February 06, 2011
Area(s) of Interest: Payor Issues and Reimbursement Practice Management
Physicians experiencing problems with contracting, insurance claims or other reimbursement issues can get help from CMA's Center for Economic Services (CES). CES's practice management staff have a combined experience of more than 125 years in medical practice operations. Access to CMA's practice management professionals is a members-only benefit. Last year, the CES recouped more than $2.5 million from insurance companies on behalf of our physician members.
CMA members can call CMA's reimbursement helpline for one-on-one help with reimbursement or contracting issues. It might be time to call if:
- Your claims are not being paid in a timely manner.
- You are not being paid according to your contract.
- Your claims are being denied after obtaining prior authorization.
- You are receiving unreasonable requests for medical records or untimely requests for refunds.
- You are having difficulty obtaining fee schedules or payment rules or both.
- Your claims are being denied for untimely filing.
- You have been presented with a managed care contract and you're not sure if the terms are consistent with California law.
Access to CMA's advocates is a free member benefit and may include:
- Education and guidance on reimbursement and contracting issues.
- Advice on best practices for improved practice viability.
- Information on your rights and responsibilities under California law and regulations.
- Sample letters, forms and toolkits.
- Direct intervention with the payor when necessary.
- Assistance filing a formal complaint with the regulator.
- Help identifying and preventing payor abuse
To learn more or to request assistance, contact CMA's reimbursement helpline at 888/401-5911 or via email.