New law requires regulator to review physician complaints of unfair payment patterns

May 14, 2019
Area(s) of Interest: Practice Management Payor Issues and Reimbursement 

In 2018, the California Medical Association (CMA) surveyed physicians for feedback on health plans that are routinely engaging in unfair payment patterns, the types of violations and results of physician efforts to resolves these issues. Despite legislation that passed in 2000 attempting to stop these abuses by allowing providers to submit complaints to the Department of Managed Health Care (DMHC), there was no requirement that DMHC review those complaints. Because of this, the results of our survey confirmed that payors overwhelmingly continue to engage in unfair payment practices.

To address this issue, CMA sponsored AB 2674 (Aguiar-Curry), which was signed into law in 2018. Effective July 1, 2019, DMHC will be required to annually review complaints filed by providers who believe a plan is engaging in an unfair payment pattern. If the complaint data indicates a possible unfair pattern, DMHC may conduct an audit or open an enforcement action.

How physicians can take action

The effectiveness of this new law depends on physicians and their office staff. CMA urges practices to closely monitor their accounts receivables to ensure that they have been paid properly and to report any violations to DMHC through its provider complaint portal or by calling the Help Center at (888) 466-2219.

For a summary of California's unfair payment practices law, see CMA’s "Know Your Rights: Identify and Report Unfair Payment Practices” resource, which summarizes vital protections under California state law that physicians should be aware of.

CMA can help you get paid

Physicians are reminded that members have access to CMA’s practice management experts for free one-on-one help with contracting, billing and payment problems. Need assistance? Contact CMA's reimbursement helpline at (888) 401-5911 or email us.


Was this article helpful?    
Download the New CMADocs app!

Download the new CMADocs app!

CMA's new mobile app lets you connect with your colleagues and engage with CMA content!  Download the "CMADocs" app today from the Apple or Google Play app stores for daily news updates, events calendar, resource library and more.

Latest News

Load More