DMHC Proposal Would Prevent Physicians from Billing for Services Rendered

[CAL/AAEM News Service]

DMHC Proposal Would Prevent Physicians from Billing for Services Rendered

Source: California Medical Association 
(http://www.calphys.org/html/physicianleader0806.asp?anchorID#fullstory)
Date: August 25, 2006


Dear Colleagues,

Click here for an important update for physicians on one of CMA's most challenging
advocacy issues. Please read the material that follows this message about new proposed
Department of Managed Health Care (DMHC) regulations that could affect your ability to
bill for services rendered and what CMA is doing to counteract them. 

The DMHC recently proposed new regulations that would inhibit physicians’ ability to bill
for services rendered, potentially devastating the delivery of emergency care in
California. 

These regulations attack the future viability of physician practices, while doing nothing
to solve the real underlying issue of for-profit HMOs refusing to pay fairly for
emergency care. 

The issue is not about billing patients, the issue is underfunding of ER care by health
insurance companies on two fronts—the failure by insurers to pay noncontracted physicians
fairly for care provided to ER patients, and the failure by insurers to adequately value
ER services through capitation payments to medical groups.

CMA policy is to oppose any plan for banning billing for services rendered. I want you to
know that CMA is doing everything it its power to stop these regulations. Below you will
find more details about the regulatory and legal fight ahead.

READ ON

Sincerely,
Jack Lewin, MD - CMA CEO

 

 

DMHC Proposal Would Prevent Physicians 
from Billing for Services Rendered

The proposed regulations were filed in response to an executive order issued last month
by Gov. Arnold Schwarzenegger, which directed DMHC to stop physicians from billing
patients for emergency care. 

The regulations would prevent physicians from billing for services rendered, modify the
Gould criteria, and set up a dispute resolution program. The regulations are now posted
on the DMHC website for review: http://wpso.dmhc.ca.gov/regulations/#1. 

CMA ADVOCACY WILL BE ON 
MULTIPLE BATTLEFRONTS

Regulatory and legal fight. CMA policy is to oppose any plan for banning billing for
services rendered. CMA legal counsel is prepared to fight the proposed regulations
through the regulatory process and sue if the regulations are adopted as proposed. CMA is
in the process of retaining legal counsel for those purposes. CMA has obtained the
documents upon which DMHC is basing its proposed regulations and has begun to research
the facts surrounding the Administration’s sudden determination to propose such drastic
and damaging regulations. 

Media advocacy campaign. CMA hired a media advocacy expert who, in collaboration with the
CMA’s staff and political consultants, is crafting an offensive public relations
strategy.

Grassroots campaign. CMA is developing a grassroots campaign and will be working with
county medical societies to find physicians for a speakers’ bureau (which could involve
media interviews, speaking to community groups or writing letters to the editor). Contact
Susan Bassett at 916/444-5532 or sbassett at cmanet.org to volunteer. 

Partnering with specialty societies. CMA hosted a teleconference with the California
Chapter of the American College of Emergency Physicians, the California Society of
Anesthesiologists, California Association of Ophthalmologists, and the Osteopathic
Physicians and Surgeons of California to present a unified physician voice in opposition
to the proposed regulations. Specialty medical societies interested in joining the
coalition should contact Francisco Silva at 916/444-5532 or fsilva at cmanet.org.

Legislative strategy. CMA is crafting legislation and advocacy strategies for
introduction in January – the beginning of the 2007-08 Legislative Session.

TELL YOUR COLLEAGUES
The public comment period on the regulations is open until October 2, 2006. Individuals
who wish to comment on the regulations are required to submit their first and last name
only (other contact information is optional). It is critical for the DMHC to hear from
physicians directly during the comment period on the potentially devastating effect of
these regulations. Physicians are encouraged to review the regulations closely and
consider providing professional comment on the potential effect of the regulations on the
practice of medicine in California, and most importantly, the delivery of emergency care.
CMA is developing material for physicians to consider including/addressing in their
comment on the regulations. That material will be posted to the CMA website next week.
Directions on commenting are available on the DMHC website
http://wpso.dmhc.ca.gov/regulations/#1.

CURRENT STATUS
CAPG wasted at least $50,000 to run a full-page advertisement this week in the Sacramento
Bee thanking the Governor for the regulations. As expected, their ad did not generate a
single “real” news story and was virtually ignored by the Legislature. Prospect filed a
lawsuit against a physician on August 24. Clearly physicians must be unified and strong
in order to defeat the regulations and shine the light on for-profit HMOs who are
underfunding emergency care as their profits grow.

THANK YOU FOR YOUR HELP
Additional strategic tactics are being developed and CMA is holding teleconferences and
meetings to keep specialty groups and county medical executives informed


Cyrus Shahpar & Brian Potts 
Managing Editors, CAL/AAEM News Service
University of California, Irvine

The CAL/AAEM Archives are available at: http://maillists.uci.edu/mailman/public/calaaem/


__________________________________________________
Do You Yahoo!?
Tired of spam?  Yahoo! Mail has the best spam protection around 
http://mail.yahoo.com