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1. Medi-Cal Managed Care Exempt from
Federal Security Prescription Rules
As you know, the new federal security prescription rules take effect October 1. The new law requires most Medi-Cal prescriptions to be written on tamper proof pads. There are, however, a number of exemptions to this rule.
Security prescriptions are not required for:
- Prescriptions paid for by a managed care entity
- Prescriptions provided in nursing homes and some other institutional settings
- Phoned, faxed, or electronically transmitted prescriptions
CMA has also received a number of questions about writing prescription for dual-eligible (Medicare and Medi-Cal) patients. Because the vast majority of dual eligible patients receive their prescription drugs through the Medicare Part D program, prescriptions for these patients are not subject to the federal security prescription requirement.
For more information on this new law, see CMA ON-CALL documents #0510, Drug Prescribing (Not Schedule II-V Drugs) and #0509, Controlled Substance Prescribing. ON-CALL documents are free to members at the members-only website. Nonmembers can purchase ON-CALL documents for $2 per page in the CMA Bookstore.
To help ease the burden of this new requirement, especially for physicians with a high volume of Medi-Cal patients, CMA has negotiated a 20 percent member discount on tamper-proof pads and printer paper that meet both federal and state security prescription requirements.
This special discount from CMA's security prescription partner RxSecurity is available through Wednesday, November 7.
Place your order online at http://www.rxsecurity.com/cma.php or by phone at 800/667-9723.
Click here for more information.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
2. CIGNA No Longer Required to Abide by RICO Settlement
Physicians should be aware that the CIGNA settlement agreement expired on September 4 and the insurer no longer has to comply with the settlement terms. Physicians are encouraged to review their CIGNA contracts and contact their provider representatives to determine how termination of the settlement will affect their business relationships.
As you know, CIGNA in 2003 became the second health plan to settle the civil racketeering lawsuit initially filed by CMA in 2000. As part of the settlement, CIGNA made a four-year commitment to change the way they do business with physicians and to put a stop to business practices that were used to deny or delay payment to physicians for legitimate claims.
CIGNA has said that it would voluntarily continue the settlement's prohibition on downcoding E&M codes, follow the settlement's coding rules, and continue to pay appropriate rates for vaccines. The Physicians Advocacy Institute, including representatives from CMA, has been working with CIGNA, encouraging them to voluntarily continue most of the business practices required by the settlement in an effort to foster continued communication with physicians and transparency of the payment process. Based on these discussions, CIGNA has agreed, among other things, not to seek recovery of alleged overpayments more than twelve months old.
However, physicians must continue to be diligent in reviewing their CIGNA contracts. Some physician contracts recently distributed by CIGNA contain provisions that don't live up to their stated commitments.
Click here for more information.
Contact: Aileen E. Wetzel, 888/401-8911 or awetzel@cmanet.org.
3. Congress Expected to Drop Medicare Provisions from Healthy
Families Bill; Physicians Again Facing Steep Payment Cuts
Because congressional leaders have been unable to come to an agreement on the Medicare/Healthy Families legislation, it is very likely that the Medicare provisions will be eliminated so that reauthorization of the State Children's Health Insurance Program (SCHIP) is not delayed. Although CMA understands the importance of the SCHIP reauthorization, the association is extremely disappointed that physicians are once again facing steep Medicare payment cuts. Stopping the pay cuts is critical to preserving access to care in California.
The U.S. House earlier this month passed a bill that would have not only reauthorized the Healthy Families program, but also stopped the 15 percent physician pay cut. Additionally, it would have updated California's geographic payment localities and prevented any geographic payment reductions for three years. The Senate, however, passed a scaled-down version of the House bill, without the Medicare provisions.
CMA will continue to work with congressional leaders to stop the impending payment cuts before they take effect January 1. Senate leadership has committed to adopt Medicare physician payment reform legislation before the end of the year.
Click here for more information.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
4. CMA Survey: Blue Cross Fee Schedule
Changes May Impact Access to Care in California
Last week, as part of CMA's ongoing review of physician concerns with Blue Cross of California, we reported that more than 20 percent of doctors responding to our July survey said they had or were planning to terminate their contracts with Blue Cross following the insurer's recent move to slash payments to doctors.
The survey also found:
- Out of nearly 500 practices representing 1,566 doctors and 91,000 patients in 31 counties who responded, 24 percent said they have or would terminate their contracts.
- The top three counties for planned terminations of contracts were Ventura (93 doctors), Los Angeles (86), and San Mateo (32).
- Of those physicians who said they had or were planning to cancel their contracts in response to the unilateral changes Blue Cross made to its fee schedules, primary care doctors were the top specialty, making up 11.5 percent of the total. Contrary to Blue Cross' public assertions, the changes may exacerbate the existing lack of access to primary care physicians.
- 91 percent of those who have or plan to cancel their contracts are in practices with five or fewer physicians.
Furthermore, Ventura County Medical Association (VCMA) found in its own survey just this past week that 38 doctors in that county home of Blue Cross of California have terminated their contracts. Sixty of the 169 doctors responding to VCMA's survey report difficulty referring patients to specialists such as cardiologists, pulmonologists, dermatologists, and urologists. This is troubling on many fronts, especially when you consider that Blue Cross's latest contract gives the insurer the authority to unilaterally decrease contracted payment rates if a physician refers patients to out-of-network providers.
These surveys reflect what we have feared all along. "These decreased payments are forcing some doctors to end their contracts with Blue Cross, which will reduce patients access to doctors in many areas of the state," says CMA President Anmol S. Mahal, M.D.
Click here for more information.
Contact: Jodi Black, 916/551-2863 or jblack@cmanet.org.
5. Medical Board Seeking Nominations
for Physician Humanitarian Award
The Medical Board of California is seeking nominations for its Physician Humanitarian award, which recognizes physicians who have demonstrated excellence in their efforts to improve access and fill gaps in the health care delivery system. The nomination deadline is November 16.
Visit http://www.mbc.ca.gov for details.
Contact: Candis Cohen, 916/263-2394 or cchohen@mbc.ca.gov.
6. Save the Date: AAMSE Expert Summit on Quality of Patient Care
Jill Silverman, president and CEO of CMA's Institute for Medical Quality is chairing the American Association for Medical Society Executive's Expert Summit on Quality of Patient Care. The summit is October 19 -20 at the Westin O'Hare in Chicago.
This summit is designed for physician leaders and medical society executives and will give participants real world examples of how to get involved in the quality movement.
Visit http://www.aamse.org for details.
Contact: Jill Silverman, (415) 882-5151 or jsilverman@imq.org.
7. Next Medicare Conference Call on
Quality
Reporting Program Is Sept. 26
The Centers for Medicare & Medicaid Services (CMS) are hosting a series of conference calls to help physicians understand how to participate in Medicare's Physician Quality Reporting Initiative (PQRI). This voluntary program a voluntary reporting program that encourages quality improvement through the use of clinical performance measures. Participating physicians receive bonus payments of 1.5 percent of total allowed charges for covered Medicare physician services.
The next call is Wednesday, September 26, 10:30 a.m. to 12:30 p.m., Pacific time. The Q&A format will allow physicians and their staff to have their questions answered by CMS PQRI experts.
Participation is free, but registration is required. Available phone slots fill up quickly, so interested physicians are urged to register as soon as possible. Registration information is available at the the PQRI website. Physicians who are unable to participate in these calls can access on-demand audio replays, also at the PQRI website.
Visit http://cms.hhs.gov/pqri for details.
Contact: Geanelle E. Griffith, 410/786-4466 or geanelle.griffith@cms.hhs.gov.
8. Member Benefit of the Week: Free Portfolio Review
CMA members get a free portfolio checkup a $250 value from CMA's affinity partner, Mercer Advisors.
Mercer Advisors manages over $3.5 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 800/898-4642.
Click here for more information on your membership benefits.
Contact: CMA's membership hotline, 800/786-4CMA (4262) or lgodward@cmanet.org.
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No. 2110
