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1. California Insurers Must Now Cover HPV Testing
Governor Schwarzenegger recently signed a CMA-sponsored bill that requires California insurers to immediately begin covering human papillomavirus (HPV) testing as part of cervical cancer screening. The law, which makes California the fifth state in the nation to require coverage of HPV testing, underscores the test’s role as an emerging standard of care in cancer screening.
Digene Corporation manufactures the only FDA-approved test for high-risk strains of HPV. The test is approved for use along with a Pap smear to screen women age 30 and older, the group most at risk for cervical cancer.
Earlier this year the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) recommended that 11- and 12-year-old girls be routinely vaccinated against HPV. 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 requires California health plans to pay for vaccines covered by the federal vaccine program. Unfortunately, although the vaccine is approved for females age 9 to 26, is it likely that most payors will only cover the vaccine for 11 and 12 year olds, as would be required by law. The vaccine costs $360 (three shots at $120 each).
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Contact: Sandra Bressler, 415/882-5171 or sbressler@cmanet.org.
2. Don’t Procrastinate: Get Your National Provider ID Today
In less than a year, physicians who are covered by HIPAA will be required to use their new National Provider Identifier (NPI) on claims and other electronic health care transactions. All physicians who bill Medicare—even if not covered by HIPAA—must also obtain and begin using NPIs by the May 2007 deadline. NPIs will replace UPINs and other payor-specific provider identification numbers.
Beginning May 24, 2007, Medicare providers and physicians covered by HIPAA will have their claims denied if they do not have NPIs. This is not an idle threat. Physicians will have had two full years to get their NPIs.
Physicians are strongly urged to apply for NPIs immediately, if they haven’t already done so. Because many health care providers are expected to wait until the last minute to apply for their NPIs, there will likely be a backlog of applications in the months leading up to the deadline. To make sure you get your NPI on time, you should submit your application as soon as possible.
Applying for an NPI is fairly simple. Physicians can apply online at https://nppes.cms.hhs.gov. If you do not have Internet access, call the NPI Enumerator at 800/465-3203 and request a paper application form. (Physician groups and incorporated physician practices of all sizes will likely need to apply for more than one NPI. More information is available in CMA’s NPI toolkit. See details below.)
While applying for an NPI is straightforward, making sure your billing systems and vendors are ready for the transition is a more complicated process, one that requires some preparation and internal assessment. CMA’s HIPAA partner, PrivaPlan, has developed an inexpensive CD-ROM toolkit to help physicians navigate the process.
If you haven’t investigated it, you should give it a look. The toolkit will help physicians understand their NPI “readiness” and the impact the NPI may have on their practices. It also provides form letters and surveys to send to your major system vendors, clearinghouses, and health plans, to determine their NPI readiness.
CMA members can purchase the toolkit for $99. CMA members who have purchased PrivaPlan’s other HIPAA toolkits pay $79. Nonmembers pay $129. Order the toolkit by calling 877/218-7707.
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Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.
Appeal Zero-Pays
Four percent of the average practice’s monthly billed charges are “paid” by insurers at zero dollars. These “zero-pays” are effectively the same as denials but are not recorded as such. Zero-pays typically occur because the payor claims that the service is part of a bundled or global service for which it has already paid.
Because zero-pays are typically related to payor-specific idiosyncrasies, there is little you can do to prevent them. But nearly three quarters of zero-pays can be successfully appealed.
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Contact: CMA's Center for Economic Services, 916/551-2061 or jthompson@cmanet.org. |
4. IMQ Receives Grant to Promote Cultural and Linguistic Competency
The CMA’s Institute for Medical Quality (IMQ) received a substantial grant from the California Endowment to promote cultural and linguistic competency in continuing medical education (CME). The two-year grant will allow IMQ to help CME providers in California develop strategies to comply with the state’s new cultural competency CME law. The law, which took effect July 1, requires that all CME courses include curriculum on cultural and linguistic competency so that physicians better understand their patients’ health-related cultural beliefs and expectations and how different diseases affect diverse populations.
Through this grant, IMQ will provide educational opportunities, technical assistance, and informational resources to over 400 CME providers in California.
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Contact: Alecia Robinson, 415/882-5178 or arobinson@imq.org.
5. Help Avert Medicare Crisis; Tell Congress that Inaction is Unacceptable
If Congress does not act before the end of the year, Medicare payments to physicians will be cut by 5 percent on January 1 and by a total of 37 percent over the next six years. These cuts come at a time when medical practice costs are soaring. Over the last five years, the average cost to run a medical practice has gone up at least 18 percent, yet Medicare is still paying physicians the same rates it did in 2001. By 2007, Medicare physician payment rates will effectively have fallen by more than 20 percent.
Congress needs to hear from both physicians and patients that inaction is not acceptable. Physicians, call, write, or visit with your members of Congress to express your outrage and extreme disappointment that the Republican leadership in Congress again this year failed to fix the physician payment problem. They need to understand that this is an urgent issue and that failure to reform the Medicare payment formula will force physicians to stop accepting new Medicare patients or withdraw from the program entirely.
Please urge your members of Congress to stop the 5 percent payment cuts during the post-election lame-duck session in November. Tell your members of Congress to dump the flawed SGR physician payment formula and replace it with a new formula based on the medical economic index, which would increase physician payments by 2.8 percent in 2007. Please also urge your representative to show the House leadership that he or she supports Medicare payment reform by cosigning the Medicare “Dear colleague” letters that are circulating in Congress.
To contact your members of Congress, please call AMA’s grassroots action hotline at 800/833-6354. You will be prompted to enter your zip code and will be automatically connected with your local representative.
AMA has also published a flyer that physicians can use to inform patients about the impending crisis and encourage them to call their members of Congress to demand immediate action.
Click here for more information, including talking points, sample letters, and AMA’s patient flyer.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
6. Have You Completed Your Pain CME Yet?
California law (AB 487) requires physicians to complete 12 hours of continuing medical education (CME) in pain management and the care of terminally ill and dying patients. Physicians have until December 31 to satisfy this requirement.
One way to fulfill the requirement is by attending CMA's pain management conference, "Pain, Palliation, & Politics: Pain Management and End-of-Life Care in California's Regulatory Environment.” This practical two-day CME program will be offered December 1-2 at the Disneyland Hotel in Anaheim. CMA tailored this program to meet the needs of physicians who do not specialize in pain medicine. Offering 14 hours of Category I CME, this program completely fulfills California's AB 487 mandate. Members pay $335 (nonmembers $600). Register by November 1 and get a $40 early-bird discount.
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Contact: CMA's seminar line, 415/882-3330 or kdefabrique@cmanet.org.
7. Father of Variation Analysis to Speak at CMA-OMSS Assembly
CMA’s Organized Medical Staff Section will hold its Annual Assembly and Education Conference Friday, October 27, 7:30 a.m. to 5 p.m., at the Sacramento Convention Center. The conference immediately precedes the 2006 CMA House of Delegates, also at the Sacramento Convention Center.
Among the speakers is John E. Wennberg, M.D., M.P.H., director of the Center for the Evaluative Clinical Sciences at Dartmouth Medical School. Dr. Wennberg is a renowned health services researcher and former director of the Agency for Healthcare Research and Quality. Known as the “father of variation analysis,” Dr. Wennberg will discuss unwarranted variations in the cost and quality of medical care—unwarranted because they can’t be explained by illness, patient preferences, or the dictates of evidence-based medicine—and what health care providers can do to deliver more efficient, more effective care.
All physicians, medical staff professionals, and interested parties are invited to attend, but seating is limited. Cost is $100 for physicians and staff of CMA-OMSS members, $250 for CMA members who are not also OMSS members, and $300 for all others.
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Contact: Kathleen DeFabrique, 415/882-5107 or kdefabrique@cmanet.org.
8. 150th Anniversary Trivia: Did You Know?
Did you know that in 150 years, there have only been two physicians who have served as CMA's chief executive officer? The first was Frederick Warnshuis, M.D., a former AMA House of Delegates Speaker who served as CMA’s CEO from 1932 to 1935. The second is current CEO Jack Lewin, M.D., who has been chief executive since 1995.
CMA is celebrating its 150th birthday! Visit http://www.cmanet.org/150 for other interesting information about CMA history.
9. CMA Member Benefit of the Week: Health Savings Account
Open a CMA Health Savings Account (HSA) today and we’ll deposit $20 in your account. And the set-up fee is waived for CMA members, their families, an their office staff. An HSA is a tax-exempt account used to pay for current health care expenses and save money for future expenses. To maximize your federal tax deductions for 2007, you must complete the enrollment process by December 15.
Visit http://www.cmanet.org/hsa or stop by the Internet café kiosk at the CMA House of Delegates for more information.
Contact: Marsh Affinity, 800/842-3761.
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