CMA Center for Economic Services1201 J Street, #200, Sacramento, CA 95814economicservices@cmanet.org • 916/551-2061

In this issue:Aetna to require additional accreditation require-ments in order to be paid for certain surgical pathology services 1Update on two Anthem Blue Cross issues pending with the Department of Managed Health Care 1Meet Your CMA Center for Economic Services Advocate: Mark Lane 2CMA Advocacy at Work 2Urgent survey response requested 3Aetna erroneously terminates providers from California network 3Document, Document, Document 3United Healthcare announces extension of HIPAA 5010 enforcement 4What’s a COHS? 4Save the Date 4Act now to avoid the 2013 e-prescribing pen-alty 5Payor Updates 5Health plan provider newsletters 5

May 2012

Medical-Legal Library (Formerly CMA On-Call)In this publication, you will find references to “medical-legal” documents. The California Medical Association’s (CMA) online medical-legal library contains over 4,500 pages of medical-legal, regulatory, and reimbursement information.

Medical-legal documents are free to members and can be found in CMA’s online resource library, http://www.cmanet.org/resource-library. Nonmembers can purchase medical-legal docu-ments for $2 per page.

CMA resourcesWhen you see this icon, that means there are additional resources avail-able free to California Medical Asso-ciation (CMA) members at the CMA website. To access any of these resources, visit http://www.cmanet.org/ces.

CPR • May 2012 • Page 1 of 5

CMA Practice Resources (CPR) is a free monthly bulletin from theCalifornia Medical Association’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.SUBSCRIBE TO CPR OR ANY OTHER CMA NEWSLETTERS: To stay up to date, sign up for free subscriptions at www.cmanet.org/newsletters.SPREAD THE WORD: Please forward this bulletin to your coworkers and colleagues.

Aetna to require additional accreditation requirements in order to be paid for certain surgical pathology ser-vicesAetna recently notified physicians that, effective August 1, 2012, practices per-forming in-office pathology testing will be required to be both Clinical Labora-tory Improvement Amendments (CLIA) certified and accredited with the Col-lege 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 test-ing.

The California Medical Association has voiced concerns with the implemen-tation of this policy and has asked Aetna to explain the need for dual certifica-tion. Although CMS may recognize CAP as an approved accreditation organiza-tion, 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 accredita-tion prior to the deadline imposed by Aetna. According to CAP, the accredita-tion 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 close-ly 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 auditAs 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 thresh-old 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

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