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1. Is Your Clearinghouse Stripping NPIs from Medicare Claims?
The Centers for Medicare Medicaid Services (CMS) recently learned that some clearinghouses are stripping National Provider Identifiers (NPIs) before submitting claims to Medicare. While this will not affect your ability to get paid, it will adversely affect your ability to participate in the Physicians Quality Reporting Initiative (PQRI).
If you use a clearinghouse and plan to participate in Medicare's quality reporting initiative, you should check with your clearinghouse to find out if it is stripping NPIs. If your clearinghouse is stripping NPIs, you may want to consider other billing options.
One such option is CMA's clearinghouse partner, Infinedi. CMA members receive a discount of 8 to 12 percent. Physicians can choose Infinedi's flat rate monthly service, which permits unlimited electronic claims filing, or opt for a per-transaction payment plan.
You don't need special software. Claims can be transmitted 24 hours a day to Infinedi's online web portal via secure FTP, or by modem through a toll-free number. You can also access up-to-date reports on claims status and related information.
Infinedi is also developing a new tool that will track and notify physicians when their claims are PQRI eligible.
Click here for more information.
Contact: Sandra Bressler, 415/882-5171 or sbressler@cmanet.org.
2. CMA Names New General Counsel
The CMA Board of Trustees on Friday approved the appointment of Deborah Winegard as CMA's new general counsel. Winegard, an attorney from Georgia with extensive health care experience, will assemble and lead a legal team at CMA's Sacramento headquarters.
We are very pleased to have someone of Deborah's high caliber and experience in health care advocating for the California Medical Association on behalf of patients and physicians, says CMA President Anmol S. Mahal, M.D. With her leadership, we will be able to continue the legal advocacy for which CMA is known, and we will undoubtedly achieve new heights.
Winegard began representing physicians in 1985 as an associate in the Atlanta office of the national law firm of King Spalding and has remained engaged in health policy issues on behalf of physicians for more than 20 years. She served three years as general counsel for the Medical Association of Georgia, where was also director of third-party payor advocacy. In her most recent position as the RICO settlement compliance dispute facilitator for Aetna and CIGNA, Winegard helped recover millions of dollars in compensation previously denied to physicians and effected payment and policy changes beneficial to physicians.
Winegard will begin her duties immediately. She is taking a job held for 21 years by Catherine Hanson, who is now vice president, Private Sector Advocacy and Advocacy Resource Center, at the American Medical Association in Chicago.
Click here for more information.
Contact: Sonja Oehler, 916/551-2022 or soehler@cmanet.org.
3. CMA Appalled by Blue Shield of California’s
Failure to Settle RICO Lawsuit
CMA is outraged that Blue Shield of California has refused to settle a class-action lawsuit filed in 2003 that would have meant tens of millions of dollars to California physicians who were harmed by the insurer's previous failures to provide and pay for patient care.
Despite the association's best efforts to work amicably with this nonprofit insurance company — a company CMA founded — Blue Shield is demonstrating a disappointing unwillingness to provide its enrollees with the care for which they've paid.
Though not a plaintiff in this case, CMA has been working with the parties involved over the past several months to reach a fair settlement. Unfortunately, the Blue Shield of California board of directors recently decided it was not willing to pay the pro rata shares owed to doctors who provided tens of millions of dollars in uncompensated care to Blue Shield enrollees.
The case, Rick Love, M.D. v. Blue Cross Blue Shield Association, was filed in May 2003 in federal district court in Miami. The suit accused the insurers of a pattern and practice of denying and delaying care, including intentionally programming computer billing databases to automatically downcode physician claims. The suit was filed under the federal civil RICO (Racketeering Influenced and Corrupt Organizations) statutes.
Although CMA is not a plaintiff in the suit, the suit affects all physicians because of its class-action status. Blue Shield of California is one of the few Blue Shield companies in the nation of nearly 40 licensees that has refused to settle this case and pay doctors the money they are owed. Negotiations in a few states are still pending.
Click here for more information.
Contact: CMA's legal information line, 415/882-5144 or legalinfo@cmanet.org.
4. Highlights from CMA Board of Trustees Available
The CMA Board of Trustees met July 20 in Sacramento. A summary of the board's major actions is now available online.
The board highlights offer a brief summary of major action and informational items discussed by the board. The highlights are not intended to be all-inclusive of items discussed, and these documents are not official CMA policy.
Members can access complete and official board-approved minutes at CMA's members-only website. (Official board meeting minutes are not posted until approved at the following meeting.)
Contact: Ginnie Yee, 415/882-5170 or gyee@cmanet.org.
5. Blue Cross Forced to Give Doctors More
Time to Consider New Fee Schedule
CMA recently filed a RICO lawsuit compliance dispute, objecting to Blue Cross's failure to provide physicians with timely access to its new fee schedule, originally scheduled to take effect June 1. As part of its RICO settlement, Blue Cross agreed to provide physicians with greater notice of policy and procedure changes.
Blue Cross's failure left many physicians unable to assess the financial impact that the fee schedule changes would have on their practices. Last month, the Department of Managed Health Care (DMHC) forced Blue Cross to delay implementation of the new fee schedule and take appropriate measures to notify doctors of the rate changes. The insurer, as part of the RICO compliance dispute process, yesterday agreed to further delay implementation to allow physicians more time to determine how the changes will impact their practices. The new implementation date is August 30.
Click here for more information.
Contact: CMA's reimbursement help line, 888/401-5911 or jblack@cmanet.org.
6. Get Involved: Submit a Resolution to the 2007 House of Delegates
The most effective way an individual member can influence CMA's policies and activities is to submit resolutions to the House of Delegates, the association's legislative body. The delegates meet annually to debate and act on resolutions and reports dealing with myriad medical practice, public health, and CMA governance issues. This year's annual meeting is October 27 to 29 in Anaheim.
The deadline to submit resolutions to this year's House of Delegates is August 28. Any CMA member may author a resolution, but a delegate, alternate delegate, component medical society, or specialty delegation must submit the resolution. Before authoring a resolution, physicians are strongly encouraged to review CMA's policy compendium to make sure that the association is not already addressing the issue.
For more information on submitting a resolution, contact your county medical society. Detailed instructions (including required format, allowed subject matter, and submission rules) are available at CMA's members-only website.
Contact: Roger Purdy, 916/444-5532 or rpurdy@cmanet.org.
7. Physician Leadership Training, September 22 in Oakland
Your dues dollars allow CMA to tackle major health care reform, fight scope of practice infringement, and help physician practices remain economically viable. Wouldn't it be great if all your colleagues who benefited from your membership dues started contributing, too? To make it easy and fun to talk to your colleagues about getting involved in organized medicine, join us for an interactive day of leadership training Saturday, September 22, in Oakland.
Attendees will learn how to confidently speak to their colleagues on the value and benefits of CMA membership. You'll learn how to overcome objections without animosity or frustration. You will learn how to respond when a colleague tells you dues are too high or objects to CMA's position on an issue. You'll also learn how to appeal to young physicians, delinquent members, and physicians in various modes of practice.
This interactive session will include role playing so that you can practice your communication skills. The workshop will also prepare you to share your skills with others to support membership efforts in your county.
Space is limited, so register early. To register, contact your county medical society or sign up online.
Contact: Lynn Godward, 916/551-2078 or lgodward@cmanet.org.
8. Help Make the CMA Foundation Annual Dinner a Success
The CMA Foundation's 11th annual dinner dance is October 28 in Anaheim, during CMA's annual meeting. Proceeds will support CMA Foundation, a charitable organization that links physicians and their communities to raise awareness about important public health issues, including appropriate antibiotic use, childhood obesity, diabetes, smoking cessation, and health disparities.
Even if you will not be able attend, placing an ad in the dinner program. The foundation is a nonprofit charitable organization, and all ads are tax deductible.
Tickets will go on sale soon. Click here for more information.
Contact: Liz Burdick, 916/551-2886 or lburdick@cmanet.org.
9. Member Benefit of the Week: 25% Off Avis Car Rental
CMA members receive up to 25 percent off on car rentals from Avis. To make a reservation, visit www.avis.com or call 800/698-5685.
You will need CMA's AWD (Avis Worldwide Discount) number to receive your CMA discount. Log in to CMA's members-only website or call CMA's member help line (888/231-2937) to get your discount code.
If making a reservation online, be sure to both select "lowest rate" and enter the AWD when prompted to ensure you receive the lowest rate available.
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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