CMA Practice Resources (CPR) is a free monthly e-bulletin from the California Medical Association’s practice management experts that focuses on critical payor and health care industry changes and how they directly impact the business of a physician practice. Each issue includes tips on reimbursement and contracting related issues along with information on the latest practice management news.
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In this issue:
- $12 million reasons to be a CMA member
- Noridian replaces eligibility and claim status web portal
- New 2016 drug testing codes impacting payor payment policies
- Physicians: Get ready for new provider directory accuracy law!
- Noridian to present in-person Medicare seminars in Glendale and Sacramento
- Reminder: Deadline to register for CURES is July 1, 2016
- Earn up to 13.5 CME at 2016 Western Health Care Leadership Academy in San Francisco
- Anthem reports claims payment errors in March
- CMA hosting webinar on how to file IMR and other complaints with DMHC
- The Coding Corner: Coding to support an injection procedure with a same-day E/M service
The California Medical Association (CMA) Center for Economic Services (CES) has now recouped $12 million from payors on behalf of CMA member physicians. These monies, recovered over the last six years, represent actual physician reimbursements that would have likely gone unpaid without the intervention of the CES team.
Founded in 1999, CES provides CMA members with one-on-one assistance for billing, contracting and payment problems. With more than 125 years of combined medical practice operations experience, CES staff helps members with issues ranging from underpayment or denials by payors to assisting with contract analysis during negotiations. Assistance from CES also includes education on how to increase practice efficiency and direct intervention with payors or regulators. This support is reserved exclusively for CMA members.
In 2016, the CES team is continuing its support of local office manager forums and county medical society outreach programs by conducting in-person educational seminars throughout the state. Seminar titles include “Contract Renegotiations: How to Get Past "No" with a Payor,” “Getting Paid: A Physicians Guide to Taking Charge of Accounts Receivable,” and “CMA Presents Medicare Updates.” If you are interested in attending one of these seminars, contact your local county medical society to request they host one.
CES also provides physicians and their staff with access to the invaluable newsletter you are reading now – CMA Practice Resources (CPR). CPR is a free monthly bulletin from CMA’s practice management experts that focuses on critical payor and health industry changes and how they directly impact the business of a physician practice. Each issue includes tips on reimbursement and contracting related issues along with information on the latest practice management news.
If there are others in your practice who would benefit from a free subscription, they can sign up on the CMA website at www.cmanet.org/newsletters.
For practice management tools and other online assistance, visit www.cmanet.org/ces.
Noridian, California's Medicare Contractor, recently replaced its Endeavor web portal with the new Noridian Medicare Portal. Effective May 1, 2016, the Endeavor portal has been taken offline; providers who attempt to access the Endeavor portal will be prompted to register for the new Noridian Medicare Portal for continued access to Medicare eligibility, claim status and remittance advices.
Providers registering for the new Medicare Portal will be required to identify their access as one of two new roles, "Administrator" or "End User."
To speed up the registration process, practices should first:
- Identify a Provider Administrator. The Provider Administrator must be registered before any associated End Users may register.
- Ensure your Electronic Data Interchange (EDI) Support Services (EDISS) Connect account is accurate. An EDI-issued Trading Partner/Submitter ID will be required (Part A and B only). The Trading Partner ID is referring to the Provider Submitter ID assigned to the billing NPI when registering for an electronic transaction with EDISS. Being registered for electronic transactions is required in order to access the Noridian Medicare Portal.
- Contact Interactive Voice Response to retrieve a check number and amount. Check information may not be the same as it appears on the RA.
As part of the Calendar Year 2016 Clinical Laboratory Fee Schedule (CLFS) Final Determinations issued by the Centers for Medicare and Medicaid Services (CMS), drug testing codes G6030-G6058 were eliminated and replaced with new HCPCS “G” codes, which now differentiate between presumptive (used to identify possible use or non-use of a drug or drug class) drug testing and definitive (qualitative or quantitative methods that identify possible drug use or non-use and identify the specific drugs and associated metabolites) drug testing.
The following three new HCPCS “G” codes have been created for presumptive testing; only one of these codes may be billed per day.
Drug tests(s), presumptive, any number of drug classes; any number of devices or procedures, (eg, immunoassay) capable of being read by direct optical observation only (eg, dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service
Drug tests(s), presumptive, any number of drug classes; any number of devices or procedures, (eg, immunoassay) read by instrument-assisted direct optical observation (eg, dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service.
Drug tests(s), presumptive, any number of drug classes; any number of devices or procedures by instrumented chemistry analyzers (eg, immunoassay, enzyme assay, TOF, MALDI, LDTD, DESI, DART, GHPC, GC mass spectrometry), includes sample validation when performed, per date of service.
The following four new HCPCS “G” codes have been created for definitive testing; only one of these codes may be billed per day.
Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (eg, IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)); qualitative or quantitative, all sources, includes specimen validity testing, per day, 1-7 drug class(es), including metabolite(s) if performed.
Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (eg, IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)); qualitative or quantitative, all sources, includes specimen validity testing, per day, 8-14 drug class(es), including metabolite(s) if performed.
Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (eg, IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)); qualitative or quantitative, all sources, includes specimen validity testing, per day, 15-21 drug class(es), including metabolite(s) if performed.)
Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (eg, IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)); qualitative or quantitative, all sources, includes specimen validity testing, per day, 22 or more drug class(es), including metabolite(s) if performed.
Medicare also continues its non-recognition of CPT codes (80300-80377) for drug testing. Recently, a number of commercial health plans, including Aetna, Anthem Blue Cross and Health Net, have changed their reimbursement policies to be reflective of Medicare's policies. Other commercial payors continue to review the CMS policy changes to determine if any modifications of their payment policies are warranted.
On July 1, 2016, a new law will take effect that requires plans to ensure that their physician directories are accurate and up-to-date. The law (SB 137) includes multiple components aimed at providing patients with more accurate and complete information to identify which providers are in their payors' networks.
The new law also requires physicians to do their part in keeping their information up-to-date. Specifically, the law requires providers to notify payors within five business days if they are no longer accepting new patients or, alternatively, if they were previously not accepting new patients and are now open to new patients.
If a provider is not accepting new patients and is contacted by a new patient based on information found in the payor's provider directory, the new law requires the provider to direct the patient to the plan/insurer to find a provider, or to the regulator to report a directory inaccuracy.
Physicians are also required under the new law to respond to plan and insurer notifications regarding the accuracy of their provider directory information, either by confirming the information is correct or by updating demographic information as appropriate. Failure to do so may result in a delay in payment and removal from the provider directory. Additionally, a payor may terminate a contract with a provider for a pattern or repeated failure to update the required information in the directories.
Some payors have already notified physicians of the new requirements via contract amendment and/or provider manual updates. Specifically, Anthem sent out an amendment to contracted providers on March 30, while Blue Shield of California sent its notice and amendment out on April 22.
Practices are encouraged to review the amendments and/or provider manual updates closely to ensure they can comply with the requirements. When contract changes are made purely to comply with a change in the law, plans are required to notify practices before the change takes effect. However, if there are other changes included in the amendment that are considered “material changes,” payors will be required to provide practices with 45 business days’ advance notice.
While the majority of the changes noted in the amendments will likely be regulatory in nature, practices should review the amendments closely to identify any nuances between payors. For example, SB 137 requires providers to respond to requests from payors to confirm/update provider directory information within 30 business days. However, Anthem is requiring responses within 15 business days. Additionally, while the legislation states a payor may terminate a physician or physician group contract for repeated failure to update provider directory information, Section 9 of the Anthem amendment is more specific and states practices may be terminated if they fail to respond more than twice during the term of the contract.
It will be imperative that staff responsible for phones, email and faxes are aware of the requirements and are prepared for the inquiries. It is also important that practices respond in a timely manner and are accurate in the responses given.
The California Medical Association (CMA) recently hosted a webinar, “Ensure Your Practice is Ready and Won’t Be Penalized Under the New Provider Directory Accuracy Law," that gives an overview on the new law and a pilot program launched by America’s Health Insurance Plan. The pilot was designed to ensure physician directories are more accurate and payors are compliant with SB 137 requirements, while reducing the administrative burden for practices. This webinar is now available on demand in CMA's online resource library and is free to CMA members.
Contact: CMA's reimbursement help line, (888) 401-5911 or firstname.lastname@example.org.
Noridian, the Medicare administrative contractor for California, has announced several half-day, in-person seminars around the state this spring. The presentation, titled “Getting Paid and Keeping It,” will include information on the following:
- Successful documentation
- Medical review
- Top appeals, billing and claim review errors
Sessions are designed to provide education on processes, tools and best practices. The cost for the half-day session is $20.
Sessions will be offered in the afternoon from 1-4 p.m. Two continuing education units have been approved for the program. Dates and locations are:
- May 5, Glendale at the Embassy Suites - Hilton
- May 7, Sacramento at the Lions Gate Hotel
For more details and registration, click here.
Under California law, all individuals practicing in California who possess both a state regulatory board license authorized to prescribe, dispense, furnish or order controlled substances and a Drug Enforcement Administration Controlled Substance Registration Certificate (DEA Certificate) must register to use the Controlled Substance Utilization Review and Evaluation System (CURES) by July 1, 2016.
The California Medical Association (CMA) has compiled a list of educational materials to familiarize physicians with the registration process and key features of the newly upgraded system, CURES 2.0. These resources are available at www.cmanet.org/cures.
Physicians who experience problems with the new system should contact the Department of Justice (DOJ) CURES Help Desk at (916) 227-3843 or email@example.com. Providers are also encouraged to report these technical issues to CMA's member service center at (800) 786-4262 or firstname.lastname@example.org.
CMA recently cohosted a webinar with DOJ to help physicians navigate the CURES 2.0 registration process. The presentation is now available on demand in CMA's online resource library and is free to all interested parties. The webinar, “CURES 2.0: Navigating the State’s New Prescription Drug Monitoring Database,” provides an overview of key user features of the updated system and tips on how to avoid technical issues.
Attendees at this year’s Western Health Care Leadership Academy, taking place May 13-15 in at the Hilton San Francisco Union Square, now have the chance to receive up to 13.5 continuing medical education (CME) credits!
This year’s event has a dynamic lineup of keynote speakers, including Atul Gawande, M.D., MPH, a MacArthur “Genius” Fellowship winner, a New Yorker columnist and an author; entertainer, internist and founder of Turntable Health, ZDoggMD (also known as Zubin Damania, M.D.); Bennet Omalu, M.D., MBA, MPH, the doctor who identified chronic brain damage as a major factor in the deaths of NFL players; and veteran political strategists Karl Rove and Donna Brazile.
Also new this year are five educational tracks that will provide attendees with a customized conference experience that is most relevant to their unique circumstances. Attendees can follow one track, or mix and match breakout sessions for a personalized education experience. This year's tracks include:
- A: Running Your Practice
- B: Future Trends and Health Care Innovation
- C: Organizational Leadership Principles
- D: Improving Quality of Patient Care
- E: Physician Leadership
With less than two weeks until Leadership Academy, time is running out and spots are filling up! For more information or to register, visit www.westernleadershipacademy.com.
The California Medical Association/Institute for Medical Quality (CMA/IMQ) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The California Medical Association/Institute for Medical Quality designates this live program for a maximum of 13.5 AMA PRA Category 1 creditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
This credit may also be applied to the CMA Certification in Continuing Medical Education.
Anthem Blue Cross recently announced that a software upgrade the weekend of March 19, 2016, resulted in a zero allowance for some provider claims. According to Anthem, approximately 130,000 BlueCard claims were affected. The error was resolved on Thursday, March 24.
The California Medical Association (CMA) was made aware of this problem by calls from members to our reimbursement help line. Anthem advised CMA that all impacted claims will automatically be reprocessed within 90-120 days, and that physicians do not need to resubmit claims or file appeals. Interest and penalties will automatically be applied to those claims where required by state law. CMA was advised that the insurer is reprocessing the claims on a priority basis.
The California Department of Managed Health Care (DMHC), the regulatory agency that oversees 122 health plans, will conduct a webinar on June 22, 2016, providing an overview of the department with a focus on the DMHC Help Center.
DMHC Deputy Director of Health Policy and Stakeholder Relations Mary Watanabe will discuss the DMHC Independent Medical Review (IMR) and complaint processes, including the importance of these processes in the policy, legislative and regulatory arenas and will provide information on how to submit the IMR/complaint form to the DMHC Help Center. Tips and best practices for assisting patients with access to care, billing issues including denials of care, and overview of the provider complaint unit will all be provided.
To register for the June 22 webinar, click here.
CPR’s “Coding Corner” focuses on coding, compliance and documentation issues relating specifically to physician billing. This month’s tip comes from Oby Egbunikea, Manager of Professional Coding at Lahey Hospital and Medical Center, and G. John Verhovshek, the managing editor for AAPC, a training and credentialing association for the business side of health care.
Under both CPT® and Centers for Medicare and Medicaid Services (CMS) guidelines, you may report an evaluation and management (E/M) service in addition to a minor procedure (such as an injection), only if:
- Documentation substantiates the medical necessity for, and performance, of a significant, separately-identifiable E/M service, and;
- You report the appropriate E/M service code with modifier 25 Significant, separately identifiable evaluation and management service by the same physician or other qualified healthcare provider on the same day of the procedure or other service appended.
Not every E/M is separate
All CPT® procedure codes include an E/M component: a brief patient history and physical, for instance, are inherent to any procedure. In practical terms, this means you should not report a separate E/M service on the same date as an injection (or other minor service)—even if the provider writes an assessment and plan—unless the patient has a new complaint or is experiencing a worsening of symptoms that prompts a new history, exam, and medical decision-making (which may include additional testing or therapy).
Example 1: The patient is a 57-year-old male who presents for follow-up of evaluation of pain in his left wrist. The physician evaluated him last time and discussed waiting six weeks before considering another injection if his pain did not subside. He improved in some capacity but has continued to have difficulty moving the thumb and wrist when doing something that involves grasping or pinching.
- Review of Systems: No new injury or traumatic event.
- Plan: The physician and patient had a lengthy discussion about options and patient would like another injection performed today.
- Procedure: After informed consent was obtained, patient was prepped and draped in a sterile fashion. The physician identifies the injection site by palpitation and marks the injection site. A 22-gauge needle is inserted medially and a mixture of 1cc of 1 percent lidocaine and 40mg of kenalog-10 is injected into the tendon sheath. Patient tolerated the procedure well with no immediate complications.
- 20550-LT Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar fascia)-Left side
- J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg x 4 units
Because this is follow-up visit with no new patient complaint or complications, you may not report a significant separately identifiable E/M service. The injection is the only billable procedure.
Identifying separate E/M services
You should apply modifier 25 for “a significant, separately identifiable E/M service that is above and beyond the usual pre- and post-operative work for the service,” per CMS Transmittal R954CP (Medlearn Matters Number: MM5025, Change Request 5025). To help you decide if an E/M service is truly “significant” and “separately identifiable” (and therefore separately reportable with modifier 25), ask yourself, “Can I quickly find in the documentation a clear history, exam and medical decision-making apart from any other procedures the provider performs on the same day?” If the answer is “Yes,” the E/M service is billable.
Example 2: An established, 57-year-old male presents to his physician with complaints of left wrist pain that he noticed four months ago. He has been taking over-the-counter pain reliever, which sometimes relieves the pain. The patient noticed swelling in the area two days ago.
Review of Systems:
- Constitutional: No fever
- Respiratory: No cough or shortness of breath
- Cardiac: No chest pain
- Musculoskeletal: Swelling on the left wrist
- The physician reviews the past medical history, social history, medications and allergy, no pertinent update.
- Vital Signs: HT 5 6”(1.676M), WT: 202IB (91.627) Kg, BMI 32.62Kg/m
- Patient appeared to be healthy, well developed, well nourished and in no acute distress. He is alert and well oriented x 3 and in no apparent distress with normal mood affect.
- His skin is pink and well perfused.
Musculoskeletal Exam: Both left and right wrist was examined. Finkelstein test on the left wrist positive for De Quervain tenosynovitis
Assessment and Plan: The physician discussed the clinical impression with the patient. He also discussed the results of all diagnostic testing and the relevance to the current problem. The physician discussed treatment options, both non-operative and operative including the benefits and risks of each. The patient and physician discussed options and the patient wants an injection performed today.
Procedure: After informed consent was obtained, patient was prepped and draped in a sterile fashion. The physician identifies the injection site by palpitation and marks the injection site. A 22-gauge needle is inserted medially and a mixture of 1cc of 1 percent lidocaine and 40mg of kenalog-10 is injected into the tendon sheath. Patient tolerated the procedure well with no immediate complications. Physician also recommended immobilizing the thumb and wrist, by keeping them straight with a splint or brace to help rest the tendons. Follow up was scheduled for six weeks.
- 99214-25 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity
- J3301 x 4 units
In this case, the patient’s complaint of wrist swelling is new. The provider performs and documents a significant, separately identifiable E/M service, which leads to the decision to perform the injection. You may bill both the injection and the E/M service (with modifier 25 appended).
Document all diagnoses
The diagnoses underlying the E/M and the injection (or other minor procedure) may be the same, or different. Per Transmittal R954CP, “The E/M service may be prompted by the symptom or condition for which the procedure and/or service was provided. As such, different diagnoses are not required for reporting of the E/M services on the same date” (emphasis added). When an E/M service leads to an unplanned, same-day procedure (as is the case in our second example, above), be sure that documentation substantiates that the decision to perform the procedure was made during the encounter. Per CMS Transmittal R954CP, you do not need to submit full documentation with your claim, but the documentation must be available upon request.
Counseling also may quality for separate E/M
Per CPT® guidelines, time—rather than history, exam and medical decision making—may become the controlling factor to qualify for a particular level of E/M services, “when counseling and/or coordination of care dominates (more than 50%) the encounter with the patient and/or family (face-to-face time in the office or other outpatient setting or floor/unit time in the hospital or nursing facility)…”
In such cases, you should use CPT® “reference times” to determine an appropriate E/M service level. Per CPT® guidelines, “When codes are ranked in sequential typical times and the actual time is between to typical times, the code with the typical time closest to the actual time is used.” For example, a level 3 established patient outpatient visit (99213) has a reference time of 15 minutes, and a level 4 service (99214) has a reference time of 25 minutes. When reporting a time-based E/M service lasting 19 minutes, report 99213 because it has the closest reference time. When reporting a time-based E/M service separately with a minor procedure, be sure to append modifier 25 to the appropriate E/M service code.
Finally, be sure to document all pertinent information discussed during the session. For example, rather than enter into the medical record, “30 minutes of counseling,” the provider should summarize the content of the counseling or coordination of care. Best practice is to document the beginning and ending time of the counseling and/or coordination of care, and the beginning and ending time for the overall face-to-face visit.
Portions of this article previously appeared in AAPC’s Healthcare Business Monthly.
MEDI-CAL: The Department of Health Care Services (DHCS) has identified two different claims processing issues affecting pathology codes. One issue is causing denials of almost 70 different pathology codes billed without an attachment. Click here for more information, including codes affected and instructions on how to appeal.
The second issue is causing denials of almost 100 pathology codes billed without a modifier. DHCS reports that affected providers do not need to take any action and that affected claims will be reprocessed via an EPC. Click here for more information on codes affected.
The California Medical Association offers our members free programs to educate physicians and staff on a range of practice management issues. Space is limited, so register soon.
Upcoming CMA webinars
Most webinars are held over the lunch hour, from 12:15 to 1:15 p.m. and are free for CMA members and their staff. See the event calendar for additional details and to register.
5/4: Contract Renegotiations: How to Get Past "No" with a Payor: When submitting a request to renegotiate, best practice is to present a “business case” as to why the payor wants to keep your practice in the network. However, many practices fail to present a business case, which often results in a quick reply from the payor indicating that they are not in a position to renegotiate at this time. This webinar will cover steps practices can take to build their best business case and identify the uniqueness of their practice to prevent the “auto-reply” and present a thoughtful renegotiation request.
5/18: Reimbursement 101: Getting Paid: This webinar is intended for physicians, medical group practice administrators and physician executives to learn ways to maximize reimbursement in the face of declining payor and government reimbursement and increased regulatory scrutiny. This webinar will provide managed care and payor contracting tips, as well as what to do when you aren’t getting paid. In addition, it will help you prepare for and defend against government and payor reimbursement audits.
Upcoming CMA seminars
CMA experts travel to local county medical societies throughout the state, holding live seminars for members and their staff on a variety of issues.
5/4: Orange County Medical Society: Practice Management 101 (Two sessions available, afternoon and evening)
5/11: Sacramento Medical Group Management Association: Medicare Changes: 2016 and Beyond
5/11: San Joaquin Medical Society: Contract Renegotiation: How to Get Past No with a Payor
5/18: Fresno-Madera Medical Society: Contract Renegotiation: How to Get Past No with a Payor
5/24: Alameda-Contra Costa Medical Association: Contract Renegotiation: How to Get Past No with a Payor
Contact: CMA’s member help center, (800) 786-4262 or email@example.com.
The California Medical Association’s Center for Economic Services provides direct reimbursement assistance to CMA physician members and their office staff.
Reimbursement Help Line (888/401-5911)
- One-on-one educational and reimbursement assistance to physician members and their staff
- Tools and resources to empower physician practices
- Seminars and toolkits for physicians and their staff
- Staffed by practice management experts with a combined experience of over 125 years in medical practice operations
Need help? Contact CMA’s reimbursement experts at (888) 401-5911 or firstname.lastname@example.org.
To make sure that you are aware of important news from your contracting health plans, we encourage you to regularly read plans' provider newsletters and bulletins. Follow the links below to access the current issues.
AETNA: www.aetna.com. Click on "Health Care Professionals" in the main menu, then on "News for Providers" in the left sidebar.
CIGNA: www.cigna.com. Click on "Health Professionals" under "Customer Care" in the main menu. Then, scroll down and click on "Newsletters."
ANTHEM BLUE CROSS: www.anthem.com/ca. Click on "Providers" in the main menu, then on "Professional Network Update" under "Spotlight."
BLUE SHIELD: www.blueshieldca.com. Click on "I'm a Provider," then on "Announcements" under "News and Features."
HEALTH NET: www.healthnet.com. Click on "I'm a Provider" and then "California." Enter username and password, and then click "Online News."
MEDI-CAL: www.medi-cal.ca.gov. Click on "Publications" in the main menu, then on "Provider Bulletins."
MEDICARE/NORIDIAN: https://med.noridianmedicare.com/web/jeb/fees-news. Noridian publishes individual articles through the Latest Updates section in the left sidebar. The articles are condensed approximately every six-to-eight weeks into a Bulletin.
UNITED HEALTHCARE: www.unitedhealthcareonline.com. Click on "Tools & Resources" in the main menu, then on "Network Bulletin."
CMA RESOURCE: Find up-to-date profiles on each of the major payors in California.
If you have questions related to any of the articles in this issue, please contact CMA's reimbursement help line, (888) 401-5911 or email@example.com. Questions about membership, including technical website issues, should be directed to CMA's member help center, (800) 786-4CMA or firstname.lastname@example.org.
Let us know which topics you would like to see addressed in future issues. Contact CMA's Center for Economic Services at (916) 551-2061 or email@example.com.