Tuesday, August 21, 2018

OCMA Blog

CALL TO ACTION: CONTACT CONGRESS AND URGE THEM TO PROTECT HEALTH CARE TODAY!

Congress has three weeks left to stop the 26.5 percent Medicare sustainable growth rate (SGR) physician payment cuts (to take effect on January 1, 2013) before they adjourn for the holidays. The Orange County Medical Association urges physicians to keep the pressure on Congress to stop these cuts.

Call AMA's Grassroots Hotline, (888) 434-6200, to be connected with your members of Congress.

Description

Members of Congress have returned to Washington, D.C. for a Lame Duck Session to address the so-called "fiscal cliff" issues affecting the future of medicine and our country. These issues must be addressed before January 1, 2013 or the following occurs:

  •  26.5 percent Medicare physician fee-for-service rate cut because of the SGR formula;
  • Across-the-board spending cuts known as "sequestration" - $109 billion/year. While Medicaid is exempt from the sequestration cuts, the Medicare program faces 2 percent cuts; Defense takes $500 million in cuts and the rest comes from domestic programs.
  • Expiration of the Bush 2001 and 2003 tax cuts (including individual rates, capital gains, dividends, child tax credit, marriage penalty reduction, and the estate tax).
  • The Alternative Minimum Tax patch expires.
  • The Social Security Payroll tax cut expires.
  • Unemployment benefits extension expires.

It is important that members of Congress work together in a bipartisan way to resolve these vital issues and avoid going over the "fiscal cliff." Most economists speculate that if Congress fails to act, economic growth will drop significantly, unemployment will rise, and the country will slip back into a deep recession. 

CALL your members of Congress and urge them to work together to stop the Medicare SGR physician payment cut of 26.5 percent and the Medicare sequestration cut of 2 percent before they take effect on January 1, 2013.


How to contact members of Congress:

Phone:  Call AMA's Grassroots Hotline, (888) 434-6200, to be connected with your members of Congress. You will be asked to enter your zip code and select your Representative.

Email: Federal legislators must be contacted via the email forms on their websites: www.writerep.house.govwww.boxer.senate.gov and www.feinstein.senate.gov.


Talking Points

Urge California Senators and your member of Congress to:

  • Repeal the Medicare SGR and stop the 26.5% physician payment cut.
  • Stop the Medicare 2% Sequestration Cut.    
  • Adopt long-term Medicare Payment Reform.
  • Update the California Medicare Geographic Payment Localities.
  • Stop Medicaid and Other Health Care Cuts  


Background

Tough decisions will have to be made in the coming weeks but Congress must make Medicare funding a top priority. We can't allow Congress to ignore the nearly 30 percent Medicare cuts facing physicians and patients in California. Such cuts will certainly harm access to doctors for seniors, military families and potentially all California patients because private insurers follow Medicare. 

 

Moreover, comprehensive reform of the Medicare physician payment system is long overdue. Working together, CMA, AMA, the national specialty societies and state medical associations are currently developing an alternative Medicare payment system that will stabilize the Medicare program and promote high quality, high value care. Physicians are leading the way. But first, Congress must act responsibly and stop the scheduled Medicare SGR payment cut of 26.5 percent. Such cuts seriously threaten the viability of California physician practices and your ability to care for patients. Physicians are also important employers crucial to the California economy.

 

In recent days, Senate and House Republicans have forwarded a proposal to cut the Affordable Care Act (ACA) Medicaid (Medi-Cal) physician payment increase as a way to fund the fiscal cliff issues. CMA is opposed to such cuts. California Medi-Cal rates are already some of the lowest in the nation - 50 percent below Medicare. Because of these low rates, 75 percent of physicians cannot afford to participate in Medi-Cal and thus, 50 percent of Medi-Cal patients can't find a physician. Regardless of the ACA, California needs the Medi-Cal rate increase to protect access to care. 

 

CMA will also be working to stop sequestration budget cuts to other vital health care programs, such as public health and graduate medical education (GME).

 

Finally, CMA is pursuing an update to the Medicare physician payment localities in the Medicare/Budget Sequestration legislative package. California's localities have not been updated and thus, 14 urban counties are still designated as rural and physicians in these counties are paid up to 14 percent less than their urban counterparts.  


OCMA Selects Citizens Business Bank as Preferred Business Partner

Irvine, Calif., Nov. 13, 2012 – The Orange County Medical Association is pleased to announce another benefit of membership.  The OCMA has designated Citizens Business Bank as a Preferred Business Partner for physicians seeking deposit and lending services for their professional or personal needs. 

Citizens Business Bank offers a comprehensive array of credit products and services designed to meet the specific needs of OCMA members, including: working capital loans, equipment loans and leases, real estate loans and SBA loans.  Citizens Business Bank also offers accurate and reliable depository accommodations that provide convenience and flexibility for busy professionals, so that they can spend less time banking and more time focusing on their patients.

Citizens Business Bank has a reputation as one of the safest, strongest and best managed business banks in the United States.  Their specialists are ready to help support OCMA members with the personal attention and customized solutions needed for their practices to grow. 

Citizens Business Bank provides banking services throughout Orange County at its seven Business Financial Centers located in Brea, Fullerton, Orange, Santa Ana, Irvine Spectrum and Laguna Beach.  Founded in 1974, the bank is the largest financial institution headquartered in the Inland Empire with assets of $6.3 billion and 41 business financial centers statewide.    

The strategic business partnership with Citizens Business Bank reinforces OCMA’s commitment to bring added value to its members by aligning with companies who offer business practice expertise, allowing physicians to focus their attention on patient care.

About CVB Financial Corp.

CVB Financial Corp. is the holding company for Citizens Business Bank.

Shares of CVB Financial Corp. common stock are listed on the NASDAQ under the ticker symbol of CVBF.  For investor information on CVB Financial Corp., visit the Citizens Business Bank website at www.cbbank.com and click on the Our Investors tab.

For more information contact Arthur Bergmann, Vice President & Manager -- asbergmann@cbbank.com -- work: (949) 581-4444 cell: (714) 864-0378


The Doctors Company Announces Five-Year Anniversary of the Tribute Plan

Career Award Represents Tangible Proof of Membership for Nearly 20,000 Doctors in California

The Doctors Company is the sponsored medical liability carrier of the Orange County Medical Association (OCMA). We share a joint mission of supporting doctors and advancing the practice of good medicine.

One of the many advantages of coverage with The Doctors Company is the Tribute® Plan, a significant financial benefit that rewards doctors for their loyalty to The Doctors Company and for their dedication to outstanding patient care. This year marks the Tribute Plan’s fifth anniversary.

“The Tribute Plan is recognition of a career spent practicing good medicine,” said Richard E. Anderson, MD, FACP, chairman and CEO of The Doctors Company. “In the last five years, more than 1,300 Tribute awards have been distributed, and over 22,700 members of The Doctors Company have qualified for awards when they retire from the practice of medicine. These members have an average Tribute balance of $11,500, and the highest distribution to date is $88,708.”

A special Tribute Plan five-year anniversary video—featuring details about Tribute, perspectives from members of The Doctors Company, and commentary from Dr. Anderson—can be viewed at www.thedoctors.com/tribute.


About The Doctors Company


Founded by doctors for doctors in 1976, The Doctors Company (www.thedoctors.com) is relentlessly committed to advancing, protecting, and rewarding the practice of good medicine. The Doctors Company is the nation’s largest insurer of physician and surgeon medical liability, with 71,000 members, $4 billion in assets, an A (Excellent) rating from A.M. Best Company, and an A (Strong) rating from Fitch Ratings.


Medi-Cal Requiring Re-Enrollment

The California Department of Health Care Services (DHCS) will soon be notifying physicians that they must re-enroll in Medi-Cal as one of the provisions of the Affordable Care Act (ACA). The ACA requires every state Medicaid program (Medi-Cal in California) to re-validate provider enrollment information at least every five years  beginning January 2, 2013.

DHCS is currently working to identify an initial list of all physicians and other providers who will be required to re-validate. Notices of re-validation will be mailed beginning the second week of January 2013. Notices will be sent to business location on file with DHCS. Each notice will include information on which application(s) must be completed. Anyone receiving a notice must complete and return the requested form(s) and required attachments within 35 working days of the date of the notice. Failure to do so may result in payment delays.

Physicians who have re-validated, updated or submitted new applications to the Medicare program within the last 12 months (January 1 through December 31, 2012) will not be required to re-validate at this time. However, your Medicare enrollment information must match the information on file with the Medi-Cal program. If it does not you will receive notice from DHCS requiring you to re-validate.

The California Medical Association (CMA) and DHCS have worked collaboratively over the past year to establish a phased, tightly-controlled re-enrollment process within the confines of current state and federal laws and regulations.

In addition, CMA will host two live webinar training courses with representatives from DHCS to walk attendees through the Medi-Cal enrollment process for both individual providers and groups. Also to be discussed will be program requirements and how to avoid common mistakes that can lead to delays, denials and exclusion from the Medi-Cal program. These extended-length webinars will be held November 15, 2012, and January 16, 2013, from 12:15 to 1:45 pm. These webinars are free and open to everyone.

OCMA/CMA members can contact the CMA reimbursement helpline: (888) 401-5911 or economicservices@cmanet.org


Anthem Blue Cross Amending Some Physician Contracts to Include Individual/Exchange Product

On October 24, Anthem Blue Cross sent a notice to 8,345 physicians who are part of the Blue Cross Select PPO network announcing its intent to participate in the California Health Benefit Exchange, the state's new insurance marketplace called for under the Affordable Care Act.  Beginning in 2014, individuals and small business will be able to purchase health insurance using tax subsidies and credits from the exchange.

 

According to the notice, Blue Cross will be creating a new provider network called the "Anthem Individual/Exchange Network," which will serve both individuals who purchase coverage through the exchange and individuals who purchase coverage from Anthem Blue Cross in the individual market outside of the exchange. In other words, the fee schedule would apply to all individual business, whether bought on or off of the exchange. 


Blue Cross has clarified for the California Medical Association (CMA) that this fee schedule change will not apply to Small Business Health Options Program (SHOP) business purchased through the exchange.


It's important to note that the letter also states that Blue Cross is amending the physician's Blue Cross Prudent Buyer Agreement to automatically include the new individual/exchange network, effective January 1, 2014. The new fee schedule associated with this product was included with the notice.

CMA has been actively working with exchange stakeholders to address significant concerns regarding the exchange grace period, monitoring of network adequacy and clinician-level performance measurement in qualified health plans offered in the exchange. (Click here for more information about contracting with exchange plans.)  


Though not mentioned in the Blue Cross cover letter, Sections VI and VIII of the enclosed amendment provide instructions for physicians who wish to opt out of the individual/exchange network. Physicians who do not wish to participate in this network must notify Blue Cross of their intent to opt out by December 31, 2012. Opt out notices should be in writing and sent via certified mail, return receipt to the address specified in Section VI of the amendment.


CMA is working with Blue Cross to obtain additional clarification on the amendment and will provide updates as they are received.

Please note that a small subset of Select PPO Network physicians did not receive the October 24 notice automatically opting them into the individual/exchange network. This subset of physicians received a notice from Blue Cross dated October 9 regarding fee schedule reductions. Physicians who choose to discontinue participation in the Select PPO network at the reduced rates have until December 14 to notify Blue Cross in writing.

As always, physicians are encouraged to carefully review all proposed amendments to payor contracts. You do not have to accept substandard contracts that are not beneficial to your practice.


Physicians who did not receive a letter and are unsure whether they are affected by this change or those who have general questions about the amendment can contact Blue Cross's Network Relations Department at (855) 238-0095 or networkrelations@wellpoint.com.


OCMA/CMA members can contact the CMA reimbursement helpline: (888) 401-5911 or economicservices@cmanet.org


OCMA Specialty Spotlight: The Pocket Dietitian

Developed by Dr. Eric Wechsler of Newport Beach, The Pocket Dietitian™ offers a personalized dietary prescription for easy use on the iPhone or iPad. Based on the expertise of a registered dietitian, and board-certified nephrologist, The Pocket Dietitian™ targets a variety of ailments: chronic kidney disease (CKD), end-stage renal disease (ESRD), hypertension (high blood pressure), diabetes, and obesity. People with these ailments, or a combination of them, will benefit most from using this product.

Poor dietary decisions in patients with one or more of these diseases can lead to dire medical outcomes, including increased risk of congestive heart failure, cardiac arrhythmias, accelerated decline in kidney function, early coronary artery disease, and even pre-mature death.

As a nephrologist, Dr. Wechsler has intimate knowledge of the power of healthful eating combined with proper medical care. Many scientific studies indicate that a proper diet can either decrease medication requirements or improve their efficacy. Additionally, following a recommended diet for specific illnesses can improve quality of life and increase longevity.

The Pocket Dietitian™ App was designed with the user in mind. It's pragmatic enough so that planning a   single meal is simple; yet it's comprehensive enough to analyze and integrate a host of complex dietary recommendations for patients with CKD, ESRD, hypertension, diabetes, dyslipidemia, cardiovascular disease, and obesity. It also knows that these diets occasionally contradict one another - so the final recommendation will provide an accurate dietary prescription.

How does it work?


Before using The Pocket Dietitian™ for the first time, the user answers a questionnaire found at the registration of the app. The Pocket Dietitian™ then calculates a dietary recommendation based on a number of dietary guidelines using, but not limited to, the Harris-Benedict Equation and the Body Mass Index calculation, combined with the accepted dietary guidelines recommended by the American Diabetes Association, National Kidney Foundation, American Heart Association and the American Dietetic Association.

From the home page, the user is able to add food to the diary. The Pocket Dietitian™ App then calculates the nutritional information and alerts the user to foods that may expend too much of their daily total. The Pocket Dietitian™ at this point will then suggest a healthier food option. There is even a quick list of super foods that are almost always good to eat in the right proportions.

With a real-time color-coded bar graph the viewer can visualize how the food items affect one's daily nutritional requirements for the day. Our goal is to help individuals maintain a balanced approach to their daily meals and avoid eating foods that lead to a disproportionate consumption of their tracked nutrients. For example, eating a twelve-ounce steak at lunch may consume more than 50% of one's recommended sodium and fat intake for the entire day. The Pocket Dietitian™ App will recommend several options: either decreasing the portion size, or offering an alternative, such as an  eight-ounce chicken breast. This real-time dietary assessment will help educate users on the impact food has on their bodies.

The Pocket Dietitian™ allows one to harness the most information and best available options as quickly as possible, leading to informed decisions. The user will enjoy healthful eating, and, in turn, learn more about the effects of food on overall wellness and longevity.



In 2012, Dr. Wechsler developed a mobile medical application for the iPhone, called The Pocket Dietitian. His motivation stemmed from witnessing the struggles his patients were having adhering to their dietary restrictions while maintaining a healthy, balanced diet. On a daily basis, the patients expressed confusion about what they were supposed to eat while also feeling a significant loss in their quality of life when dietitians would tell them they could never eat their favorite foods again. This mobile application was designed to provide more freedom and understanding of the various medical dietary   prescriptions and offer a simulated experience to a dietitian, on a real-time basis.


 Also, in 2012, Dr. Wechsler was asked to be the medical director of a dialysis company, called First Learn Balance. This will be unlike any dialysis unit ever developed, focusing on complementary medicine including yoga, Tai Chi, acupuncture, as well as nutrition education and lifestyle management. Dr. Wechsler hopes to develop ways to minimize some of the detrimental effects of dialysis and develop new modalities that can help improve the quality of life for dialysis patients.

Dr. Wechsler believes very strongly that kidney disease and the associated conditions of heart disease and diabetes can be prevented or slowed with early detection and treatment. His general philosophy in medicine is to educate his patients so they will be empowered to aid the doctor in treating their disease.

Dr. Wechsler states, "Without the patient's complete involvement in the process of medical management, even the brightest doctor in the world would be of little use."

 Dr. Wechsler is eager to work with new patients and continuously strives to expand his knowledge in different areas of nephrology including nutrition, dialysis, hypertension, weight loss, and disease prevention. 


Recovery Audit Contractor Overpayments: Pulmonary Diagnostic Testing and E/M Services

The Medicare Modernization Act of 2003 established the Medicare Recovery Audit Contractor (RAC) program to identify fraud and waste in the Medicare system.

The California Medical Association (CMA) has recently learned that RAC contractor Health Data Institute (HDI) is currently assessing overpayments for evaluation and management services billed without a modifier -25 on the same day as a diagnostic pulmonary study. Affected claims have dates of service of 2009 or 2010.

In order for a physician to receive payment for a E/M visit on the same day as a service in the pulmonary diagnostic range (i.e., any service in the series from 94010 to 94620), the physician must append a modifier -25 with the visit code, indicating that the patient's condition required a significant, separately identifiable visit above and beyond the diagnostic service provided. For additional information, please refer to The National Correct Coding Initiative Policy Manual (http://cal.md/ncci-manual). See Chapter 11, Evaluation and Management Services, Codes 90000 to 99999, Section J. Pulmonary Services.

Physicians should appeal the overpayment if medical record documentation supports the E/M code. Submit the medical record and request that the modifier -25 be appended to the E/M code. Redetermination request forms for RAC overpayments are available at http://cal.md/rac-redetermination.


OCMA Specialty Spotlight: Should Tissue from Mammoplasty be Examined by the Pathologist?

According to The American Society of Plastic Surgeons, 296,203 breast augmentations and 21,714 breast implant   replacements were performed in 2010. In 2011, after 60 cases of breast implant-associated anaplastic large cell lymphoma  (ALCL) became known to FDA, that agency issued a warning to patients who already had or were considering breast implants.1,2 Breast implant-associated ALCL is a rare type of lymphoma of T-cell lineage with clinical signs and symptoms of swelling, pain, pruritis and/or effusion around the implant.3According to a recent study in M.D. Anderson Cancer Center, patients who present with effusion without a distinct mass have an excellent nprognosis if the breast implant and fibrous capsule are removed. In contrast, patients who present with a distinct mass in the vicinity of the implant may have advanced stage or possibly systemic disease and poorer prognosis.4

One of 500,000 women receiving breast implants is estimated to develop implant-associated ALCL.5However, this frequency may be underestimated for the following reasons. Firstly, there are no standardized recommendations for pathologic examination of tissue excised during cosmetic surgery. The routine submission of tissue from that type of procedure is not typically considered the standard of care and is dictated by the individual and/or institutional policies. Secondly, there are no consensus recommendations for examination of the fibrous capsule surrounding the implant, where the lymphoma would be most commonly detected. According to a survey of 413 institutions in 1999, mostly in the United States, 10.7% had policies that exempted the submission of mammary   implants for pathology examination, and 63% had policies that recommended mammary implants for gross examination only, without distinguishing implants from capsulectomy specimens.6 Being more cognizant of the disease, one can surmise that the detection rate of ALCL will increase as more surgeons send the capsule and breast tissue surrounding the implant to pathology, and as pathologists submit more tissue for microscopic  evaluation.

In view of the above discussion, the following questions merit consideration. Should patients with breast implants have them removed for the fear of a malignancy? A negative response to this question would be appropriate; there is no ground for panic unless the patient experiences pain, swelling, retraction, or effusion around the implant. Should the implant, the surrounding capsule and breast tissue be submitted to pathology for both gross and microscopic examination, even though the likelihood of detecting a malignancy in this type of specimen is quite low? An affirmative response would be appropriate in this situation considering that in addition to ALCL, a very small    number of patients could harbor a clinically undetectable mammary carcinoma. 

Newport Coast Pathology (NCP), Inc. is committed to providing high quality care and exceptional anatomic pathology    services for the patient and the referring physician, respectively. Our pathologists treat every specimen as if it were their own or that of their family member. We strongly believe that the pathologist is an integral member of the team of physicians involved in the patient's care, and that communication between the pathologist and the clinician is essential to serving the needs of the patient. Our pathologists are available for consultation with referring physicians and their staff, any time. 

NCP offers a comprehensive menu of diagnostic tests, including: Histopathology, Histochemistry, Immunohistochemistry, Non-GYN Cytology, Cancer prognostic marker tests by various methods  

Newport Coast Pathology, Inc., was founded in 2010 by Mani Ehteshami, MD, a pathologist who recognized a need for a local laboratory that would provide personalized service. Dr. Ehteshami is certified in anatomic and clinical pathology by the American Board of Pathology, and has 17 years of post-fellowship experience and expertise in surgical pathology and cytopathology, specifically in gastrointestinal, liver, genitourinary and breast pathology. He earned a medical degree from Rosalind Franklin University of Medicine and Sciences in Chicago. Following the completion of his residency in anatomic and clinical pathology at the University of New Mexico School of Medicine in Albuquerque, Dr. Ehteshami was a fellow in oncologic surgical pathology at the University of Texas, M.D. Anderson Cancer Center in Houston, where he was trained by many internationally known academic pathologists including Drs. Kathy Foucar, Elvio Silva, Nelson Ordonez, and Ruth Katz. 

http://newportcoastpath.com/  T: (888) 463-3606 


Prior to relocating to Orange County, Dr. Ehteshami was the Medical Director and co-owner of a highly successful private anatomic pathology laboratory in northern California for 13 years. In addition, he held several key leadership positions including Medical Director of Clinical Laboratories, chair of the Pathology Department and chair of the Cancer Care committee at Shasta Regional Medical Center. He was interviewed by and published in Make [Me] Heal publication:"Checking for Breast Cancer when you Have Breast Implants", April 28, 2011 issue. He has affiliation with the following professional organizations: Fellow of the College of American Pathologists, Fellow of the American Society of Clinical Pathology, Member of the California Society of Pathologists, Member of the California Medical Association, Member of the Orange County Medical Association.

Before earning his medical degree, Dr. Ehteshami volunteered his services to educate and counsel patients with multiple sclerosis, and helped to establish housing for those patients. As the Chairman of the Patient Services Committee, a member of the Medical Advisory Committee, and a member of the Board of Trustees of National Multiple Sclerosis Society in Orange County, he was recognized for his outstanding volunteer service. Dr. Ehteshami is an avid runner who has raced in dozens of full and half marathons in the US and abroad. 


References

1. US Food and Drug Administration. Anaplastic large cell lymphoma (ALCL) in women with breast implants: preliminary FDA findings and analyses. 2011. Available at: http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm239995.htm. Accessed June 22, 2011.

2. US Food and Drug Administration. FDA medical device communication: reports of anaplastic large cell lymphoma (ALCL) in women with breast implants. 2011. Available at:  http://www.fda.gov/medicaldevices/safety/alertsandnotices/ucm240000.htm. Accessed January 26, 2011.

3. Keech JA Jr, Creech BJ. Anaplastic T-cell lymphoma in proximity to a saline-filled breast implant. Plast Reconstr Surg. 1997;100:554-555.

4. Anaplastic Large Cell Lymphoma Associated With Breast Implants: A Report of 13 Cases.  Aladily, Tariq N.; Medeiros, L. Jeffrey; Amin, Mitual B.; Haideri, Nisreen; Ye, Dongjiu; Azevedo, Sergio J.; Jorgensen, Jeffrey L.; de Peralta-Venturina, Mariza; Mustafa, Eid B.; Young, Ken H.; You, M. James; Fayad, Luis E.;  Blenc, Ann Marie; Miranda, Roberto N. American Journal of Surgical Pathology. 36(7):1000-1008, July 2012.

5. Kenkel JM. Discussion: anaplastic large cell lymphoma and breast implants: a systematic review. Plast Reconstr Surg. 2011;127:2151-2153.

6. Zarbo RJ, Nakhleh RE. Surgical pathology specimens for gross examination only and exempt from submission: a College of American Pathologists Q-Probes study of current policies in 413 institutions. Arch Pathol Lab Med. 1999;123:133-139.


Introducing: WorldPay

Irvine, Calif. - The Orange County Medical Association is pleased to announce another benefit of membership. The OCMA has designated financial processing partner WorldPay as its Business Partner for physicians seeking credit card processing solutions, check verification services, Cash Advance services and other processing technologies for the medical field.

OCMA members may receive complimentary consultations and discounted rates on a wide range of processing needs, including stand-alone terminals, integrating into current POS/Software systems, check verification services, wireless methods of payment, cash advance products and the latest in HIPAA and PCI Security. They process all card types such as VISA, MasterCard, Discover, AMEX, and JCB.

"Our Medical Professional Plan is designed to specifically help busy physicians protect their professional practices against fraud," said Andy Varble, Regional Sales Manager at WorldPay. "We offer quality credit card processing at an attractive rate while keeping each doctor PCI-DSS compliant which in turn keeps them HIPAA compliant. We look forward to offering our many services through this special arrangement to the OCMA membership."

The following services are included within WorldPay's healthcare practice: current credit card processing reviews at no cost, fraud protection reviews, PCI-DSS training to keep each doctor HIPAA compliant. WorldPay can offer integration with many of the physician-specific POS systems and software that is available on the market today along with check verification services and cash advance programs.

Carla Mullet, who has 19 years industry experience, has been chosen as the point of contact for the relationship between the OCMA and WorldPay. With her tenure she is experienced in every facet of credit card processing and the fraud prevention features that are unique to WorldPay. She uses a consultative approach with each doctor to ensure she understands completely their business model, current needs, and also keeps in mind the future growth strategies for each office with which she consults. Located in the heart of Orange County, Carla Mullet is local to meet face-to-face with each doctor and staff to ensure she is providing the best service, technology and pricing to their practice.

The strategic business partnership with WorldPay reinforces OCMA's commitment to bring added value to its members by aligning with companies that offer business practice expertise, state-of-the-art technology at a competitive price point, and allowing physicians to focus their attention on what matters most, patient care. 

For assistance please contact Carla Mullet at 714-878-2031 or Carla.mullet@worldpay.us 

Or contact Andy Varble at 714-380-1491 or andy.varble@worldpay.us 


Blue Shield Recontracting Effort Expanding to Orange County

Earlier this year, Blue Shield began recontracting with physicians across the state. The California Medical Association (CMA) has learned that physicians in Orange County will be next to see the new contracts.

Blue Shield has assured CMA that if a physician chooses not to sign the new agreement, his or her participation status with Blue Shield will not be affected.

The reason for the recontracting initiative, according to Blue Shield, is twofold: 1) Blue Shield has not done a large scale recontracting with physicians in over a decade, so the new contracts will allow Blue Shield to ensure consistency and compliance with new laws and regulations; and 2) Blue Shield is offering various tiered networks based on price point in anticipation of possible participation in California's Health Benefit Exchange.    

CMA continues to work with exchange stakeholders to address significant concerns regarding the exchange grace period, monitoring of network adequacy and clinician-level performance measurement in qualified health plans offered in the exchange.

Exhibit A of the new Blue Shield contract allows physicians to designate which products they are willing to participate in by product type.

While Blue Shield did update its fee schedule statewide on July 1, there is no fee schedule change associated with this recontracting initiative, with the exception of the Direct Contract HMO Medicare Advantage product.

Physicians are encouraged to carefully review and understand the vast range of legal and practical implications associated with the execution of any new contract and new product types. To assist physicians, CMA has completed an  analysis of the new Blue Shield contract, which is available to members in CMA's online resource library at  http://www.cmanet.org/resource-library.

For additional information on evaluating and negotiating complex managed care contracts, see CMA's contracting toolkit, "Taking Charge: A step by step guide to evaluate and prepare for negotiations with managed care payors."The toolkit is also available free to members in CMA's resource library.

The notice  directs physicians with questions about the new contract terms to contact Blue Shield Provider Services at (800) 258-3091.

Questions: CMA at (888) 401-5911 or economicservices@cmanet.org.


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