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:
- Are you ready for the new prescription drug prior authorization form required on October 1?
- There's still time to order Prop. 46 campaign materials for your office
- DHCS releases duals project toolkit
- New rules on prescribing hydrocodone combo products take effect October 6
- How much revenue is your practice losing by not working denials?
- DHCS announces additional delays for some ACA Medi-Cal primary care rate increases
- DHCS announces new continuity of care rules for duals demonstration project
- DHCS revises Cal MediConnect ‘Choice Forms’
- Medi-Cal audits began in September
- Meet your CMA affinity partners: Staples Advantage
- Updated payor profiles now available
- The Coding Corner: Coding office E/M at the highest level: 99215
- CMA advocacy at work
- Payor updates
- Save the date
- Problems getting paid?
- Health plan provider newsletters
Over the next several months, a new law will take effect that streamlines and standardizes the prior authorization process for prescription drugs. The new law (SB 866) requires all insurers, health plans (and their contracting medical groups/IPAs) and providers to use a standardized two-page form for prior authorizations of prescription medications.
The law also requires plans and insurers to make a determination on prescription drug prior authorization requests within two days of receipt, and if they fail to do so the requests will be deemed authorized. The new law does not expand the list of medications that require a prior authorization.
The Department of Managed Health Care (DMHC) and the Department of Insurance (DOI) jointly developed the standardized authorization form and implementing regulations. The two agencies, however, will be enforcing the regulations on different timetables.
The regulation for DMHC regulated products, which includes all HMOs, their contracting medical groups/IPAs and most Blue Cross and Blue Shield PPOs, becomes effective January 1, 2015. However, the regulation for DOI regulated products, including all other PPOs and the Blue Cross and Blue Shield Life & Health products become effective on October 1, 2014.
The lack of synchronicity in the effective dates has the potential to cause confusion for practices, particularly those who treat patients with Anthem Blue Cross PPO or Blue Shield of California PPO products, as it can be difficult to determine whether the patient has a DOI regulated product, a DMHC regulated product or a product that is regulated out-of-state (i.e., Blue Card product).
However, in an effort to avoid confusion for practices, some plans/insurers are implementing the new form across most, if not all, of their product lines on October 1. There are exceptions, however, so practices are encouraged to review the payor notices and to call payors with any specific questions they may have.
Links to the payor notices that were available at the time of publication are below:
- Aetna (not available)
- Anthem Blue Cross
- Blue Shield of California
- Health Net
- United Healthcare (not available)
Click here to access the new form. The form (Form No. 61-211) will also be available on the payor websites by October 1 and can be submitted via paper, electronic transmission, fax, web portal or another mutually agreeable method.
For more information on the new form and accompanying regulations, including a chart of the effective dates by payor and product, see the California Medical Association physician FAQ, “A Physician’s Guide to Implementation of SB866: The new standardized prescription drug prior authorization form.” This document is available free to members.
The November 4 election is around the corner and voters will soon be asked to weigh in on Proposition 46, which was carelessly thrown together and paid for by the trial lawyers in order to make millions of dollars from more medical lawsuits and higher jury awards. If Prop. 46 passes, physicians, patients and all of California will suffer.
The Los Angeles Times recently released a Prop. 46 poll, which found that half of voters oppose the trial lawyer-sponsored ballot initiative, with only 37 percent in favor of the measure.
According to the poll, "Initial support for Prop. 46 erodes as the debate is played out. Likely voters initially support the ballot summary for Prop. 46 by a wide margin, but that edge dissipates with the simple inclusion of the fiscal impact statement, dropping support for Prop. 46 below 50 percent. While likely voters favor the drug testing requirement, they outright oppose increasing the cap on medical malpractice damages."
The poll results show a critical fact: When the public hears the real intent of this harmful ballot initiative, they become skeptical about the measure. This makes it even more critical for physician practices to order free campaign materials to educate their patients about this dangerous measure.
Materials available include:
- Lab coat cards (available in batches of 100)
- English-language patient brochures
- Spanish-language patient brochures
- Campaign buttons
- Office posters
- Bumper stickers
Not sure what to order? You can order an Office Kit, which contains a little bit of everything: 150 brochures, five posters, five campaign buttons, 10 stickers, 100 lab coat message cards and 10 bumper stickers.
The California Department of Health Care Services (DHCS) has published a physician toolkit to help providers and their patients understand the Cal MediConnect duals demonstration project. The toolkit has been developed in conjunction with Harbage Consulting and various stakeholder groups, including the California Medical Association.
The toolkit contains several documents, including an overview and several fact sheets that include information on the following:
- How to submit crossover claims to Medi-Cal plans
- Contracting with Cal MediConnect plans
- How crossover claims are processed for Medi-Cal managed care patients
- Continuity of care
- Sample patient letters (for contracted and non-contracted physicians)
The toolkit also confirms that if a patient opts out of Medicare Advantage and remains with fee-for-service Medicare, the Medi-Cal managed care plan cannot require authorizations for physician services as the secondary payor (see the Coordinated Care Initiative Overview fact sheet for more information). It should be noted that no change has been made to the rules governing the billing of the 20 percent Medicare copay for dual eligible patients. It continues to be unlawful to bill dual eligible patients. In limited circumstances, Medi-Cal may cover Medicare coinsurance and copays. Such "crossover" claims for Medicare coinsurance and copays should be sent to the patient's Medi-Cal plan (see Payment for Medicare Physician Services Under the CCI fact sheet for more information.
Physicians should also be aware that the new Cal MediConnect "Choice Form" that is now online is only a visual sample, indicating patients must use their unique forms sent to them in their "Plan Choice" booklets.
Lastly, if you or your patients have questions that the plan cannot respond to, you can always contact the Cal MediConnect Ombudsman at (855) 501-3077 (TTY 1-855-847-7914), Monday through Friday, 9 a.m. to 5 p.m.
Physicians are reminded that effective October 6, 2014, medicines containing hydrocodone will be reclassified as Schedule II substances, in line with oxycodone and morphine.
This reclassification will apply to all drugs that contain both hydrocodone, which by itself was already classified a Schedule II drug, and specified amounts of other substances, such as acetaminophen or aspirin. As Schedule II drugs, patients will need a new script each time the medication is filled. (Under the Schedule III classification, a prescription could be refilled five times before the patient had to see a physician.) Physicians will not generally be allowed to call, fax or e-mail in a prescription to a pharmacy; instead, patients will have to present a written prescription.
Prescriptions that have been filled at least once before October 6, 2014, and have authorized refills remaining, are allowed to be dispensed during a transition period, until April 8, 2015, in accordance with federal rules. However, pharmacies are not required to honor such refills during the transition period, and indications are that many California pharmacies may choose not to. Physicians should be prepared for patient requests for new prescriptions.
California exceptions for emergencies and that apply to skilled nursing facilities, intermediate care facilities and hospice care remains in effect. (For more information see CMA On-Call document #3201, "Controlled Substances Prescribing.")
Under the new rule, physician assistants and nurse practitioners may administer, provide or issue a drug order for Schedule II controlled substances if they have advance approval by a supervising physician and if they have completed an approved education course that explicitly covers prescribing of Schedule II controlled substances. Physician assistants and nurse practitioners should consult their respective boards for more information on the required trainings.
In addition, current law requires that physicians must within seven days countersign and date the medical record of any patient cared for by a physician assistant under their supervision who is issuing a Schedule II drug order for that patient. Physicians are not required by law to countersign medical records for Schedule II drug orders written by nurse practitioners. However, standardized protocols and requirements from third parties may contain counter signature requirements related to Schedule II drug orders.
The Controlled Substances Act places substances with accepted medical uses into one of four schedules, with the substances with the highest potential for harm and abuse being placed in Schedule II, and substances with progressively less potential for harm and abuse being placed in Schedules III through V. (Schedule I is reserved for those controlled substances with no currently accepted medical use and lack of accepted safety for use.)
It’s no secret that claim rejections and denials can result in a significant amount of lost revenue. Consider this – a practice submitting 80 claims a day at an average reimbursement rate of $100 per claim should expect to receive $8,000 in daily revenue. If 10 percent of those claims were rejected or denied (eight claims per day at $100 per claim equals $800 per day), and the practice only appealed one out of every 10 rejections or denials ($720 per day loss), the practice could expect to lose as much as $180,720 annually (251 business days at $720 per day in denials or rejections). The numbers are staggering and the loss of income could cover the cost of several full time employees.
While it might not be feasible for a solo or small physician group to appeal every single denial or rejection, practices can significantly reduce potential lost revenue by identifying and addressing the three most common reasons for denial or rejection.
Identify whether the denial is a result of an internal billing error, a payor error, or medical necessity denial (i.e., not in line with the payor’s medical or reimbursement policy).
- Internal billing error – Share your findings with staff, identify the dollars lost due to the error and use the results as a training tool. Often, offering a modest incentive to staff to improve will generate big results.
- Payor error – If a particular payor error is contributing to a large number of denials or rejections, contact the payor directly. Addressing the root cause with the plan is more effective than continually appealing each and every claim denied for the same reason. If the payor is not responsive to the requests to fix the problem, contact the California Medical Association’s (CMA) Center for Economic Services for assistance at (888) 401-5911 or firstname.lastname@example.org. CMA members and their staff receive FREE reimbursement assistance from practice management experts.
- Medical necessity denials – Get a copy of the written medical policy. Medical necessity denials are often the result of either a lack of documentation or incorrect linking of diagnosis codes to CPT codes on the claim form. Other times, it’s a conflict with a payor’s medical policy. Share the findings with staff, including the dollars lost. Get the physician involved, as medical necessity appeals are more successful when the he or she is involved in writing the appeal. If the appeal is not successful, request a peer-to-peer between your physician and a physician of the same or like specialty at the payor. If the peer-to-peer isn’t successful, assist your patient in filing an Independent Medical Review (IMR) request with the Department of Managed Health Care or the Department of Insurance. For more information on filing an IMR request, see CMA On-Call document #7155, “Independent External Medical Review.”
The California Department of Health Care Services (DHCS) has released additional information about the timing of the outstanding Affordable Care Act (ACA) Medi-Cal primary care rate increase for certain claim types. Specifically, DHCS had previously announced delays in payment of three types of claims, including certain NICU/PICU services, Child Health and Disability Prevention Program (CHDP) services and crossover claims (also referred to as Medi/Medi claims).
- Retroactive NICU/PICU claims – At the request of CMA and other stakeholders DHCS will allow claims data to be submitted via a one-time spreadsheet upload without the need for individual claim inquiry forms. Spreadsheets must be submitted by October 1, 2014, to receive retroactive payments based upon the uploaded claims information. Providers who do not upload claims information before October 1, 2014, will receive claims payments based solely on original claims information or by submitting individual claim inquiry forms. For more information, see the DHCS bulletin.
DHCS also recently announced it will issue interim estimated payments for these retroactive claims in October with a final true up EPC to occur in December.
- CHDP claims – Some practices were previously instructed by DHCS to bill at their Medi-Cal rates. This caused concern—based on DHCS's pricing logic of paying the lessor of Medicare’s rate or the billed charges—that some practices would not qualify for the increase. At CMA and other stakeholders' urging, DHCS agreed to a workaround to allow these practices to be paid at the higher rates. DHCS is working on a web application that will allow a onetime submission of the physician's usual and customary amount, which will allow the practice to receive the higher reimbursement intended by the rate increase.
DHCS recently announced it intends to make an interim payment on CHDP claims in December. The true up will occur during the 2015 calendar year.
- Crossover Claims (Medi/Medi claims) – As previously reported, the Centers for Medicare and Medicaid Services (CMS) agreed with CMA and has required DHCS to modify its proposed bundled code methodology for crossover claims, as it would have consistently underpaid physicians anytime they billed a code eligible for the increase with any other codes that are not eligible. DHCS anticipates the necessary system enhancements will be made in time for checks to be issued in December.
According to DHCS, the clean-up process to address all exceptions and reconciliation of the estimated dollars previously released, has been delayed from August to December, 2014.
Managed care payments
Many physicians report they have begun receiving payments from their Medi-Cal managed care plans, while others report they have not. According to DHCS, some plans have only received additional monies for part of calendar year 2013. Some plans that haven’t yet received any funds will receive their outstanding monies for calendar year 2013 with their upcoming October capitation cycle check. No plans have received increased payments for calendar year 2014 because they are still awaiting CMS approval. DHCS will issue 2014 monies to the plans for distribution once the CMS approval is received. Providers are encouraged to work with their medical groups or health plans directly regarding the distribution of these monies.
There's still time to attest!
According to DHCS, eligible physicians who have already attested have received over $283 million in ACA primary care rate increases. Don't miss out! Remember, to qualify for the payment increases, you must first self-attest to your eligibility. The deadline to attest is December 31, 2014. Practices with questions can call Medi-Cal’s Telephone Service Center at (800) 541-5555.
If you have attested and not received your additional funds for fee-for-service Medi-Cal patients, practices are encouraged to confirm the accuracy of the information submitted through the attestation process.
The California Department of Health Care Services (DHCS) recently announced new continuity of care rules for the Cal MediConnect duals demonstration project. The project – an effort to save money and better coordinate care for the state’s low-income seniors and persons with disabilities – transitions a large portion of the state's dual eligible beneficiaries to managed care plans.
Although the program already had continuity of care provisions, the new rules make it easier for a patient to continue receiving needed care from out-of-network physicians without interruption.
The new continuity of care rules allow beneficiaries who meet certain criteria to keep their current providers for up to six months for Medicare services and up to 12 months for Medi-Cal services. Patients must demonstrate they’ve seen the out-of-network physician at least once in the previous 12 months for primary care and twice in the previous 12 months for specialists.
Providers can request continuity of care
The new rules will now allow providers to request continuity of care for their patients under the duals demonstration project. Previously, only the patient could initiate such a request. This new rule will help beneficiaries who have difficulty navigating the health care system so they can maintain their provider for up to 12 months.
Continuity of care can be requested via telephone
Under the new rules, continuity of care requests can be made via telephone and plans will be prohibited from requiring beneficiaries to submit a request through a paper form.
Plans must process request within 3 days
Under the new rules continuity of care requests must be processed within three days if there is a risk of harm to the beneficiary. Urgent requests will be processed within 15 days and all other requests are to be processed within 30 days.
Retroactive continuity of care
Under these new rules, providers or the beneficiary can now request continuity of care after delivering the service – ensuring payment for treatment. To qualify, the request must be received within 20 business days of the first service following the beneficiaries’ enrollment in Cal MediConnect. Once a beneficiary is approved for continuity of care, providers must work with the health plans to ensure compliance with the plan’s utilization and management policies.
These changes in continuity of care do not apply to providers of DME, transportation or ancillary services.
DHCS is expected to release a Dual Plan Letter within the next few weeks with direction on the new continuity of care rules for the Cal MediConnect population with an effective date.
CMA is pleased with the efforts DHCS has made to strengthen the physician-patient relationship and will continue to work with the department in ensuring adequate access to care.
After advocacy from the California Medical Association (CMA) in conjunction with patient advocacy groups, the California Department of Health Care Services (DHCS) has revised its “Choice Forms” that allow dual eligibles to opt-out of the Cal MedConnect duals demonstration project and remain in traditional Medicare fee for service.
The project was authorized by the state in July 2012 in an effort to save money and better coordinate care for the state’s low-income seniors and persons with disabilities. The program begins with a three-year demonstration project that transitions a large portion of the state's dual eligible beneficiaries transition to managed care plans. The project will impact approximately 450,000 duals in eight counties – Alameda, Los Angeles, Orange, Riverside, San Diego, San Mateo, San Bernardino, and Santa Clara.
The previous Choice Forms did not make it clear how a patient could opt-in or out of the program and DHCS was criticized for its lack of transparency in the documents. CMA was very vocal in requesting DHCS change the forms to clearly state the patient’s options. The state hopes the new forms provide clarity and make it easier for patients to make the choice between opting into the Cal MediConnect program or opting out of it. The Spanish language forms were also revised.
The updated forms are found here and should be included in new Plan Choice books for newly enrolled members. The plan Choice Form is located in the middle of the Plan Choice Book.
The California Department of Health Care Services (DHCS) has begun post-payment claims review of Medi-Cal claims in California. The purpose of this audit is to identify and correct improper Medicaid payments through the collection of overpayments and reimbursement of underpayments made on claims for health care services provided to Medicaid beneficiaries. The program will enable the Centers for Medicare and Medicaid Services (CMS) to implement actions that will prevent future improper payments in all 50 states.
DHCS has contracted with Health Management Systems, Inc. (HMS) to act as the Recovery Audit Contractor (RAC) for the State of California. HMS will perform desk and field audits for selected fee-for-service Medi-Cal claims paid within the last three years to determine if claims were paid correctly. HMS will contact providers whose claims have been selected for review. After the initial contact, providers may receive letters from HMS requesting medical records for further review. These letters, which should specify HMS’ preliminary results will be coming out no earlier than October.
DHCS is urging all providers to comply with requests for medical records from HMS. If you fail to submit the requested records, it will be considered a valid overpayment and you will be required to refund the claim payment amount to DHCS. Your cooperation will help ensure that the audit results are accurate and that California retains its much-needed federal matching monies for the Medi-Cal program.
For more information on Medi-Cal audits, see CMA On-Call document #7201, “Medi-Cal Audits.”
A better way to manage your supplies and save money
California Medical Association (CMA) members enjoy exclusive negotiated discounts of up to 80 percent off list prices from Staples Advantage on the things you buy most. We’re able to bring you these deeper discounts by leveraging the combined purchasing power of nearly 40,000 CMA members.
Staples Advantage offers CMA members a one-stop shop for all your supply needs, including office supplies, cleaning supplies and break room supplies, plus technology, furniture, custom printing and more.
Benefits of the Staples Advantage program include:
- Discounted pricing
- One-source provider for office, facility, technology, furniture and printing needs
- Fast, easy ordering online through StaplesAdvantage.com
- Custom pre-built shopping lists for commonly used items
- Free next business day delivery on orders over $50
- Easy online return process
- Online reporting on practice purchases
- Receive your CMA discounts at Staples retail stores (Contract Card Program)
- Award-winning customer service
- Dedicated account management team
- Customer appreciation days that include additional savings offers
You can also rely on Staples Advantage for health care-specific items, from examination gloves to infusion recliners.
Click here to see all the ways Staples Advantage can help keep your business running smoothly.
Not taking advantage of Staples Advantage yet? Click here to register for your online account.
The California Medical Association’s (CMA) Center for Economic Services has published updated profiles on each of the major payors in California including Aetna, Anthem Blue Cross, Blue Shield of California, CIGNA, Health Net, United Healthcare, Medicare/Noridian and Medi-Cal. Each profile includes key information on health plan market penetration, a description of the plan’s dispute resolution process and the name and contact numbers for medical directors, provider relations and other key contacts. Don’t waste your time searching the internet for this information – members can download CMA’s Payor Profiles free of charge.
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, managing editor for AAPC, a training and credentialing association for the business side of health care.
Claims for level 5 established outpatient visits (CPT® 99215) have been targeted by Centers for Medicare & Medicaid Services (CMS) Recovery Audit Contractors (RACs), as well as private and government payers, following a 2012 Office of Inspector General (OIG) report that claimed providers have reported higher level E/M codes for all types of E/M services in recent years. This shouldn’t discourage providers from reporting 99215, when appropriate, but you should keep the following points in mind.
Medical necessity trumps all. The number one requirement driving any medical service is always medical necessity. Medicare’s Claims Processing Manual, Chapter 12, section 30.6.1.A, stipulates:
Medical necessity of a service is the overarching criterion for payment in addition to the individual requirements of a CPT® code. It would not be medically necessary or appropriate to bill a higher level of evaluation and management service when a lower level of service is warranted. The volume of documentation should not be the primary influence upon which a specific level of service is billed.
In other words, the level of service billed must be commensurate with a patient’s presenting problem or chief complaint. If the reason for the patient encounter is not documented, you cannot report the service. If the patient presents without either a complaint or signs/symptoms (e.g., follow-up, annual exam, etc.), you cannot report a problem-focused E/M service, but should instead turn to preventive medicine codes.
HPI demonstrates medical necessity. Medical necessity is demonstrated based on information captured in the history of present illness (HPI). Documentation quality matters more than quantity. The information should be relevant to the presenting problem(s), and it should seek to answer the questions each HPI element asks, as follows:
- Location: e.g., back pain, nasal congestion
- Quality: e.g., sharp or shooting pain, dry cough
- Severity: e.g., extremely nauseated, moderate pain
- Duration: e.g., onset two weeks ago
- Timing: e.g., worse in the mornings, occurs constantly
- Context: e.g., dizzy upon standing, worse after exercise
- Associated signs/symptoms: e.g., chief complaint of nausea accompanied by associated symptoms of vomiting and diarrhea
- Modifying factors: e.g., no relief from over-the-counter meds, improves with rest
Note that only the performing provider may document HPI. Copying the nurse’s notes or patient responses in a questionnaire does not count.
Diagnosis alone doesn’t justify a high-level E/M. Follow-up visits with critically (or terminally) ill patients won’t necessarily call for a high-level E/M service. For example, when a patient is in the middle of chemotherapy, and no adverse reactions are reported or no new complaints are noted, the visit would not merit a high level just because there is a cancer diagnosis.
MDM is the single best indicator of E/M service level. In the everyday struggle to assign E/M codes, medical decision-making (MDM) is usually the best indicator of the E/M service level. When two of three components (history, exam or MDM) are necessary to support the level of service (as is the case with 99215), CPT® does not require that MDM must be one of those elements. Generally speaking, however, the history and exam should approximate the level of MDM, because MDM influences the extent of history and exam that are required. For example, the use of documentation templates can make it too easy to document more detail in the history and exam than is necessary, which can lead to upcoding.
Reserve 99215 for the sickest patients. The “sickest” patient does not mean the patient is heading to the emergency room or to the hospital for admission (although such patients would surely qualify). The “sickest” patient, in this context, can be the patient with multiple stable chronic conditions that require ongoing monitoring to assure that the patient is compliant with the treatment plan, and that the treatment plan is effecting the desired outcome. Identifying non-compliance or ineffective treatment may present a higher risk to the “sickest” patient.
CMS specifically allows for providing the status of chronic illnesses as an alternative method to describe the history of the presenting problem. To count as HPI, the name of the illness must be stated, along with the status of the illness and a description of the treatment plan. Be sure to document your decision-making processes by listing any possible concerns regarding the status of multiple chronic conditions. This will assist in identifying the “sickest” patients, and provide clarity in supporting medical necessity for 99215.
“Thank you, CMA, for your dedicated help and persistence in resolving our issues. We appreciate all you do."
Eric Mariotti, M.D.
CMA member since 1999
ANTHEM BLUE CROSS: CalPERS Health Plan – EFT, ERA and EOB changes. Effective August 2014, payments issued for CalPERS PPO plans administered by Blue Cross will change, allowing claims processed for the same payee ID at the same address to be paid as a single payment instead of being processed as separate payments for each claim.
In addition, providers who are currently registered for Electronic Funds Transfer (EFT) with Anthem Blue Cross will begin receiving payments via EFT in lieu of paper checks. Providers who have elected to receive their claim payment details via an 835 Electronic Remittance Advice (ERA) will also now receive those details electronically.
Providers who have elected to continue receiving paper checks will also see claims combined into one payment, including a one-page summary remittance indicating the number of claims paid and the total dollar amount of the payment. Detailed claims payment explanations of benefits (EOB) will be provided separately from Anthem Blue Cross either as a paper remittance advice or an 835 ERA. Participating providers will also be able to view the detailed EOBs on the provider portal at https://provider2.anthem.com/wps/portal/ebpmybcc.
For questions related to the changes to CalPERS Health Plan claims payments and EOBs, contact Anthem Blue Cross CalPERS customer service at (877) 737-7776.
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
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.
10/1: Family Medicine, Frontline of Care: Family Medicine specialists are often gatekeepers under many payor models, and face competing pressures from the patients to gain access, the payors to control cost, and potentially third party vendors (e.g. durable medical equipment providers) that may offer to help to provider by providing completed referral forms etc. that are not in the physician’s best interest. This webinar will review strategies to help the provider take a pro-active approach to dealing with these external pressures, as well as review basics in documentation, prescribing, referring, and practice management.
10/8: Protect and Preserve Your Patient Relationships: Presented by the Department of Health Care Services (DHCS), this webinar will help you increase understanding and awareness of the impact of fraud, waste and abuse on patient care, and discuss methods to prevent abuse and ways to preserve the integrity of the physician/patient relationship.
10/29: Managing Up! For Managers: Managers, administrators and CEOs in medical practice positions need to successfully learn to supervise staff or manage down but also to achieve results by influencing their physician bosses by managing up. Learn techniques from Debra Phairas, President Practice & Liability Consultants, who has worked with over 1700 practices and recruited over 100 medical practice administrators.
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.