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1. Medicare Participation Options for
Physicians 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. 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 (although Medicare specifies that these contracts contain certain terms). Once you opt out, you cannot opt back in for two years. Physicians can change their Medicare status between participating and non-participating only during Medicare’s annual open enrollment period. Although that period is normally, November 15 to December 31, it is being extended this year until at least 30 days after the 2003 fee schedule is published, now expected to occur in early January. Once made, Medicare participation and nonparticipation decisions are binding for the entire year. Physicians who already alerted their carrier that they will become nonparticipating physicians for 2003 may have an opportunity to change their status back to participating if Congress acts to increase the payment rates. To become a nonparticipating provider, physicians must send a letter that states that they wish to become a nonparticipating provider and that includes their name and provider number, the date they want to begin as a nonparticipating provider, and their signature. Physicians do not need to indicate why they want to change their status. This letter must be submitted to Medicare by fax or mail. For more information on your participation options, including Medicare addresses and fax numbers, click here.
2. DMHC Must Protect
Physician Groups' Financial Data CMA brought a lawsuit earlier this year to invalidate DMHC regulations that mandated public disclosure of physician groups’ confidential financial information. CMA argued that the regulations would give health plans an unfair advantage when negotiating contracts with medical groups, increasing the likelihood of physician group bankruptcies and the resulting disruptions of patient care. The judge ruled in favor of CMA, stating that DMHC never addressed whether financial data disclosure would adversely affect the contract negotiations. CMA has since learned that DMHC is developing new regulations that will again require full public disclosure of risk-bearing medical groups’ financial statements. During the meeting with Mr. Zingale, the CMA representatives emphasized that the 1999 financial solvency legislation was not a disclosure statute but rather a framework for DMHC to collect financial information that would help it address the solvency problems plaguing California’s physician groups. They reiterated that disclosure of proprietary financial data would give health plans an unfair advantage in contract negotiations. CMA prepared and presented Mr. Zingale with a proposed compromise to full public disclosure. Click here to read the details of CMA’s proposal. Contact: Aileen Wetzel, 916/444-5532 or awetzel@cmanet.org.
3.
Judges Ruling Slows Cigna's Attempt to Sidestep
CMA's Class Action Suit CMA and the medical societies from 18 other states publicly condemned the proposed settlement last week, calling it "woefully inadequate." The lawyers for the plaintiffs in the case, brought on civil racketeering charges, petitioned Judge Moreno last week to block the Cigna settlement, saying it was no more than an attempt to circumvent the jurisdiction of the court where the class-action suit is being heard. "Cigna’s action in this situation is a perfect example of the dishonorable conduct physicians have had to endure over the past two decades," says Archie Lamb, co-lead counsel for the doctors. In a strongly worded ruling, Judge Moreno wrote, "This court is well aware of the strong public interest favoring settlements. However, it cannot turn a blind eye to the underhanded maneuvers Cigna took to obtain this settlement agreement. Cigna snookered both this court and Judge Murphy in Illinois in an obvious attempt to avoid this court’s jurisdiction." Click here to download a copy of Judge Moreno’s ruling. Contact: Karen Nikos, 213/630-1139 or knikos@cmanet.org.
4.
'Nickel a Drink' Legislation Would Fund Trauma and Emergency
System "In light of our $21 billion budget deficit, California taxpayers cannot continue to bear the financial burden for an industry’s product that is responsible for substantial health care costs to the public and the state," Senator Romero said during a press conference at White Memorial Medical Center in Los Angeles. "The alcohol industry must assume greater responsibility for a product that, by its design, debilitates an individual’s physical and mental capacities." The legislation comes on the heels of Governor Davis’s announcement that he has rescinded a one-time appropriation of $25 million to assist struggling trauma centers in California and has rolled back Medi-Cal reimbursement to 1985 levels. The governor’s $2 billion in proposed cuts from health care programs and services are going to have a devastating impact on California’s already struggling emergency rooms and trauma centers, Senator Romero said, adding that counties will be hard-pressed to find the funding necessary to help keep California’s health care delivery system afloat. Contact: Karen Nikos, 213/630-1139 or knikos@cmanet.org.
5.
CDC Broadcast to Detail Smallpox Vaccinations for First
Responders
6. CaliforniaPhysician Corps Loan Repayment
Program Begins Jan. 1 The MBC anticipates having applica-tions available on January 1, with the selection process beginning in April. The first series of program participants will be announced in June. To receive an application, e-mail MBC at mdloan@medbd.ca.gov and request to be added to its CPC distribution list. Contact: Bryce Docherty, 916/444-5532 or bdocherty@cmanet.org. BACK TO TOP
7. Budget
Update Contact: Heather Campbell, 916/444-5532 or hcampbell@cmanet.org.
8. Medical
Students/Residents/Fellows: Call for 2003 CMA Committee Nominations
For more information, including a list of the available seats and nomination/application forms, click here. The deadline for nominations is December 28. Contact: Lynn Godward, 916/551-2078 or lgodward@cmanet.org.
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