Volume 8, No. 8
Meeting with Blue Cross
On Friday, January 12, CSA President Mark Singleton, M.D., and other CSA representatives met with Blue Cross Medical Director Anthony Nguyen and other Blue Cross representatives regarding problems related to payments for anesthesia for colonoscopy.
The discussion about claims processing for anesthesia with colonoscopy was productive. Having reviewed several denied claims prior to the meeting, the Blue Cross representatives understood the concerns raised regarding implementation of the medical review criteria for anesthesia with colonoscopy. We arrived at several agreements related to documenting medical necessity, educating physicians and claims processing:
CSA will further educate its members about the medical necessity criteria and that it should be supported in the anesthesia record. Denied claims often do not have any reference to the medical necessity criteria in the anesthesia record.
Blue Cross will process claims that have appropriate medical necessity criteria checked off on the form derived from the Blue Cross policy and, if necessary, do post-payment review.
Blue Cross will further educate referring physicians on the need to be judicious about requesting anesthesiologists' services only when medically necessary.
Blue Cross will urge referring physicians and CSA will urge its members to obtain pre-approval for anesthesia services with colonoscopy.
Blue Cross will clarify to customer service representatives that they should not tell patients they have no obligation to pay for their anesthesia after the patient has been told the anesthesia probably will not be covered and signs a financial responsibility form.
These changes should greatly reduce denials and appeals, resulting in more legitimate claims being paid. Perhaps most important, we agreed to work in collaboration on addressing this and other issues that may arise in the future.
Blue Cross officials noted that the vast majority of anesthesia claims are paid and that the rate of anesthesiologist attended colonoscopies is about 3% - 5% throughout the state. Some facilities have a rate of up to 25% of cases involving an anesthesiologist, and where significant differences in the frequency exist, claims may be subject to greater scrutiny.
Please contact Barbara Baldwin for more information.
The Governor's Health Plan Proposal
The Governor announced his new health care proposal on January 9, 2007. The proposal focuses on the themes of prevention, coverage and affordability. Specifically, the proposal includes a Medi-Cal and Healthy Families expansion, an individual mandate, employer mandate, insurance market reforms, easing of licensure requirements for physician extenders, tax system reform and a physician/hospital tax.
The proposal is more of a concept paper about California health care reform. At this point, very little of it has been translated into legislative language. Assembly Speaker Nunez has announced his plan, but has only introduced a skeleton bill as a placeholder. Senate President Pro Tem Perata has introduced SB 48 which provides for an individual mandate and insurance purchasing pool. It is similar to the Governor's proposal but will be fleshed out later. No legislation to carry out the Governor's proposal has yet been introduced.
Until there is far more detailed legislation to analyze, answering the many likely questions of CSA officers and members is not possible. Much of the proposal could well be the floating of many trial balloons. No proposal of this size or complexity advanced in January has ever looked the same when it takes final form in August or September. "Don't panic or get overly alarmed about the initial presentation. The effort will be a 'work in progress' for some time" was the admonition to CSA lobbyists last November by Herb Schultz, the chief architect of the Governor's proposal.
CMA Legislative Day, April 24
The legislature has many new members, some with little knowledge of health care issues in California. With the Governor's reform proposal and the groundswell of interest in addressing the problem of providing coverage for the uninsured, it is of critical importance that anesthesiologists get to know their state representatives. To that end, the CSA urges members to identify their legislators and meet with them at their district offices in the next few months. Click on http://www.legislature.ca.gov/legislators_and_districts/districts/districts.html and enter your zip code to access their information.
Talking points are being prepared to help members focus on a few key issues, along with pointers on how to be effective in meeting with your representatives. Prototype letters also will be offered on the CSA web site. GASPAC members have an extra incentive to meet their representatives, to insure their donations are well spent.
In addition, the California Medical Association will hold its annual legislative day on Tuesday, April 24 in Sacramento. The CSA will reimburse travel costs (mileage or 14-day advance airfare) for members to attend and sit with the CSA delegation, and later make visits to the Capitol. Notify Michael Whitelock at the CSA office if you plan to attend. Details will be provided as soon as they are available.
Automated CME Modules will go Live on the CSA Web Site on January 29, 2007
The new automated version of the CSA CME Program in Pain Management and End-of-Life Care will be live on the CSA Web site on January 29. For those of you who did not make the December 31, 2006, deadline to complete these 12 CME credits in compliance with AB 487, you may still do the modules, complete the self-assessments, and print your own CME certificates. For those of you who were not licensed by the end of 2002, you have four years from the date of licensure to complete the requirement for 12 CME credits for pain management and end-of-life care.
CSA will offer an Obstetric Anesthesia CME Program consisting of four modules. The first module will be published in the spring 2007 issue of the CSA Bulletin. The remaining three modules will be published in each of the next three Bulletin issues and, after publication, will be available on the CSA Web Site. Each module is worth one CME credit and is free to CSA members. Non-members may complete the modules for $25 each.
CSA Needs Your Correct Home Address
We are currently updating our database and one of the important new features will be the ability to provide members with targeted legislative information and the correct state and federal lawmakers for each member. CSA does not make member information, including home address, available to any third party. This information is used to support legislative advocacy on behalf of CSA members and the profession. Simply log on to the CSA Web Site and click on the Member Profile Update on the right-side navigation bar to enter your home address.
Nominations for 2007 Elections Are in the Mail!
Nominations information for district directors, CSA delegates and alternate delegates, lists of eligible members, and nomination forms for the 2007 elections have been mailed to the members of each district. Please complete your nomination forms and return them to the CSA office no later than February 22. If you wish, you may view the vacant offices for your district online in the members only section under elections. A list of eligible members and a copy of the nomination form are also available in PDF format from the Web site.
CSA/UCSD Annual Meeting and Clinical Anesthesia Update
This year's meeting will be held in San Diego at the Sheraton San Diego Hotel & Marina from May 31 through June 3, 2007. Registration fees have been reduced for CSA members. Brochures were mailed recently and include the CME program, governance, hotel and other information. Saturday afternoon is free this year so attendees and their families can enjoy the San Diego area. Star Destinations, a tour company, will be available to help everyone make the most of their visit. Registration for the seminar is available online at the CSA Web Site.
Mark A. Singleton, M.D.