1. CMA Checklist Helps Physicians Assess Economic
Impact Medicare Cuts Will Have on Their Practices
CMA has published a checklist to help physicians assess the impact the impending Medicare payment cuts will have on their practices. It is important that physicians understand how these cuts will affect their bottom line so that they can make informed decisions about Medicare participation for 2007.
Assess Economic Impact of the Cuts on Your Practice
- Determine Your Payor Mix: The first step is to complete an internal analysis of your payors to determine your Medicare claim volume. Use CMA’s “Utilization by Payor Class” worksheet.
- Identify Your Top 20 CPT Codes: Next, calculate the financial impact the Medicare payment changes will have on your practice, based on your 20 most commonly billed CPT codes. (See the comparison of 2006 and 2007 payment rates by CPT code.) You may have seen in previous issues of Alert a chart that shows the average impact of the cuts by specialty. However, since every practice is unique, identifying your top 20 CPT codes will give you a better idea of the actual impact of these cuts on your bottom line. Use CMA’s “Medicare Financial Impact” worksheet.
- Calculate Change in Practice Costs: These latest Medicare rate 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. Use CMA’s “Cost Analysis” worksheet to determine anticipated increases to your practice costs for 2007.
Make Medicare Participation Decision
Using the data that you have collected, determine whether it is financially viable for you to continue seeing Medicare patients.
Physicians have three choices regarding Medicare: be a participating provider; be a nonparticipating provider; or opt out of Medicare entirely.
- A participating physician must accept Medicare allowed charges as payment in full for all their Medicare patients.
- A nonparticipating provider can choose to accept or not accept assignment on Medicare claims on a claim-by-claim basis. If you choose not to accept assignment, you can charge the beneficiary up to 115 percent of the amount allowed in the nonparticipating physician fee schedule (also referred to as the “limiting charge”). The nonparticipating physician fee schedule amounts are 95 percent of the participating physician fees. Therefore, a nonparticipating provider who does not accept assignment can charge 109.25 percent (95 percent x 115 percent) of the amounts allowed in the participating physician fee schedule.
- Physicians who opt out of Medicare are bound only by their private contracts with their patients. Medicare’s limiting charges do not apply to these contracts, but Medicare does specify that these contracts contain certain terms. When a physician enters into a private contract with a Medicare beneficiary, both the physician and patient agree not to bill Medicare for services provided under the contract. Once you opt out, you cannot opt back in for two years.
For more information on your participation options, see CMA ON-CALL document #0151, “Medicare Participation (and Nonparticipation) Options.” 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.
Review Private Payor Contracts
CMA also encourages physicians to review any of their private payor contracts that tie their payment rates to Medicare. CMA has sent a letter to all major California payors urging them not to adopt the 2007 Medicare fee schedule changes that will negatively impact physicians. CMA has asked the payors to notify CMA as soon as possible if and when they plan to adopt the 2007 Medicare fee schedule changes so that physicians can assess the value of these contracts to their practice.
Tell Congress to Stop the Cuts
Physicians are urged to contact their members of Congress and tell them they must stop the 5 percent SGR cut. Call AMA’s grassroots hotline at 800/833-6354, enter your zip code, and you will be automatically connected with your member of Congress.
Click here for more information.
2. Officials Expect Last Minute Rush on NPIs;
Physicians Urged to Submit Applications Immediately
In six months, 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. NPIs will replace UPINs and other payor-specific provider identification numbers.
Physicians are strongly urged to apply for NPIs immediately, if they haven’t already done so. According to the Centers for Medicare & Medicaid Services, as of October only half the nation’s 2.3 million health care providers had applied for an NPI. This means there will be a backlog of applications in the final 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.
CMA is also surveying major California payors to assess their NPI-readiness. The results of the survey, which was mailed to payors earlier this month, will be made available to members as soon as possible.
More information on NPIs is available in CMA ON-CALL document #1608, “National Provider Identification Numbers.” ON-CALL documents are free to members at CMA’s members-only website. Nonmembers can purchase ON-CALL documents for $2 per page in the CMA bookstore.
Click here for more information.
Contact: CMA's legal information line, 415/882-5144 or legalinfo@cmanet.org.
3. DHS Cuts Medi-Cal Provider Application Backlog
The California Department of Health Services (DHS) recently announced that the backlog of Medi-Cal provider applications has been reduced to about 3,000. Last year, there were more than 11,000 physicians waiting for Medi-Cal approval, with an average wait of six months. Today, after the state hired management consultants and temporarily redirected staff, the average wait is just 35 days.
CMA this year sponsored a bill (SB 1353) that would have expedited the provider enrollment process to avoid future backlogs. Specifically, the bill would have shortened the time that DHS has to process provider applications, and authorized Medi-Cal to expedite enrollment using a new short-form application for Medicare providers and physicians with privileges at acute care hospitals. Unfortunately, the Governor vetoed the bill, saying it could create opportunities for fraud.
While CMA is pleased that the state has reduced the provider application backlog, the association will continue to advocate for increased efficiency in the Medi-Cal provider enrollment process.
Click here for more information.
Contact: Sandra Bressler, 415/882-5171 or sbressler@cmanet.org.
4. CMA’s 10th Annual Health Care Leadership Academy
Is April 13-15 in Monterey
CMA’s 10th Annual California Health Care Leadership Academy is April 13-15 at the Monterey Convention Center.
In a departure from recent academies, the 2007 conference, “California Health Forum 2007,” will address a variety of current health issues rather than focus on a single theme.
The preliminary agenda includes presentations on practice variations and quality of care, population diversity and its implications for health care, health information technology, access to care initiatives, hospital medical staff issues, emergency medical services and public health, and the California stem cell research initiative. Also new for 2007 will be a slate of workshops devoted to practice management issues.
Expanded social and networking activities will include a cocktail reception at the Monterey Bay Aquarium.
Stay tuned for more details.
Contact: Roger Purdy, 916/444-5532 or rpurdy@cmanet.org.
5. Learn How You Can Exchange Secure, HIPAA-Compliant
E-mail with Patients and Colleagues
MedePass, a CMA subsidiary, and Image-X have teamed up to allow physicians to exchange secure, HIPAA-compliant e-mail with patients and colleagues.
CMA MedMail ensures all youre-mail communications and attachments are fully encrypted and backed up. No change of e-mail address is required.
The service costs only $9.95 per month for CMA members ($16.95
for nonmembers).
Find out more by attending CMA’s free MedMail seminar, December 6 in Sacramento and San Francisco.
Click here for more information.
6. CMA Member Benefit of the Week: Pain Management CME on DVD
CMA and University of California-San Diego have collaborated on a unique case-based CME program on DVD that physicians can use to receive their state-mandated 12 hours of Category I CME for pain medicine and end-of-life care. Physicians have until December 31 to satisfy this requirement.
The DVD, “Pain Management: A Case-Based CME Program for Physicians,” provides specific information on the most common pain syndromes. It features several expert presenters who have also been participating in “Pain Management and End-of-Life Care in California’s Regulatory Environment,” CMA’s ongoing series of pain and end-of-life care symposia.
This program, including CME testing and credits, is $150 for members, $200 for nonmembers.
Click here for more information.
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No. 2072
