May 2012
In this issue: Aetna to require additional accreditation requirements in order to be paid for certain surgical pathology services 1 Update on two Anthem Blue Cross issues pending with the Department of Managed Health Care 1 Meet Your CMA Center for Economic Services Advocate: Mark Lane
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CMA Advocacy at Work
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Urgent survey response requested
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Aetna erroneously terminates providers from California network
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Document, Document, Document
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United Healthcare announces extension of HIPAA 5010 enforcement 4
ARE YOU READING CPR? CPR contains the latest in Practice Management Resources, Updates and Information.
What’s a COHS?
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Save the Date
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Act now to avoid the 2013 e-prescribing penalty 5 Payor Updates
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Health plan provider newsletters
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CMA resources
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Aetna to require additional accreditation requirements in order to be paid for certain surgical pathology services Aetna recently notified physicians that, effective August 1, 2012, practices performing in-office pathology testing will be required to be both Clinical Laboratory Improvement Amendments (CLIA) certified and accredited with the College of American Pathologists (CAP). In a letter to physicians, Aetna claims that the change is consistent with the Centers for Medicare & Medicaid Services (CMS) recognition of CAP as an approved accreditation organization for non-hospital anatomic pathology testing. The California Medical Association has voiced concerns with the implementation of this policy and has asked Aetna to explain the need for dual certification. Although CMS may recognize CAP as an approved accreditation organization, CMS does not require both a CLIA certification and a specialty society accreditation to perform in-office pathology testing services. Further, CMA expressed concerns with the ability of physicians to obtain the CAP accreditation prior to the deadline imposed by Aetna. According to CAP, the accreditation process takes approximately 90 days. Additionally, the process of obtaining a secondary accreditation can be very costly for practices. In addition to their contact with Aetna on this issue, CMA is working closely with the American Medical Association (AMA) and several other state and specialty medical societies. Stay tuned for further details. Practices with questions about the letter can contact Tammy Gaul, senior network manager at Aetna at (215)775-6604. Contact: CMA reimbursement help line, (888) 401-5911 or mlane@cmanet.org
Update on two Anthem Blue Cross issues pending with the Department of Managed Health Care DMHC claims audit
As previously reported, on Jan. 12, 2012 the Department of Managed Health Care (DMHC) ordered Anthem Blue Cross to reprocess provider claims, with interest, dating back to 2007. The order is based on 2008 DMHC audits of the seven largest health plans in California. These audits found violations of claim payments above the threshold allowed under California law at all seven health plans. As a result, DMHC assessed administrative fines, required the plans to pay providers the money they were owed and mandated that plans demonstrate CPR • May 2012 • Page 1 of 5
CMA Practice Resources (CPR) is a free monthly e-mail bulletin from CMA’s Center for Economic Services. This bulletin is full of tips and tools to help physicians and their office staff improve practice efficiency and viability.
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