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1. Physicians Must Register NPIs with Medi-Cal by March 1
to Prevent Cash Flow Disruption
Physicians must register their national provider identifiers (NPIs) with Medi-Cal by March 1 to ensure that their payments are not interrupted when Medi-Cal transitions from its current provider numbering system to the NPI system on May 23.
Providers can register their NPIs online at the Medi-Cal website, http://www.medi-cal.ca.gov, or by mail. To request a paper NPI registration form, call 800/541-5555 and select option 16, followed by option 18.
If you haven’t already applied for your NPI, you should do so immediately. 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.
Click here for more information.
Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.
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2. Workers’ Comp to Increase E&M Reimbursement
The Division of Workers’ Compensation (DWC) on Friday announced plans to increase reimbursement for evaluation and management (E&M) procedures effective February 15. The proposed changes would increase the reimbursement for E&M codes (99201 - 99215) by 0.4 to 35.8 percent. The increases will bring workers’ comp physician fees into line with Medicare’s 2006 rates for these services and were calculated based on a weighted average of Medicare’s rates for the nine California regions.
Although DWC is planning a more detailed review of its entire physician fee schedule, the department determined that the E&M increases are necessary now so that physicians are more fairly compensated for the additional work created by new reporting requirements and utilization review processes.
"This is a step in the right direction and CMA appreciates the department's work on this issue," says Frank Navarro, a reimbursement specialist in CMA's Center for Economic Services. "CMA will, however, continue to advocate for additional increases so that physicians are appropriately reimbursed for providing care to injured workers in California."
Formal notice of this rulemaking will be published in the California Notice Register on December 29. A public hearing on the proposed regulations has been scheduled for 10 a.m. on January 24.
Click here for more information.
Contact: Reimbursement Help Line, 888/401-5911.
3. Deadline to Opt-Out of Blue Cross Workers’ Comp Networks Is January 21
Physicians should be aware that even though Blue Cross has an “all products” clause in its Prudent Buyer contract, the plan agreed as part of its RICO settlement with CMA that it would not require physicians to participate in its Workers’ Compensation networks. Physicians who do not wish to participate in these networks can opt out by notifying Blue Cross in writing by January 21. Physicians who opt out will still be free to negotiate separate contracts with Blue Cross to provide workers’ comp services.
Even though providers are required to give notice by January 21, 2007, that election will not become effective until January 21, 2008. Until then, all Prudent Buyer providers will continue to be obligated by their Prudent Buyer contracts to treat Blue Cross patients with work-related injuries and illnesses.
This opt-out right does not apply to physicians or physician groups that have any contract other than the standard Prudent Buyer contract, or an addendum to the standard contract that is specifically related to the provision of medical services for work-related injuries and illnesses.
Newly contracting physicians and groups will be given the opportunity to opt-out of Blue Cross’s Workers’ Comp networks at the time the contract is executed.
Blue Cross also confirmed in the RICO settlement that physicians with Prudent Buyer contracts who participate in other workers’ comp networks (MPN) can provide services to injured workers under the other MPN contracts and are not required to refer those patients to Blue Cross participating physicians.
Click here for more information.
Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.
4. CMA Trustee to Receive AMA Pride in the Profession Award
San Bernardino surgeon Appannagari “Dev” Gnanadev, M.D., is the 2007 recipient of AMA Foundation’s Pride in the Profession Award for his extraordinary efforts in the medical profession. The award is given to “recognize the contributions of exemplary physicians who work in underserved areas or sacrifice their time for volunteer or public service efforts.”
Dr. Gnanadev has dedicated over 23 years to the underserved. In the mid to late 1990s, his grassroots efforts helped replace a crumbling county hospital with a state-of-the-art 373-bed hospital for the people of San Bernardino. In 1996 he developed a free tattoo-removal program for former gang members and in 2003 he helped create the Inland Empire Burn Institute.
Dr. Gnanadev, a CMA trustee, will be honored at the AMA Foundation’s Excellence in Medicine Awards Banquet on February 12 in Washington, D.C.
Click here for more information.
Contact: Ginnie Yee, 415/882-5170 or gyee@cmanet.org.
5. Support California’s Physician Loan Repayment Program
Physicians closing out their accounts for the year may want to consider a tax-deductible donation to the Steven M. Thompson Loan Repayment Program. By supporting this program you will help improve access to care in underserved communities in California.
Physicians selected for the program receive medical school loan repayment grants of up to $105,000 in exchange for a three-year commitment to serve in a medically underserved area of the state. The program was created under a CMA-sponsored law in 2002.
To qualify for a tax deduction on your 2006 return, your donation must be post-marked by December 31. (Donation forms are available here.)
The program is open to newly licensed physicians who commit to serve a minimum of three years in the approved geographic areas, which include official “health professionals shortage areas” (HPSA) and federally qualified “health center look-alikes,” community health centers, migrant health centers, and public housing centers. Last year, loan recipients worked in a variety of underserved areas throughout the state, from community clinics in downtown Los Angeles to farmworker health clinics in the Central Valley and rural health facilities in Northern California.
Please consider supporting this worthy program with a tax-deductible year-end donation. You will also have the opportunity to support the program with a voluntary donation during the medical license renewal process.
Click here for more information.
Contact: Susan Bassett, 916/444-5532 or sbassett@cmanet.org.
6. Podcast: CMA CEO Talks About His Vision for the Future of Organized Medicine
Click here to listen to the California Medical Association’s new Chief Executive Officer speak to the association’s Council on Legislation, December 2 in San Diego.
7. Member Benefit of the Week: Online Practice Management
CMA has partnered with Athenahealth—a leading revenue management company—to help physicians get paid quickly, correctly, and with minimal hassle. CMA members receive 6 percent off Athenahealth’s unique web-based practice management services, which include eligibility verification, claims submission, and insurance collection. (Group practices are eligible for the member discount if all of their physicians are CMA members.)
Athenahealth has even developed a “Prompt Payment Robocop,” to help physicians take full advantage of California’s prompt-payment law. The system monitors every claim, calculates interest when a claim has not been paid on time, and flags the unpaid claim for follow-up.
On average, practices that use Athenahealth’s revenue cycle management service get paid 30 percent faster and see a 5 to 10 percent increase in collections.
Click here for more information on CMA member benefits.
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No. 2075
