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New
Medi-Cal Provider Enrollment Rules Provide Relief to
ER and On-Call Docs
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. Contact: CMA Reimbursement Specialist Frank Navarro at 916/551-2046.
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