1. Complete CMA's Cost Survey and Enter to Win a Free iPAQ Pocket PC
Fill out CMA’s 2004 Cost Survey by July 15 and you’ll automatically be entered in a drawing to win a free iPAQ Pocket PC.

The survey, which can be completed online, is designed to gather data to help physicians and office managers evaluate and improve practice performance. The survey results will enable you to evaluate and manage practice expenses and accounts receivable and benchmark your costs against other practices with similar profiles.

Responses, which will be tabulated by an independent accounting firm, are confidential. CMA will not have access to individual physician surveys.

Participants will also receive a free copy of the survey report. CMA members
who do not complete the survey may purchase the report for $100.
(Nonmember price is $250.)

Click here to complete the survey.

Contact: Aileen Wetzel, 916/444-5532 or awetzel@cmanet.org.

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2. CMA Working with DHS to Address Problems
    with Medi-Cal Physician Enrollment

New Medi-Cal Provider Enrollment Rules
Provide Relief to Emergency and On-Call Physicians
The Department of Health Services (DHS) recently updated its Medi-Cal provider enrollment regulations to allow retroactive provider numbers for emergency and on-call physicians. The new regulations will provide significant relief for these physicians, many of whom have treated Medi-Cal patients without pay for many months while waiting for their provider applications to be approved.

CMA last month submitted comments to DHS on its proposed changes, and we are pleased to report that the final regulations incorporate many of CMA’s recommendations.

“The backlog of provider applications awaiting approval has been a constant source of complaint from many physicians who have experienced delays of many months and in some cases approaching a year,” wrote CMA Vice President of Economic Services Nileen Verbeten. “Physicians who provide emergency services-- hospital-based physicians or those who provide on call services to patients in emergencies-- do not have the luxury to wait on an approval by the department before they provide care to Medi-Cal recipients.”

Under the previous regulations, physicians experienced unfair financial hardship due to dealys in the application process. These physicians—who are required by law to provide emergency services to all patients—often had to write off monies due them for services provided to Medi-Cal patients because of the backlog in the approval process.

The new regulations require the effective date-of-enrollment for emergency and on-call Medi-Cal providers to be retroactive to the date the application package was received by DHS or, if requested by the physician, up to three months prior to the date of receipt.

Click here for more information.

Contact: CMA Reimbursement Specialist Frank Navarro at 916/551-2046.

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DHS Must Process Backlog of 2003
Medi-Cal Provider Applications by June 29
In addition, the Department of Health Services (DHS) is required by law to process by June 29 the Medi-Cal provider applications received by the department in 2003. The current application backlog goes as far back as August 2003.

This steps follows approval by the state legislature last year of bill SB 857, which is designed to improve the Medi-Cal provider application process and reduce fraud. Under this measure, physicians who submitted provider enrollment applications in 2003 can expect to be notified by mail next week of the status of their application.

DHS has offered to work closely with CMA to help individual physicians through the provider application process. Physicians who need assistance should call CMA Reimbursement Specialist Frank Navarro at 916/551-2046.

Click here for more information.

Contact: CMA Reimbursement Specialist Frank Navarro at 916/551-2046.

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3. CMA Objects to Misleading Information on
    Balance Billing in Blue Cross Newsletter
A few months ago, CMA sent a letter to Blue Cross of California, objecting
to misleading information on balance billing published in its January issue
of PPO Network News.

The newsletter stated that “except for applicable copayments and deductibles, a physician shall not invoice or balance bill a Blue Cross member for the difference between a physician’s billed charges and the reimbursement paid by Blue Cross for any covered benefit.” CMA’s letter pointed out that while California law does prohibit contracting physicians from balance billing patients for covered services, there is no restriction on balance billing by noncontracting physicians. The letter asked Blue Cross to issue a correction.

Blue Cross refused. In a letter to CMA, Blue Cross Vice President and Corporate Medical Director Jeff Kamil, M.D., said the health plan’s newsletter targets and is sent only to PPO providers listed in the plan’s contracting provider database and therefore “Blue Cross does not believe any clarification is necessary or appropriate.”

CMA’s letter had pointed out, however, that not only did noncontracting physicians receive the newsletter, but other content in that same newsletter was clearly intended for noncontracting physicians. “The fact that the newsletter includes a lengthy description of how noncontracting physicians can access Blue Cross’s dispute mechanism leads CMA to the conclusion that contracting and noncontracting providers were the intended recipients of this correspondence,” wrote CMA Past President Ronald Bangasser, M.D., in CMA’s letter.

To learn the real story on balance billing by noncontracting physicians go to CMA ON-CALL document #0130, “Noncontracting Physicians/Implied Contracts.” ON-CALL documents are free to members at the members-only website. Nonmembers can purchase ON-CALL documents for $2 a page from the CMA Bookstore.

For more information, including a copy of CMA's letter, click here.

Contact: Aileen Wetzel, 916/444-5532 or awetzel@cmanet.org.

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4. Will Your Cash Flow Be Interrupted Next Month?
Is your practice transmitting HIPAA-compliant electronic claims? Your cash flow is in jeopardy if you are not certain that your practice has successfully made the transition to a HIPAA-compliant billing system.

After July 1, Medicare payments will be delayed for two weeks if they aren’t submitted in compliance with HIPAA’s electronic transactions rule. Physicians will be penalized for noncompliant claims, even if a third-party biller is at fault.

In October, Medicare recognized the low level of HIPAA-readiness among physicians and implemented a contingency plan under which carriers would accept both the new formats and the old electronic formats. This “grace period” will soon be over. The agency called the two-week payment delay “a measured step toward ending the contingency plan completely.”

There are still some billing services, clearinghouses, and practice management software vendors that are not yet able to submit compliant electronic claims. If you are concerned about your practice’s ability to submit HIPAA-compliant claims, consider using Infinedi, the CMA-sponsored clearinghouse. CMA has confirmed with NHIC (California’s Medicare carrier) that Infinedi is successfully clearing Medicare claims. Infinedi reports to CMA that it files daily batches with close to a 100 percent acceptance rate.

Physicians can choose Infinedi’s flat-rate monthly service, which permits unlimited electronic claim filing, or opt for a per-transaction payment plan.
CMA members receive a discount of 8 to 12 percent.

Enrollment is risk-free. If Infinedi is unable to convert your existing claims
into the new HIPAA formats, the one-time $175 enrollment fee is refunded.
(The enrollment fee for nonmembers is $200.)

For more information on how to minimize claim delays or denials, click here.

Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.

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5. Reminder: Geriatrics CME Requirements
To help meet the needs of California’s aging population, the state legislature in 2000 passed the Geriatric Medical Education Training Act, which established new geriatric medicine CME requirements for physicians. The law requires general internists and family practitioners with a significant number of senior patients (25 percent of their patient population older than 65) to complete at least 20 percent of their mandatory CME hours in the field of geriatric medicine. All other physicians are encouraged to take at least one CME course in geriatric medicine.

Physicians must keep detailed records—including course title, dates of attendance, number of credit hours received, and sponsoring/accrediting agency—for all mandatory CME hours completed, including those that fulfill the geriatric medicine requirement. However, neither the law nor the regulations that govern the law’s implementation define specifically what subjects satisfy the geriatric medicine CME requirement, so it is up to physicians to determine what course work will qualify. In addition to geriatric medicine and geriatric pharmacology, other applicable subjects might include internal medicine, disease management, or any subject that involves treatment of the elderly.

Physicians are advised to document on their CME certificates the number of hours that are attributable to geriatric training and retain course syllabi and course content descriptions. Such documentation may be needed in the case of a medical board audit. One percent of physicians submitting license renewal applications are audited each year by the medical board’s licensing division for CME compliance.

CMA’s Institute for Medical Quality (IMQ) offers a CME tracking service, which certifies physicians’ CME activity for credentialing purposes to the medical board, as well as to hospitals, health plans, specialty societies, and others. IMQ also handles all medical board audits for physicians who subscribe to this service.

For more information, click here.

Contact: CMA’s legal information line, 415/-882-5144 or legalinfo@cmanet.org.

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6. ‘Retired’ Physicians Cannot Practice After July 1
As reported in a previous issue of CMA Alert, physicians with “retired” licenses will no longer be allowed to practice medicine, even in a volunteer capacity, after July 1. Retired physicians who wish to volunteer their services will need to apply for the new “volunteer” license. Volunteer licenses will still be exempt from licensing fees. All physicians who practice for pay, no matter what the amount, will be required to maintain an “active” license and pay licensing fees.

For more information on these new rules, click here.

Contact: Sandra Bressler, 415/882-5107 or sbressler@cmanet.org.

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For previous editions of CMA Alert, visit our news archives.

Prepared by the CMA Communication Center
Katherine Gallia, Editor,
916/551-2074, kgallia@cmanet.org
Noel Tatlonghari, Publishing Assistant,
916/551-2072, ntatlonghari@cmanet.org

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