1. Congress Overrides Presidential Veto;
Medicare Cuts Reversed for 2008- 2009
In a huge victory for CMA and all of organized medicine, Congress last week rebuffed a White House attempt to protect overpaid for-profit Medicare HMOs at the expense of physicians and patients and overturned President Bush’s veto of the bill (HR 6331) to stop the 15 percent Medicare physician payments cuts. The bill becomes law immediately and CMS will retroactively process most claims based on the pre-July 1, 2008 rates. (For more information, see “Medicare Will Automatically Reprocess Physician Claims Paid at Lower Rate,” below.)
CMA extends its heartiest thanks to the physicians of California who met with their Representatives and made phone calls to their offices. This victory was won through the one-on-one grassroots lobbying of physicians and their patients.
The House voted to override the veto by a vote of 383-41 (with 12 not voting). All California Representatives voted yes except Campbell, Doolittle, and Royce. Representatives Herger, Nunes, Radanovich, and Lungren originally voted no on HR 6331 but voted yes on the veto override. The Senate followed suit by overriding the veto on a vote of 70-26. Both Senators Feinstein and Boxer voted yes.
Please be sure to call your Representatives and thank them for their Yes vote. It is extremely important that we follow-up with our strong appreciation. Use the AMA Grassroots Hotline (800/833-6354). Enter your zip code and it will automatically connect you to your Representative.
CMA will now turn its focus to the 2009 campaign to enact long-term reform of the physician payment system. Last year, CMA led the nation by unveiling a long-term overhaul of the sustainable growth rate (SGR) physician payment formula and we will be aggressively pursuing its enactment next year.
Click here for more information.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
2. Medicare Will Automatically Reprocess
Physician Claims Paid at Lower Rate
As you know, the Centers for Medicare & Medicaid Services (CMS) delayed Medicare claim processing to give Congress more time to come to an agreement on legislation to stop the 10.6 percent physician payment cut. However, because federal law does not allow payments to be held for more than 10 days, carriers were required to begin processing those held claims on July 15 and some physicians will receive payments at the lower rates. CMS has instructed carriers to automatically reprocess these claims as soon as their systems have been updated with the pre-July 1 rates.
NHIC, California’s Medicare carrier, has indicated that it will implement the new fee schedule in 10 business days or less. Claims with dates of service of July 1 and later that were billed at the pre-July 1 rates will be automatically reprocessed. Physicians who submitted claims at the lower rates will need to contact NHIC to request an adjustment.
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Contact: Michele Kelly, 888/401-5911 or mkelly@cmanet.org.
3. CMA Seeking Clarification on Blue Shield Contract Amendment
CMA has received a number of calls from physicians concerned about a new Blue Shield contract amendment. The amendment, according to the notice, was issued in response to the California Department of Insurance’s new health care access regulations.
CMA’s review of the amendment has determined that the language in section 1B goes beyond the regulatory parameters. CMA is seeking to ensure that the language is in line with California’s nondiscrimination laws and that physicians are not required to provide care that is not appropriate given their level of skill and specialty. CMA is concerned how this language may be interpreted and is working collaboratively with Blue Shield to minimize the adverse impact the language could have on physicians’ ability to practice medicine. Blue Shield has been responsive to physicians’ concerns and has committed to work with CMA to provide clarification shortly.
Physicians have also reported receiving a similar addendum from Health Net. CMA is reviewing the document and will provide additional information after the review is complete.
In addition to the specific questions raised by these amendments, CMA has concerns about the regulations themselves and has taken several steps to address both the underlying regulations and implementation efforts by insurers. CMA will be meeting with DOI soon to discuss these issues. Stay tuned for more information.
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Contact: CMA’s Reimbursement Helpline 888/401-5911 or jblack@cmanet.org.
4. United to Withdraw 3,000 Overpayment Requests
United Healthcare, at CMA’s urging, has agreed to withdraw nearly 3,000 overpayment requests recently sent to physicians. Beginning in April 2008, CMA began to receive complaints from physicians regarding notices they had received from Johnson & Rountree, a recovery company hired by United Healthcare to recoup alleged overpayments made to physicians. In some circumstance, the notice erroneously identified the patients as Secure Horizons enrollees when in fact they were PacifiCare Signature Options PPO patients.
The examples provided by physicians included requests for refunds for dates of service in 2004, 2005, and 2006. California law clearly states that insurer requests for refunds must be made within 365 days of the date of payment on the overpaid claim.
To further confuse the issue, the letters from Johnson & Rountree were labeled “second request” and incorrectly stated that Johnson & Rountree had previously attempted to contact the physician regarding the overpayment.
CMA’s Center for Economic Services intervened to resolve the individual physician complaints. In each case, United acknowledged that the refund requests were sent in error. CMA continued to pressure United to investigate this issue and to fix any underlying systemic issues. Ultimately, United determined that nearly 3,000 erroneous overpayment requests were made for claims with dates of service from January 2004 to June 2007. Efforts to recover these alleged overpayments have been canceled and affected physicians will soon receive closure notices from PacifiCare.
CMA has also brought this issue to the attention of the Department of Insurance and urged them to investigate.
Click here for more information.
Contact: Aileen E. Wetzel, 916/551-2037 or awetzel@cmanet.org.
5. Blue Cross Files Medi-Cal Managed Care
Termination Notices in Eight Counties
CMA recently learned that Blue Cross has filed Medi-Cal Managed Care termination notices in eight California counties. These notices do not necessarily mean that Blue Cross will terminate, but rather that they have the option to terminate. (Last year they filed a similar notice in San Diego, but ultimately decided not to terminate when the state gave them an 8.3 percent rate increase.)
All of the affected counties — Alameda, Contra Costa, San Francisco, Santa Clara, Fresno, San Joaquin, Stanislaus, and Tulare — are two-plan model counties. If Blue Cross does choose to terminate, beneficiaries in these counties will be given a choice of moving into their counties’ other Medi-Cal plans or into fee for service. The California Department of Health Services has not yet decided which will be the default.
If Blue Cross does terminate, the effective date would be September 30 and beneficiaries would be notified in early September.
Contact: David Ford, 916/444-5532 or dford@cmanet.org.
6. Deadline to Submit Resolutions to
CMA’s 2008 House of Delegates Is 8/5
The most effective way an individual member can influence CMA’s policies and activities is to submit resolutions to the House of Delegates, the association’s legislative body. The delegates meet annually to debate and act on resolutions and reports dealing with myriad medical practice, public health, and CMA governance issues.
Before authoring a resolution, physicians are strongly encouraged to review CMA’s Policy Compendium (available at CMA’s members-only website), to determine whether policy already exists on a particular topic.
Resolutions must be submitted by e-mail to resolutions@cmanet.org by August 5. For more information on submitting a resolution, contact your county medical society.
Detailed instructions (including required format, allowed subject matter, and submission rules), are available at CMA’s HOD website.
Contact: Roger Purdy, 916/444-5532 or rpurdy@cmanet.org.
7. Help Make the CMA Foundation Annual Dinner a Success
The CMA Foundation’s 12th Annual President’s Dinner and Awards Gala is October 5 in Sacramento, during CMA’s annual meeting. Proceeds will support CMA Foundation, a charitable organization that links physicians and their communities to raise awareness about important public health issues.
Even if you will not be able attend, please consider placing an ad in the dinner program. The foundation is a nonprofit charitable organization, and all ads are tax deductible.
Tickets will go on sale soon. Click here for more information.
Contact: Liz Burdick, 916/779-6639 or lburdick@thecmafoundation.org.
8. Member Benefit of the Week: 30-50% off Epocrates
CMA members receive 30 percent off one-year subscriptions and 35 percent off two-year subscriptions to any Epocrates product. Students and residents receive 50 percent off all Epocrates products. Group discounts are also available.
Epocrates provides physicians with point-of-care access (via PDA/smartphone, or online) to up-to-date information on drugs, diseases, and diagnostics. Epocrates allows physicians to make better clinical decisions, saving time and improving quality of care. To receive your discount, log in to the members-only website and follow the links to the Epocrates website.
Click here for more information on your membership benefits.
Contact: CMA’s Member Helpline, 800/786-4CMA or info@cmanet.org.
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