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:
- Health Net Federal Services begins TRICARE contracting initiative
- UnitedHealthcare requiring stricter notification requirements for out-of-network ASC referral
- River City Medical Group expands into new Northern California counties
- Health Net sends SB 137 notice to some docs in error
- $14 million reasons to be a CMA member
- CMS to remove SSNs from all Medicare cards by April 2019
- CMS accepting 2016 meaningful use hardship exceptions
- AMA hosts MACRA update in April
- CMA updates MACRA preparation checklist
- CHPI publishes physicians' quality ratings for cycle 2
- Special Leadership Academy rate available for practice managers!
- Ask the expert: Making a business case to join a payor network
- The Coding Corner: Incident-to billing for Medicare patients
As previously reported, the Department of Defense awarded the $17.7 billion TRICARE West Region contract to Health Net Federal Services (HNFS). As the recipient of the contract, HNFS will provide managed care services to 2.9 million TRICARE beneficiaries in 19 western states, including California, beginning October 1, 2017.
In preparation for the transition, Health Net has sent recruitment notices to physicians soliciting interest in participation in the new Health Net Federal Services (HNFS) West Region network.
Included in the recruitment packet is a “Join our Network” form. Physicians interested in joining the HNFS network should return the completed form to HNFS via email, fax or mail. According to Health Net, submission of the “Join our Network” form is only an expression of interest and does not obligate the physician to participate. HNFS will then mail the physician a contract offer approximately 72 hours after receipt of the completed form. Physicians will have the opportunity to review the contract terms before making a final decision.
Physicians should be aware that terms of the HNFS contract may vary from the prior United Healthcare Military and Veterans (UMVS) TRICARE contract. Providers are encouraged to closely review the proposed contract terms.
The California Medical Association (CMA) is in the process of reviewing the HNFS contract and will publish an update as soon as more information is available.
During the 2013 transition of TRICARE managed care services from TriWest to UMVS, a CMA survey found widespread reports of problems, including contracting issues and significant delays in processing of authorizations and referral requests, which delayed timely access to medical care. CMA has shared feedback with HNFS on the flawed transition to UMVS. HNFS advised that it has been a continuous TRICARE administrative contractor for 28 years, has an existing medical management system in place in the North Region that it will be utilizing and that it, along with the Department of Defense, is taking proactive steps to ensure the transition goes smoothly. CMA will work closely with HNFS on the transition and will be publishing a TRICARE transition guide to provide assistance to physician practices.
Physicians with questions regarding the TRICARE amendment may contact HNFS at HNFSProvRel@healthnet.com.
UnitedHealthcare (UHC) recently issued a notification to approximately 80 California physicians reminding them that their participation agreement requires them to refer to in-network ambulatory surgical centers (ASC) for elective services. This notice comes on the heels of an August 2016 announcement that UHC will begin enforcing stricter notification requirements related to out-of-network ASC referrals. According to the UHC letter, physicians wishing to perform services at an out-of-network ASC will be required to notify UHC at least five days in advance of the procedure. Additionally, physicians will be expected to complete the UHC Member Advance Notice Form any time they are referring a patient out-of-network. The new policy does not apply to emergencies.
The California Medical Association (CMA) raised concerns with the August 2016 notice, as it was unclear whether physicians were required to submit a copy of the completed Member Advance Notice Form to UHC and what the impact would be for non-submission of the form by a physician. In response to CMA’s questions, UHC issued a clarifying notification to physicians, which stated that UHC will request that physicians submit a copy of the completed Member Advance Notice Form at the time of prior notification to the payor.
If a provider fails to submit the completed form with the prior notification, UHC will contact the patient to verify that his or her choice to use an out-of-network facility was discussed with the care provider, and that the patient agreed to receive services from a non-participating provider while understanding the potential increased out-of-pocket costs associated with that decision. Additionally, UHC has advised CMA that non-submission of the form will not be grounds for non-payment of any associated claims. However, failure to provide prior notification to UHC may result in the denial of claims per the Administrative Actions for Non-Compliance section contained in the UnitedHealthcare Administrative Guide.
UnitedHealthcare states that the intent of the policy change is not to dissuade patients from utilizing their out-of-network benefits, but is rather an effort to “minimize unnecessary member costs.” Similar programs have already been implemented by Anthem Blue Cross and Blue Shield of California.
More information regarding the change to the notification requirements can be found in the UnitedHealthcare Administrative Guide 2016 located on the UnitedHealthcareOnline.com website. Providers can also contact UnitedHealthcare at (866) 574-6088 for additional information.
Anthem Blue Cross recently notified contracting physicians of a change to its Medi-Cal managed care product in 10 Northern California counties. According to the notice, as of February 1, 2017, Anthem has contracted with River City Medical Group (RCMG) for its Medi-Cal managed care business in Butte, Colusa, Glenn, Nevada, Placer, Sacramento, Sierra, Sutter and Tehama counties. Previously, Anthem had contracted directly with physicians for services to its Medi-Cal managed care enrollees in many of these counties. The notice states that Northern California Physicians Medical Group will continue to provide services in Butte, Colusa, El Dorado, Glenn, Nevada, Placer, Sacramento, Sierra, Sutter and Yuba counties.
RCMG has advised the California Medical Association (CMA) that any prior authorizations obtained from Anthem directly will be honored by Anthem for 60 days.
CMA already encourages physician practices to check eligibility each time a patient is seen, and this change underscores the importance of double-checking eligibility for these Anthem Medi-Cal managed care patients in affected counties. Physicians who are not contracted with RCMG, but provide services to RCMG patients, are at risk of not being reimbursed for services provided.
If a patient’s treating physician is not participating in the RCMG network, the patient may be eligible to continue to see the out-of-network physician by requesting continuity of care through Anthem. For more information on the conditions that qualify for continuity of care, see CMA’s On-Call document #7051, “Contract Termination By Physicians and Continuity of Care Provisions,” available free to members in the CMA resource library at www.cmanet.org/cma-on-call. Patients should call the number on the back of their Anthem ID card to request continuity of care.
Physicians who are not contracted with RCMG, but who wish to explore a contract, can contact RCMG Network Development at (916) 228-4300 (option #4).
Practices with questions can contact RCMG directly at (800) 928-1201.
Health Net recently issued a notice to all California participating physician groups advising that monthly updates of provider demographic changes would be required as part of its initiative to comply with Senate Bill 137.
The California Medical Association (CMA) inquired further with Health Net regarding the frequency of the updates. Health Net clarified that the notice was only intended for its delegated groups. CMA has asked whether a correction notice has or will go out to affected physicians, and is waiting to hear back from Health Net
SB 137, the provider directory accuracy law, requires physicians to respond payor notifications regarding the accuracy of their provider directory information, either by confirming the information is correct or by updating demographic information as appropriate. Plans are required to make outreach to physicians at least annually for groups and at least every six months for individual providers. Failure to respond to the requests may result in a delay in payment and removal from the payor’s 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.
To help physicians understand the new law, and what they need to do to avoid penalties, CMA published a toolkit: “What Physicians Need to Know to Avoid Penalties Under the New Provider Directory Accuracy Law.” The toolkit is available FREE for CMA members on our website at www.cmanet.org/ces.
The California Medical Association (CMA) Center for Economic Services (CES) has recouped $14 million from payors on behalf of CMA member physicians over the past eight years. These monies 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 2017, 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 “Practice Management 101,” “MACRA: Medicare Quality Payment Program 2017 and Beyond,” “Contract Renegotiations: How to Get Past ‘No’ with a Payor,” “Getting Paid: A Physician’s 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 this invaluable newsletter – 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.
Anyone who would benefit from a free subscription can sign up on the CMA website at www.cmanet.org/newsletters, or can contact CMA at (916) 551-2061.
For practice management tools and other online assistance, visit www.cmanet.org/ces.
The Centers for Medicare & Medicaid Services (CMS) will remove social security numbers (SSNs) from all Medicare cards by April 2019, as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). As part of the Social Security Number Removal Initiative, a new Medicare Beneficiary Identifier (MBI) will replace the SSN-based Health Insurance Claim Number (HICN) for all Medicare transactions. The MBI is confidential like the SSN, and should be protected as personally identifiable information.
By replacing the SSN-based HICN on all Medicare cards, private health care and financial information and federal health care benefit and service payments will be better protected.
Moving to new Medicare numbers and cards will require changes to provider systems and how they conduct business. Practices should assess the potential impact on their business operations, including whether their practice management software can accept and process transactions using the new MBI. Additionally, practices may find that additional time is required to educate patients on the purpose of the new Medicare cards and MBI, to advise that the new MBI will not change patients’ Medicare benefits.
Beginning in April 2018, CMS will start sending the new Medicare cards with the MBI to all Medicare beneficiaries. People with Medicare may start using their new Medicare cards and MBIs as soon as they receive them.
There will be a transition period, beginning no earlier than April 1, 2018, through December 31, 2019, where providers can use either the HICN or the MBI.
The MBI will be:
- Clearly different than the HICN
- 11 characters in length
- Made up only of numbers and uppercase letters (no special characters)
For MBI specifications and to make changes to your systems, see the MBI format specifications.
More information regarding the Social Security Number Removal Initiative can be found on the CMS.gov website.
The Centers for Medicare and Medicaid Services (CMS) announced that it is now accepting hardship exceptions from the meaningful use requirements of the electronic health record (EHR) incentive payment program for the 2016 reporting year. Physicians who can show that demonstrating meaningful use would result in a significant hardship can apply for a one-year exception and avoid a negative payment adjustment in 2018. The deadline to apply is July 1, 2017.
To be considered for an exemption (to avoid a payment adjustment), you must complete a hardship exception application and provide proof of the hardship. If approved, the hardship exemption is valid for one payment year. You would need to submit a new application for subsequent years.
Physicians who have never before successfully attested to meaningful use under the EHR incentive program and are transitioning in 2017 to the new Merit-Based Incentive Payment System (MIPS) may also apply for a one-time hardship exception to avoid a 2018 payment adjustment.
The exception deadline for physicians transitioning to MIPS is October 1, 2017.
For more information and applications, click here.
The American Medical Association (AMA) will host a free 90-minute webinar on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and its quality payment program (QPP) on April 20 at 4 p.m. PT.
Last fall, the Centers for Medicare & Medicaid Services (CMS) released final policies on implementation of MACRA’s merit-based incentive payment system (MIPS) and alternative payment models (APMs). Collectively, these programs are part of what CMS now calls the quality payment program.
CMS has given physicians the opportunity to pick their pace of participation during the 2017 QPP transition year. For 2017, physicians only need to report one quality measure for one patient, one improvement activity or all of the required advancing care information (ACI) measures to avoid a negative payment adjustment in 2019. While the performance year is 2017, physicians will not receive their payment adjustment until two years later.
The webinar will help physicians understand MACRA and prepare for the transition so they can be rewarded for providing quality care.
Click here to register.
The California Medical Association’s (CMA) Center for Economic Services has published an update to its Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) preparation checklist. The checklist, “MACRA: What Should I Do Now to Prepare?”, is available in CMA's MACRA resource center at www.cmanet.org/macra.
CMA published this important checklist to help physicians understand MACRA payment reforms and what they can do now to start preparing for the transition. Also available in the MACRA resource center is an overview of MACRA, and a comprehensive list of tools, resources and information from CMA, the American Medical Association and the Centers for Medicare and Medicaid Services.
On March 22, 2017, the California Healthcare Performance Initiative System (CHPI) released its second cycle of physician quality ratings to the public. The ratings can be accessed at CHPI’s newly launched website, CAqualityratings.org, which allows consumers to search ratings on approximately 10,000 California physicians.
As previously reported in September 2016, approximately 13,000 physicians in California received their individual quality measurement scores for the second cycle of the CHPI quality rating program. The program rates physicians using claims data from Medicare fee-for-service, Anthem Blue Cross, Blue Shield of California and UnitedHealthcare. This claims data includes both commercial and self-funded health plan data from HMO, PPO, POS and Medicare Advantage products.
The individual quality measurement scores were based on claims data for patient care provided January 1, 2012, through December 31, 2014. Physicians were assigned a star rating of one to four stars, based on where they fall as a percentile within a “peer group,” for each measure as well as a composite score.
For more information on the CHPI Cycle 2 rating methodology, visit the CHPI website at www.chpis.org. CHPI has also published an FAQ on its rating program. If you have questions or concerns about the CHPI rating results, email firstname.lastname@example.org and expect a response within 48 hours.
The California Medical Association (CMA) is pleased to offer a special rate for practice managers to attend the 2017 Western Health Care Leadership Academy!
Register today for the low price of only $295 (use discount code OFFMGR17) – and join us in San Diego May 5-7 for the West Coast's premier health care leadership conference! This price includes all conference sessions, meal functions and the Friday evening network reception. When registering, choose "Create Account" at the bottom, then enter the email address where you received this special offer.
With a dramatic shake-up happening in Washington, D.C., the Western Health Care Leadership Academy is the right place and time for health care leaders who want to stay on top of what's being done to shape the future of health care. This year's program provides especially great educational opportunities for practice managers; you may be especially interested in the following breakout sessions in our Running Your Practice track:
- Finding Your MACRA Rosetta Stone: Discovering Your Essential Clues
- Merging Practices: Marriages Made in Heaven or Hell?
- ADEPTTM Workflow: The Five Pillars of Practice Performance
- MACRA Made Easy
- The Platinum Rule: A Panel Conversation About Diversity in the Medical Practice
- Top 10 Tips to Avoid “Practice Management Hypertension”
The 2017 Leadership Academy program features notable speakers like physician and author Abraham Verghese, M.D., MACP; Chief of Digital Innovation at Seattle Children’s Hospital and social media superstar Wendy Sue Swanson, M.D.; veteran National Public Radio science correspondent and award-winning science TV journalist Ira Flatow; and television contributors Paul Begala and Hugh Hewitt. More information and the full agenda are now available at westernleadershipacademy.com.
Reserve your hotel room by April 14!
Unique among other downtown San Diego hotels, the Marriott Marquis San Diego Marina provides an environment that easily transitions from dynamic meetings to resort-style relaxation with luxury guest rooms, 280,000 square feet of meeting space and a 446-slip marina. Reserve your room by April 14! Reservations made after this date cannot be guaranteed for the special conference rate.
When physicians identify a payor network they wish to join, typically their first step is to submit a letter of interest or intent signaling their desire to join. However, physicians often fail to adequately present a “business case” as to why the payor would want to add the practice into their network. Failure to present a business case often results in a quick reply from the payor indicating that they have no interest or need to add providers to their network at this time. To prevent the “auto-reply,” the California Medical Association (CMA) suggests you be thoughtful in preparing your letter of interest submission and do the following prior to submitting your letter.
Step 1: Assess the payor’s specific need for your services
Try to determine whether a payor needs you in its network by researching the payor’s provider directory. Utilizing your own knowledge of the marketplace, review the directory (noting any errors) to get a sense of whether the payor needs you in the network. For instance, if you are a primary care physician, but the payor directory shows an abundance of participating primary care physicians within your area who are accepting new patients, then making the case that the payor should add you to the network may be a tough sell. On the other hand, if there are very few participating physicians in your specialty in your area, you are likely in a better position to be considered for participation by the payor.
Step 2: Identify the uniqueness of your practice
Think about what makes your practice special and sets you apart from others, then tell the payor about it. The payor needs to understand why it wants you in its network. For example, do you speak multiple languages in the practice, or offer a unique service to your patients? Identifying why your practice is different is an important step in getting the payor’s attention and increases the value of your participation into the payor network.
Step 3: Draft your letter of intent to the payor
The purpose of the letter of intent is to get the payor’s attention. You want to focus on why your practice should be considered for participation in the payor’s network, including what sets you apart. You are marketing your practice, so be clear and detailed in your letter.
Typically, requests to join a network are best sent to the payor’s contracting department. Some payors now require you to submit your letter of interest via e-mail rather than via fax or mail submission. If you are not sure where to send the request, you can refer to CMA’s payor profiles on our website at www.cmanet.org/payorprofiles.
To help physicians prepare for contract negotiations or renegotiations, CMA has published a guide to help members present a compelling business case. “Contract Renegotiations: Making Your Business Case” is designed to help physicians to identify negotiating leverage and the uniqueness of their practice, how to analyze the economic impact a contracting offer may have on your practice, and how to draft an attention-getting written request for renegotiation.
The document also includes a sample letter that can be completed and submitted to the payor to request a renegotiation of your contract. The guide is available free to members only on the CMA website.
Contact: CMA's reimbursement helpline at (888) 401-5911 or email@example.com.
CPR’s “Coding Corner” focuses on coding, compliance and documentation issues relating specifically to physician billing. This month’s tip comes from G. John Verhovshek, the managing editor for AAPC, a training and credentialing association for the business side of health care.
Under Medicare rules, covered services provided by non-physician practitioners (NPPs) are reimbursed at 85 percent of the fee schedule amount. “Incident-to” billing rules provide an exception, allowing 100 percent reimbursement for non-physician services that meet the requirements detailed in the Medicare Benefit Policy Manual, Chapter 15, Section 60.
There are six basic incident-to requirements for Medicare payment:
1. The service must take place in a “noninstitutional setting,” which the Centers for Medicare & Medicaid Services (CMS) defines as “all settings other than a hospital or skilled nursing facility” (SNF).
Additionally, the Benefit Policy Manual allows, “Hospital services incident to physician’s or other practitioner’s services rendered to outpatients (including drugs and biologicals which are not usually self-administered by the patient), and partial hospitalization services incident to such services may also be covered.”
2. A Medicare-credentialed physician must initiate the patient’s care. If the patient has a new or worsened complaint, a physician must conduct an initial evaluation and management service for that complaint, and must establish the diagnosis and plan of care. Incident-to services cannot be rendered on the patient’s first visit, or if a change to the plan of care occurs.
3. Subsequent to the encounter during which the physician establishes a diagnosis and initiates the plan of care, an NPP may provide follow-up care under the “direct supervision” of a qualified provider. Per the Benefit Policy Manual:
Direct supervision in the office setting does not mean that the physician must be present in the same room with his or her aide. However, the physician must be present in the office suite and immediately available to provide assistance and direction throughout the time the aide is performing services.
If auxiliary personnel perform services outside the office setting, e.g., in a patient’s home or in an institution (other than hospital or SNF), their services are covered incident to a physician’s service only if there is direct supervision by the physician [e.g., the physician must be physically present to oversee the care].
Any physician member of the group may be present in the office to supervise. The supervising physician does not have to be the physician who performed the initial patient evaluation.
4. A physician must “actively” participate in and manage the patient’s course of treatment. This requirement typically is defined precisely by the state licensure rules for physician supervision of NPPs (e.g., the physician must see the patient every third visit).
5. Both the credentialed physician and the qualified NPP providing the incident-to service must be employed by the group entity billing for the service (if the physician is a sole practitioner, the physician must employ the NPP).
6. The incident-to service must be the type of service usually performed in the office setting, and must be part of the normal course of treatment of a diagnosis or illness. The Benefit Policy Manual elaborates: “Where supplies are clearly of a type a physician is not expected to have on hand in his/her office or where services are of a type not considered medically appropriate to provide in the office setting, they would not be covered under the incident to provision.”
Services meeting all of the above requirements may be billed under the supervising physician’s NPI, as if the physician personally performed the service. Documentation should detail who performed the service, and that a supervision physician was in the office suite (although not necessarily the same room) at the time of the service.
For example, a general practitioner diagnoses a Medicare patient with hypertension and diabetes in February, and creates a plan of care. The patient returns for a follow-up in June with a nurse practitioner (NP). At the follow-up visit, the patient complains of knee pain. Although the physician is in the office, the NP evaluates and treats the patient for the new problem.
In this case, if the NP had evaluated only the hypertension and diabetes, for which there were established diagnoses and plans of care, the service would meet incident-to requirements. But because the physician did not personally perform the initial service for the patient’s new complaint of knee pain, the service may not be reported as incident-to. Instead, the NP (if properly credentialed) would report the service to Medicare under his or her own provider ID.
Similarly, if a physician assistant sees Medicare patients in the office while the physician is at the hospital making rounds, you may not bill incident-to because the requirement for direct supervision hasn’t been met (the physician is not physically present in the office suite).
Services delivered by auxiliary personnel incident-to a physician’s services are coded normally, using standard CPT®, ICD, and HCPCS codes, without additional modifiers, and are billed under the supervising physician’s provider ID. Although certain NPPs may bill Medicare independently for their services, those services generally are paid at a lesser rate (typically 85 percent of fee schedule); whereas, Medicare reimburses for services properly reported incident to at 100 percent of the fee schedule amount.
Remember: Incident-to applies only to Medicare. And, the incident-to requirements do not apply to services with their own benefit category. Diagnostic tests, for example, are subject to their own coverage requirements. “Depending on the particular tests,” the Benefit Policy Manual explains, “the supervision requirement for diagnostic tests or other services may be more or less stringent than supervision requirements for services and supplies furnished incident to physician’s or other practitioner’s services.” Similarly, pneumococcal, influenza, and hepatitis B vaccines do not need to meet incident-to requirements. MLN Matters SE0441 elaborates:
Must a supervising physician be physically present when flu shots, EKGs, Laboratory tests, or X-rays are performed in an office setting in order to be billed as “incident to” services?
These services have their own statutory benefit categories and are subject to the rules applicable to their specific category. They are not “incident to” services and the “incident to” rules do not apply.
Additional rules apply for incident-to physicians’ services in clinic, and services incident-to a physician’s service to homebound patients under general physician supervision. These can be found in the Medicare Benefit Policy Manual, Chapter 15, Section 60.
“Thank you for all your help, CMA. Their guidance has ranged from directing me to legal resources, working on our behalf to recoup payments owed to the practice from reluctant payors, and referring us to a workers’ comp policy that literally saved us thousands of dollars each year. The cost of membership has been paid many times over by the actual monies you have saved our practice.”
Therese Laurance, Office Manager
Edward Laurance, M.D.
CMA member since 1983
Los Angeles County
The California Medical Association (CMA) 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: April 2017
Most webinars are held over the lunch hour, from 12:15 to 1:15 p.m. and are free to CMA members and their staff. See the event calendar for additional details and to register.
4/12: Implementing Strategies to Enhance Advance Care Planning: Discussing care goals with patients is often challenging, especially during a serious illness or toward the end of life. This webinar will review the kinds of conversations that are necessary for effective advance care planning and when to have them. Presenters will also discuss how to approach implementing advance care planning in an office setting and review emerging health care programs that highlight the need for quality advance planning conversations.
4/26: Aligning Clinical Practice with Diabetes Prevention: Screen, Test and Refer: CMA has partnered with the American Medical Association to raise awareness of prediabetes resources, help providers connect their patients to CDC-recognized Diabetes Prevention Programs, and allow patients to take charge of their health. This webinar will describe the clinical practice burden and trends in prediabetes and type 2 diabetes in California; review the evidence that supports systematically screening patients for prediabetes and referring to a community based program, like the National Diabetes Prevention Program; and recognize the tools available to identify patients with prediabetes and establish a referral process.
Contact: CMA’s member help center, (800) 786-4262 or firstname.lastname@example.org.
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 email@example.com.
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 firstname.lastname@example.org. Questions about membership, including technical website issues, should be directed to CMA's member help center, (800) 786-4CMA or email@example.com.
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 firstname.lastname@example.org.