The Southern California Physician, September, 2001

SBCMS/CMA Working for You

SBCMS/CMA offers a variety of valuable resources and services to assist member physicians and physician groups with payment, financial and medical practice management related problems. This is how we work to improve your contracting, operational and fiscal stability:

Economic Advocacy

• Medi-Cal Rate Increase - won a 17½ % percent average rate increase and will continue to seek more.
  
• Medicare Increase - helped obtain a 5% increase by adjusting the Sustainable Growth Rate.
  
• MedPartners Payments - secured $45 million in payments to physicians.
  
• Workers Compensation Increase - won an increase in the E & M conversion factor.
  
• Medicare Evaluation and Management - stopped HCFA's burdensome 1997 documentation guidelines.
  
• Medicare Rates Paid by Medicare Secondary Payers - aggressively advocating that Medicare secondary payers must pay Medicare rates. Recently, CALPERS, the largest California purchaser, required Blue Cross to pay Medicare rates.
  
• MICRA - protected MICRA against trial lawyers' attempts to raise the malpractice cap.

Court Advocacy

• CMA vs. For Profit Health Plans (RICO) - filed a class action lawsuit against California's major for-profit health plans to preserve the viability of California's healthcare delivery system. CMA is only seeking injunctive relief to prohibit these plans from continuing a host of unfair business and financial practices.
  
• Blue Cross Class Action Lawsuit - filed a class action lawsuit for CMA members charging that Blue Cross' 1993, 1994 and 1995 fee reductions violated contracts with physicians. CMA won the right to arbitrate the fees on behalf of all members.

Legislation Signed Into Law

• AB1455 - Payment Practices - establishes a payment dispute resolution process and penalizes health plans for patterns of unfair payments (slow, low & no pay).
  
• SB168 - FFS Vaccine Reimbursement - requires health plans to reimburse physicians for any new vaccines on a fee-for-service basis until contracts can be renegotiated.
  
• SB2136 Multiple Quality Office Audits - requires the Department of Managed Health Care to implement a uniform physician quality audit.
  

Other Advocacy

• Physician Medical Group Insolvency - more than 90% of physician medical groups in California are in financial peril. SBCMS/CMA supports legislative action to address this serious problem, including support of measures to ensure actuarially sound capitation rates and eliminating physicians' risk for pharmacy and hospital services.
  
• Access to Healthcare - nearly 7 million Californians do not have health insurance. SBCMS/CMA supports efforts to extend coverage to working parents and others that are not now covered by employer-provided or private health insurance.
  
• SBCMS/CMA strongly believe in preserving adequate programs that provide healthcare to needy Californians, including the federal Healthy Families Program.
  
• Public Health - working in partnership with the state's healthcare community and various grass-roots efforts, SBCMS/CMA is forging a plan for
  

Publications

• Monthly Southern California Physician
  
• Quarterly California Physician
  
• Bi-Annual Membership & Medical Resource Directory
  
• California Physician's Legal Handbook
  
• CMA Alert, concise legislative & legal update, sent weekly via e-mail
• Inland Empire Medicine, a bi-weekly fax with local, state and national updates
  

Opportunities for Involvement

• Gain access to CMA House of Delegates & SBCMS's governing body, committees or participation in a Mode of Practice Forum.
  
• Obtain Political Clout via Key Contacts Program
  
• CMA Young Physician Section
  
• Medical Student & Resident Sections

Resources & Services

• SBCMS/CMA's Reimbursement Hotline -888.401.5911 - reimbursement experts provide physicians personal assistance with their specific reimbursement issues.
  
• Medical Group/IPA Bankruptcy and Insolvency Assistance - provides assistance to medical groups, IPAs and their subcontracting specialists facing insolvency, closure or bankruptcy.
  
• Contract Analysis - contracted attorneys provide you detailed contract analysis. Analyses of widely distributed contracts are available free to members at www.cmanet.org.
  
• CMA On-Call - informational documents with answers to frequently asked reimbursement and managed care questions, sample letters and information about laws that protect you. Call 800.592.4CMA or visit www.cmanet.org.
  
• CMA Physician Reimbursement Resource Guide - a comprehensive manual to help you with coding, billing, documentation, payment collections & appeals issues.
  
• CMA Model Managed Care Contract - to obtain a copy, visit www.cmanet.org, select CMA "On-Call" and find document #1069 or call 800.592.4CMA.
  

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