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1. Medicare Announces 2008 Quality Measures
The Centers for Medicare & Medicaid Services (CMS) last week unveiled the 119 performance measures that will be used in its 2008 pay-for-performance program, the Physicians Quality Reporting Initiative (PQRI).
PQRI is a voluntary reporting program that encourages quality improvement through the use of clinical performance measures. It establishes financial incentives for physicians who participate in this voluntary program. The new measures apply to claims with dates of service from January 1 to December 31, 2008. The 2008 bonus payment is yet to be determined, but will likely be between 1.5 and 2.0 percent of total allowed charges for covered Medicare physician services.
Detailed specifications for the 2008 PQRI measures will be posted on the CMS PQRI website on or before December 31.
CMS will also begin testing registry-based submission of quality data in 2008 and is currently assessing the feasibility and utility of accepting clinical quality data submitted from electronic health records.
Don’t forget, claims for the 2007 reporting period (claims with dates of service of July 1 to December 31, 2007) must be received on or before February 29, 2008, to be included in the 2007 bonus payment calculation.
CMS is hosting a conference call for providers to discuss the 2008 quality reporting program. The call is 12 p.m. – 2 p.m., Pacific time, on Wednesday, November 28.
Click here for more information.
Contact: Sandra Bressler, 415/882-5171 or sbressler@cmanet.org.
2. State Regulator Orders Blue Cross
to Stop Illegal Contracting Practice
The Department of Managed Health Care (DMHC) ordered Blue Cross of California to stop using its controversial confidentiality agreement, calling the agreement an “unlawful and unfair business practice” that threatens patients’ access to care. The insurance giant has been using the confidentiality agreement to force physicians into signing its contracts without consulting a legal or financial advisor, unless that advisor is approved by Blue Cross – a tactic only available to a company with the enormous market clout of Blue Cross.
Under the mandatory confidentiality agreement, Blue Cross had the right to determine “at its sole and absolute discretion” whether or not a physician could use a particular attorney or negotiator. In February, CMA notified state insurance regulators of this unfair agreement, which not only violates laws protecting the confidentiality of attorney-client communications, but also prevented physicians from being fairly represented in managed care contract negotiations. CMA also urged Blue Cross to withdraw the unfair agreement.
CMA will request that DMHC modify its cease-and-desist order to nullify any such agreements that have already been signed.
Click here for more information.
Contact: CMA’s reimbursement help line, 888/401-5911 or drice@cmanet.org.
3. Aetna Switching to Online EOBs
Aetna recently announced it would soon be transitioning to an electronic EOB platform. The insurer’s new online EOB tool will allow you to view, print, and download your EOBs from Aetna’s secure provider website.
Physicians who want to continue receiving paper EOBs can opt out of the electronic EOBs by sending a written request to: Aetna, P.O. Box 14079, Lexington, KY, 40512-4079. The requests should be on office letterhead and include the physician’s tax ID number and a reason for the request.
Click here for more information.
Contact: Aileen E. Wetzel, 916/551-2037 or awetzel@cmanet.org.
4. Medicare Claims Must Contain NPI Effective March 1
The Centers for Medicare & Medicaid services recently announced that effective March 1, 2008, all Medicare fee-for-service claims must use an NPI as the primary identifier (i.e., in the billing, pay-to, and rendering fields).
You may continue to submit NPI/legacy pairs in these fields or submit only your NPI. Claims containing only a legacy identifier in the primary fields will be rejected or returned as unprocessable.
Click here for more information.
Contact: Frank Navarro, 916/551-2046 or fnavarro@cmanet.org.
5. Free CME From CMA Foundation
The CMA Foundation is hosting a free CME program on antibiotic resistance and appropriate antibiotic prescribing on Tuesday, December 4, 6:30 p.m. to 8:30 p.m., at Glendale Memorial Hospital. Physicians, residents, medical students, and other health professionals are invited to attend.
The seminar, “Antibiotic Resistance and Antibiotic Prescribing: Practical Strategies for Viral URIs” is a presentation of the foundation’s AWARE Project, which works to reduce unnecessary use of antibiotics and the prevalence of antibiotic-resistant bacteria in California.
Presenters will outline strategies for reducing antibiotic resistant pathogens and identify culturally appropriate messages that physicians can share with patients to explain appropriate antibiotic use.
For more information visit http://www.calmedfoundation.org.
Contact: Cristina Correa, 916/551-2551 or ccorrea@cmanet.org.
6. CMA’s 11th Annual Health Care Leadership Academy
Is May 2 - 4 at Disneyland Resort in Anaheim
CMA’s 11th Annual California Health Care Leadership Academy is May 2-4 at Disneyland’s Grand Californian Hotel in Anaheim. Building on last year’s successful program, this year’s academy will not only address leading-edge trends and developments in health care but will also feature a slate of practical practice management-oriented workshops for physicians and office staff.
New for 2008 will be discounted registration fees for young physicians. Stay tuned for more details.
Contact: Roger Purdy, 916/444-5532 or rpurdy@cmanet.org.
7. Highlights from AMA’s Annual Meeting Available Online
The California delegation to AMA’s House of Delegates presented a number of important resolutions—on subjects from health care information technology to physician collective bargaining to economic profiling of physicians—at the association’s interim meeting this week in Honolulu, Hawaii.
Click here for summaries of the resolutions that the AMA House adopted as policy.
Contact: Ginnie Yee, 415/882-5170 or gyee@cmanet.org.
8. Deadline to Resubmit CIGNA Claims for
CAD Mammography to CIGNA Is December 1
CIGNA earlier this year agreed to pay previously denied claims with add-on codes for computer-aided digital (CAD) mammography originally submitted between January 1 and October 10, 2004. The deadline to resubmit such claims is December 1.
As you know, CIGNA in early 2004 settled CMA’s civil racketeering (RICO) lawsuit, which alleged that for-profit HMOs used fraud and other illegal activities to interfere in the physician-patient relationship. In the settlement, CIGNA specifically agreed, among many other things, to pay all add-on codes from the date they became effective under the CPT system. The codes in question became effective January 1, 2004, but CIGNA did not begin paying those claims until October 10, 2004.
Click here for more information.
Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org
9. Member Benefit of the Week:
Multimedia HIPAA Training for Physician Office Staff
Did you know that HIPAA requires every new hire in your office to be trained in both privacy and security practices? PrivaPlan, CMA’s HIPAA partner, has an affordable, easy-to-use CD-based training module, with online testing.
The training has been customized for California physicians, to keep them in compliance with both state and federal law. The program includes an online comprehension quiz and a printable certificate of completion.
Existing PrivaPlan subscribers receive a special price of $99 ($70 off the public purchase price of $169). CMA members who are not PrivaPlan subscribers pay $129.
Call 877/218-7707 for details.
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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