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1. NHIC Files Protest over Loss of Medicare Contract
California Medicare carrier NHIC has filed a formal protest over the Centers for Medicare & Medicaid Services’ recent decision to name South Carolina-based Palmetto GBA as California’s new carrier for both Part A and Part B claims. The protest was filed with the federal Government Accountability Office, which has 100 days to respond.
As you know, NHIC has been California’s Medicare carrier for more than a decade, processing claims for physicians, laboratories and other practitioners under Medicare Part B. Palmetto is one of five new Medicare Administrative Contractors (MACs) named by CMS as required by the Medicare Modernization Act of 2003. The MAC contracts, which combine administration of both Part A and Part B claims, are part of an effort to streamline the fee-for-service payment system.
CMA is supporting NHIC in its protest. NHIC consistently pays claims on time and with fewer payment hassles than other payors, and has always been extremely helpful and responsive in resolving physician payment problems. While CMA was concerned that UGS, NHIC’s subcontractor for Part A Claims, is owned by WellPoint (the Indiana-based corporate parent of Blue Cross of California), NHIC was able to demonstrate to our satisfaction that there were adequate firewalls and conflict-of-interest protections in place.
CMA is also concerned that Palmetto will not commit the necessary resources to ensure effective provider relations in California.
Click here for more information.
Contact: Contact: Frank Navarro, 916/551-2046 or fnavarro@cmanet.org.
2. Read Before You Sign: IHP “Contract Amendment”
CMA has learned that a number of physicians recently received faxed “contract amendments” from Integrated Health Plan (IHP). These seemingly official notices imply that the physician receiving the notice is already contracted with IHP, when they typically are not.
Signing this document may allow IHP to include you in its discount PPO network, providing access to your rates to more than 1,700 payors and 10,000 employer groups. Signing this document may also prevent you from participating in a class action law suit against IHP.
Physicians are advised, before signing any new contract or contract amendment, to review it carefully and make sure the terms of the agreement are mutually beneficially.
For more information, read CMA’s “Silent PPO Action Guide,” which contains an overview of physician discount contracts and discusses the laws that regulate PPO network leasing. The 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 at the CMA bookstore.
Click here for more information.
Contact: Aileen E. Wetzel, 916/551-2037 or awetzel@cmanet.org.
3.Tell U.S. Senate to Stop Medicare Payment Cuts Now!
The January 1 deadline is looming and the U.S. Senate has yet to act on the Medicare physician payment issues. It is extremely urgent that physicians contact California Senators Barbara Boxer and Dianne Feinstein and tell them how these cuts will impact their ability to care for senior patients.
If Congress doesn’t stop the cuts, Medicare physician reimbursement in California could drop significantly next year, a combined result of the 10 percent sustainable growth rate (SGR) cut and the geographic payment updates recently announced by the Centers for Medicare & Medicaid Services.
The U.S. House of Representatives passed a bill in July that would stop the 10 percent SGR cut in 2008 and the 5 percent cut in 2009, replacing them instead with .5 percent increases in each of those years. That legislation would also update California’s geographic payment localities in 2008 and prevent any geographic payment reductions for three years. The bill provides an unprecedented $22 billion in payment fixes for physicians, without mortgaging this debt into future years.
The Senate is expected to tackle the Medicare issues before the end of the year. Once it does so, the House and Senate Medicare packages will be reconciled by a joint House/Senate conference committee.
Both AMA and CMA have proposed paying for these fixes by equalizing Medicare Advantage health plan rates with fee-for-service rates. Currently, Medicare Advantage plans are paid on average 12 percent more than fee-for-service physicians. Bringing plan rates in line with fee-for-service physician rates could save as much as $50 billion.
Both California Senators Barbara Boxer and Dianne Feinstein have been extremely supportive of physicians on this issue. The California senators need to hear from physicians now to help reinforce their efforts with the Senate leadership.
CMA urges all physicians to call, write, or email Senators Feinstein and Boxer and ask them to urge their Senate colleagues to:
- Stop the Medicare physician payment cuts for two years
- Provide a positive physician payment update for two years
- Equalize Medicare Advantage rates with physician rates
- Include a California GPCI fix
Call AMA’s grassroots hotline at 800/833-6354, enter your zip code, and you will be automatically connected with your member of Congress. Please also thank Senators Feinstein and Boxer for their continued support of physicians.
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Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
 4. Download CMA's “Save Medicare” Posters
CMA has produced “Save Medicare” posters to display in your office or hospital to encourage patients to join the fight to stop the physician payment cuts. High resolution posters are available in a number of sizes for you to download.
Click here to select a size.
5. Last Chance: Deadline to Resubmit CIGNA
Claims for CAD Mammography Is Dec. 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.
CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.
6. Member Benefit of the Week:
ON-CALL Medical-Legal Information Library
CMA ON-CALL is an online library that contains over 4,500 pages of medical-legal, regulatory, and reimbursement information. The searchable library contains all the information available in the California Physician’s Legal Handbook, an annual publication of CMA’s Center for Legal Affairs.
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 CMA’s online bookstore.
If you haven’t taken advantage of this extraordinary resource, spend a few minutes browsing the ON-CALL index, and see what you’ve been missing.
Click here for more information on your membership benefits.
Contact: CMA's membership hotline, 800/786-4CMA (4262) or info@cmanet.org.
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No. 2119
