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1. Budget Gridlock in Sacramento – Fate of Healthcare Cuts Uncertain
Facing a $15.2 billion shortfall, Governor Schwarzenegger and legislative leaders have not yet reached agreement on the budget for the 2009 fiscal year, which began July 1. The fate of the 10 percent cuts to Medi-Cal reimbursement rates remains uncertain as legislators and the governor grapple with how to close the shortfall.
This past weekend, the Assembly voted on the Assembly Democrats’ budget plan, which restored Medi-Cal rates to their levels prior to the cut, and reduced the budget shortfall with a mix of tax increases on corporations and wealthy individuals. The plan fell 9 votes short of the 54 votes needed under the 2/3 majority rule for legislative budget votes. It received no Republican votes.
This week, the Senate is expected to vote on a slightly different proposal. That plan could keep some portion of the 10 percent cuts to Medi-Cal reimbursement rates, but likely not all. The Senate plan is also expected to contain a mix of new revenues.
It is not clear how or when the impasse will end. While both parties generally want to avoid cuts, they disagree on how or whether to raise new revenues to deal with the shortfall. Some Republicans may eventually agree to targeted tax increases, but will likely insist on a mandatory budget cap in return, which is generally opposed by Democrats. Until these issues are largely resolved, we will remain without a budget.
What is clear is that cutting health care remains an option for a legislature under increasing pressure to resolve a huge budget shortfall. CMA urges you to contact your legislator and ask them to commit to passing a budget which doesn’t cut health care. You can find your legislator by typing in your address at the legislature’s website.
Click here for more information.
Contact: Ned Wigglesworth, 916/444-5532 or nwigglesworth@cmanet.org.
2. CMA Legislative Victory – Physicians Removed From Costly and Burdensome Reporting Legislation
In response to months of persistent lobbying by CMA and doctors in the author’s district, AB 2967 (Lieber), a bill which could impose unlimited data reporting requirements on health care providers, has been amended to exclude physicians and physician groups.
CMA has long supported efforts to improve medical outcomes, the stated intent of AB 2967. However, prior to being amended, the bill would have required physicians and physician groups to give to a newly created state agency as much patient data as the agency demanded. This new bureaucracy would be created despite the fact that the state already has a successful outcomes reporting program under the Office of Statewide Health Planning and Development.
By being excluded from AB 2967, physicians and physicians groups are also saved from paying the tens of millions of dollars in costs related to the legislation. Not only would they have been forced to pay for any additional staff necessary to collect and provide the data, physicians and physician groups would have been required to pay unlimited fees to fund the state agency.
Intent language reflecting these concerns was also amended into the bill, so that any reporting requirements reflect an understanding of the financial burdens such requirements impose on physicians and physician groups.
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Contact: Lisa Folberg, 916/551-2880 or lfolberg@cmanet.org.
3. CMA Publishes New Silent PPO Guide
CMA’s Center for Legal Affairs has published a newly updated “Silent PPO Action Guide” to help physicians understand the complexities of health plan contracting and protect themselves from unlawful or unauthorized leasing of their health plan contracts. The revised guide incorporates new case law that gives physicians more power to extricate themselves from “silent PPOS.”
What Is a Silent PPO?
Health plans often lease their networks of contracted physicians to other third-party payors, such as self-insured employers, union trusts, or even other health plans. These “silent PPOs” allow the third-party payors to take advantage of discounted rates that health plans have negotiated with their contracted physicians. Health plans make a great deal of money, sometimes as much as $4 per subscriber per month, leasing physician networks. Health plans often conceal silent PPO clauses in lengthy contracts and use language that applies in perpetuity.
CMA’s action guide contains an overview of physician discount contracts and discusses the laws that regulate silent PPO network leasing. The guide will help physician practices to detect and prevent silent PPO activity.
The silent PPO action guide is available through CMA ON-CALL (document #1907). ON-CALL documents are available free to members at CMA’s members-only website. Nonmembers can purchase ON-CALL documents for $2 per page in the CMA Bookstore
Contact: Samantha Pellon, 916/551-2872 or spellon@cmanet.org.
4. Blue Shield Clarifies Contract Amendment
As we recently reported, CMA has received a number of calls from physicians concerned about a new Blue Shield contract amendment that was issued in response to the California Department of Insurance’s new health care access regulations. CMA has been working with Blue Shield to clarify what this amendment means to physicians.
Blue Shield has assured us that the amendment is not intended to create any new onerous obligations for physicians or interfere with the scope and level of services a physician provides in his or her practice. Blue Shield has also indicated the amendment’s nondiscrimination language, while not taken directly from the regulations, will be interpreted within the framework of applicable state and federal law. (Click here for a formal clarification statement jointly developed by CMA and Blue Shield on this issue.)
If you have any questions about the amendment or the clarification statement, contact Blue Shield Provider Services at 800/258-3091.
CMA continues to have concerns about the regulations themselves and has taken several steps to address both the underlying regulations and implementation efforts by insurers. CMA is working with the DOI to obtain clarification with respect to the newly mandated language.
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Contact: CMA’s reimbursement help line, 888/401-5911 or awetzel@cmanet.org.
5. Switch to New Medicare Contractor Is September 2
On September 2, Palmetto GBA will take over as the contractor for Medicare Part B in California. Physicians should take steps now to ensure they are ready.
Important dates to be aware of:
- August 22 – NHIC will begin forwarding all mail received at the Chico mailboxes to Palmetto GBA. They will continue to process all claims and inquiries through August 27.
- August 27 – The last day to submit electronic claims to NHIC is August 27 by 5:00 p.m.
- August 29 – The last day to retrieve ERAs from NHIC is August 29 by 5:00 p.m.
- August 28 to September 1 will be “dark days.” You will not be able to transmit claims, or otherwise contact NHIC or Palmetto GBA during this period as they transition all remaining information and files.
- September 2 – Palmetto GBA will take over all processes as the Medicare Part B contractor for California on September 2.
Palmetto GBA is holding an open call on August 26 from 12:30 pm to 2:30 pm to provide updates on the transition and answer any questions. You do not need to preregister for the call. Just dial 866/604-5969 and enter pass code 512788.
Contact: Michele Kelly, 888/401-5911 or mkelly@cmanet.org.
6. Have You Updated Your Medicare Enrollment Information?
Physicians should be aware that they are required to notify their Medicare contractor of any changes to their enrollment information within 90 days.
By reporting changes as soon as possible—but no more than 90 days—after the reportable event, physicians will help to ensure that their claims are processed correctly and without delay.
The reportable events listed below may affect claims processing, payment amounts, or even eligibility to participate in the Medicare program.
- Change of Business Structure
- Change in Organization Legal Business Name/Tax Identification Number
- Change in Address or Practice Location
- Change in Participation Status
- Change in License Status
- Felony Conviction
Other reportable changes include:
- Change in Reassignment of Benefits
- Change in Banking or Payment Information
Click here for more information.
Contact: Michele Kelly, 888/401-5911 or mkelly@cmanet.org.
7. Is Your Practice Experiencing Medicare Payment Stoppage?
If your practice is experiencing a Medicare payment stoppage, call CMA’s reimbursement help line and one of our reimbursement advocates will help you identify and correct the problem.
If you previously called with a Medicare payment problem and received assistance, please call, fax, or e-mail Desiree Rice (contact information is below) and update us on your situation.
If your practice is experiencing financial hardship because of a Medicare payment stoppage, you can request a payment advance from Medicare. Advance requests must be submitted in writing via mail (to NHIC Advance Payments, P.O. Box 54905, Los Angeles, CA 90054-0905) or e-mail (to both eileen.turner@cms.hhs.gov and stewart.streimer@cms.hhs.gov). Be sure to include your name, NPI, legacy ID, average monthly Medicare income, how long your payments have been stopped, and the advance payment amount requested.
Contact: CMA’s Reimbursement Help Line, 888/401-5911 (phone), 916/551-2027 (fax), or drice@cmanet.org.
8. Medi-Cal Will Reject Claims with Legacy IDs Starting October 1
Medi-Cal and the Child Health and Disability Prevention program will reject claims submitted with legacy identifiers effective October 1. As of that date, all paper and electronic claims and transaction must include only your NPI.
There are some exceptions, however. Blood banks, Christian Science practitioners, and Multipurpose Services Program providers may continue to submit Medi-Cal claims with legacy provider numbers.
Additionally, if a Medicare claim crosses over electronically to Medi-Cal for payment, the NPI used to bill Medicare must be registered with Medi-Cal or the claim will not be processed.
Contact: Medi-Cal Telephone Service Center 800/541-5555.
9. Member Benefit of the Week: Free Portfolio Checkup
Given the current volatility in the market and talks of a potential recession, there’s no better time to take advantage of your free portfolio checkup from 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 888/642-1234.
Click here for more information on your membership benefits.
Contact: CMA’s member help line, 800/786-4CMA or vsatt@cmanet.org.
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