CMA delegates call for increased advocacy on duals transition Recognizing the challenges that California’s planned shift of Medicare and Medi-Cal dual eligible patients to managed care plans will pose to patients and the physicians that serve them, the California Medical Association (CMA) has adopted policy to help keep physician concerns in clear view of the agencies orchestrating the transition. The policy (Resolution 208-12), which was adopted at the CMA’s annual House of Delegates meeting, calls on the association to collect data from its membership regarding difficulties with the planned duals transition and, if difficulties are found to be widespread, report them to the California Department of Health Care Services, the California Department of Managed Health Care and the federal Centers for Medicare and Medicaid Services. During the floor debate regarding the issue, delegates noted that the state’s Coordinated Care Initiative, which includes a pilot program to passively enroll patients eligible for both Medicare and Medi-Cal in eight of California’s largest counties, would see more than 75 percent of the state’s dual eligibles transitioned to managed care plans. The shift, speakers said, would likely lead to considerable confusion among patients and almost certainly interrupt relationships that have been established with their existing physicians. Under the pilot program, patients will be enrolled in a managed care plan unless they actively opt out. In addition to asking that CMA monitor the transition, the newly adopted policy also requests that the association advocate that the appropriate state agencies provide “full and clear disclosure” on options and consequences facing patients affected by the pilot program. More information regarding the dual eligible transition can be found in CMA’s online duals resource center, at www.cmanet.org/duals.
Delegates strongly oppose Medicare RAC audits Members of the California Medical Association’s (CMA) House of Delegates spoke out strongly against aggressive down coding efforts being taken up by Medicare’s Recovery Audit Contractor (RAC) firm, and have adopted policy that officially puts the association on record as opposing the practice. The resolution, 222-12, stems from an ongoing problem of an out-of-state auditing firm, Connolly Healthcare, selectively down coding claims on behalf of Medicare, forcing physicians to undertake costly and time-consuming appeals. The audits and subsequent down codes, which several speakers equated to financial “bounty hunting” on behalf of the Centers for Medicare & Medicaid Services (CMS), were almost always reversed upon physician appeal, which suggested that they were of little merit to begin with, speakers said. “I can’t tell you how outraged we doctors should be that this is going on,” James Hinsdale, M.D., a past CMA president, said during the resolution’s floor debate. In addition to asking that CMA work to stop the audit practice, the resolution also requests that, if efforts to halt the practice are unsuccessful, CMA urge CMS to reimburse physicians who file successful appeals for the time and resources expended in the appeal efforts. Successful passage of the resolution brought CMA in line with the American Medical Association’s (AMA) position on the matter. AMA has been actively lobbying CMS to halt the recovery audits.
NOVEMBER / DECEMBER 2012 | THE BULLETIN | 35