call, fax, or e-mail a letter to your representatives. Key contacts also make in-person visits to lawmakers to help educate them and guide their votes on critical bills.
To sign up, click here.
Contact: Susan Bassett, 916/444-5532 or sbassett@cmanet.org.
6. Have You Checked Out CMA Alert Audio News Yet?
Don’t have time to read CMA Alert? Now you can listen on the go to the latest news from CMA in a convenient audio podcast. Don’t have an iPod or other MP3 player? No problem!
You can listen via any Internet-connected computer.
iTunes users, just search “CMA Alert” in the iTunes store.
Click here for more information.
Contact: Ron Lopp, 916/551-2042 or rlopp@cmanet.org.
7. 6% Off Online Practice Management from athenahealth
CMA has partnered with athenahealth(r) to offer physicians the industry’s leading billing, practice management solution, athenaCollectorSM.
CMA members receive 6 percent off athenahealth’s unique web-based practice management service, which integrates web-based practice management, EMR software, and back office processing specialists into a single service.
Practices can face an array of operational challenges. Constantly changing payer rules make it time-consuming for your staff to keep up. Lost and denied claims significantly impact your practice’s income. Lack of accurate data leaves you at a disadvantage during planning and payer negotiations. athenaCollector helps you solve these challenges.
athenahealth helps physicians get paid quickly, correctly, and with minimal hassle: On average, practices that use athenahealth get paid 30 percent faster and see a 5 to 10 percent increase in collections.
The result? Significantly improved financial and operational performance for your practice.
Joe Donnelly at 339/221-2954 or jdonnelly@athenahealth.com or visit athenahealth.com
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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