1. FEBRUARY 2015
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A PUBLICATION OF PNN
www.PhysiciansNewsNetwork.com
R E P O R T I N G O N T H E E C O N O M I C S O F H E A L T H C A R E D E L I V E R Y
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6. 4 PHYSICIAN M AGA ZINE | FEBRUARY 2015
FOR THE FORESEEABLE FUTURE, the Af-
fordable Care Act has laid the groundwork for
the changes in how healthcare is delivered and,
just as importantly to patients and their access
to doctors and hospitals, how that healthcare is
paid for. Within the last year about 6.8 million
Americans who did not previously have access
to health insurance got
that through the man-
dates of this new law. And
whether each of us was in
favor of the specifics of
this concept or cautiously
wary of its mandates, to-
day we know that with all
the good that it will bring
many families, there will
be serious challenges.
Among those challenges
is a shortage of physi-
cians due to an aging
population and a sudden
increase in the number of
patients who would like
access to their doctors.
Kaiser Health News
reported that approxi-
mately 10,000 baby
boomers are becoming
eligible for Medicare each day. This immediate
heavy increase of new patients now qualifying
for healthcare is challenging a primary care sys-
tem already struggling to keep up with demand,
overall contributing to an already present physi-
cian shortage. California today ranks 24th in the
country in the number of doctors per 100,000
residents. And there are parts of Southern Cali-
fornia that have fewer doctors per 100,000 peo-
ple than the state ranked 49th in the union.
A survey completed in late 2014 by the Phy-
sicians Foundation found that 81 percent of
doctors described themselves as overextended
or at full capacity—even before this sudden in-
crease in workload. Another 44 percent of phy-
sicians said they planned to cut back on the
amount of patients they see, retire from their
practice or close their practice to any new pa-
tients.
And the challenges get still more pervasive.
While the ACA’s overarching goal was to make
healthcare more accessible, some insurance
companies are limiting the number of doctors
into their physician panels as a way to cut costs.
Consequently, patients are finding it difficult to
find doctors within their insurance networks,
and when they do find a doctor affiliated with
their insurance plan they often find it difficult to
get appointments to see their doctor in a timely
manner. Today, nearly one in five Americans
lives in a region designated as having a short-
age in primary care. The Association of Ameri-
can Medical Colleges projects the shortage will
grow to about 66,000 in little more than a de-
cade as fewer residency slots are available and
more medical students choose higher-paying
specialty areas—by choice but often by necessity
because of their educational debt burden. This
is not just a stress on individual doctors, who
we can argue are accustomed to stress, this is a
stress on the healthcare system.
Los Angeles County physicians are dedicat-
ed to working through the physician shortage
in order to keep the ACA a benefit and not a
burden. We have to stay active, vigilant and en-
gaged. We all are busy. And by the measures
stated above, we will get busier. But if we do
not engage with policy makers and others to
come up with solutions for the issues facing us
and our patients, others will do that for us. Ev-
ery profession and every professional ought to
remain master of their own destiny. Doctors are
no exception.
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8. 6 PHYSICIAN M AGA ZINE | FEBRUARY 2015
Kenneth Sim, MD, chairman, Board of Directors
Allied Pacific IPA and co-chairman, Board of Direc-
tors, Network Medical Management, told PNN that
in October 2014, Allied Physicians merged with Pa-
cific IPA and now all three IPAs have come together.
The goal is to consolidate resources and create a vi-
able entity that will enable independent physicians
to remain in private medicine and be competitive in
the market where economies of scale and access to
new technologies are the key.
“The market is changing so fast that every time
you look around something new is happening. Busi-
ness models are evolving, there are mergers, acqui-
sitions, everything is changing so quickly,” Dr. Sim
said. The government is driving the changes and this
is nothing new, according to Dr. Sim, but the will-
ingness of physicians to come out of their individual
silos and work together to survive is new.
From the Health Maintenance Organization Act
that President Richard Nixon signed into law in
1973, to the Affordable Care Act of today, the pres-
sure is to contain costs while encouraging better
management of care for the patients. But you can
no longer do it without having the resources to take
advantage of the new technologies that will bring
healthcare to the level consumers expect in all other
industries, Dr. Sim said.
In the past Allied Physicians IPA, Pacific Physi-
cians IPA and Physicians’ Healthways IPA competed
with each other for patients. No one wanted to talk
to each other, Dr. Sim noted. This is no longer a vi-
able model going forward. “Instead of competing we
decided to come together and collaborate so we can
survive together.”
New technology and innovation will be key, but
individual doctors do not have resources or even
time to learn about them, let alone implement them.
Yet it is technology that will be the biggest game
changer and differentiator. Information technology
implementation, population health management
and home monitoring are the biggest challenges, Dr.
Sim said. There are ideas and products out in the
market, but most physicians don’t know about them
and don’t have time to find out. As a group, he said,
there will be opportunities and resources to address
that lack.
“Patient care in the future will require greater
investments in technology and other innovations.
Consolidation is a way to free up economic resourc-
es that can be better invested in doctors and in the
clinical management systems that take better care of
patients. This is smart. This is the future: Dr. Sim’s is
a novel and innovative model of exceptional clinical
care that has proved scalable,” Pedram Salimpour,
MD, president of the Los Angeles County Medical
Association, told PNN.
ALHAMBR A-BASED ALLIED PHYSICIANS IPA (Independent Practice Association) com-
pleted a merger with two other groups, Physicians’ Healthways IPA and Pacific IPA, which
resulted in a new entity under the name of Allied Pacific IPA that has 2,000 physicians serving
over 250,000 members in San Gabriel Valley. There are 500,000 members in seven counties in
Southern and Central California.
“Instead of
competing we
decided to come
together and
collaborate so
we can survive
together.”
INDEPENDENT PRACTICE ASSOCIATIONS COMBINE RESOURCES TO FORM THE NEW
ALLIED PACIFIC IPA
9. Membership is free for the duration of your training program
Los Angeles County Medical Association
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10. 8 PHYSICIAN M AGA ZINE | FEBRUARY 2015
Five main benefits of home ownership:
• TAX BREAKS | Mortgage interest and property tax
deductions can translate into some impressive tax
savings for homeowners. These expenses are usu-
ally completely tax-deductible on both the federal
and state income tax returns, as are several closing
costs. This is of particular benefit to new home-
owners, as the bulk of the monthly payments in the
first few years goes toward paying down the interest
on the new loan. Of course, it is best to consult
your tax professional for specifics based on indi-
vidual income bracket and other deductions.
• BUDGET STABILITY | Home ownership is a great
way to hedge against inflation. While rental rates
increase year after year based on current market
conditions, buying a home allows homeowners to
fix their payments for up to 30 years. This means
that monthly housing expenses will be capped
even when inflation takes hold and price for rent,
gasoline, and other consumer goods increase.
• BUILT-IN INVESTMENT | Owning a home can be
a wise financial decision. Over time, real estate
has proven to be a sound investment, particularly
as the mortgage principal is paid down and both
equity and home values increase. Oftentimes,
homeowners can sell their current homes and
“roll over” the equity as a down payment for an
upgraded home.
• CAPITAL GAINS INCENTIVES | Homeowners
who have lived in their homes as their primary
residence for two of the past five years have added
benefits when they decide to sell. Single taxpay-
ers can exclude up to $250,000 profit and mar-
ried taxpayers can exclude up to $500,000 profit
from capital gains tax. There is no need to buy a
replacement home, nor any age restriction.
• AUTONOMY | It is not economically advanta-
geous for renters to upgrade their homes, either
cosmetically or structurally. Homeowners, on the
other hand, have both the freedom and the incen-
tive to upgrade their living environments. These
improvements can result in increased equity and,
as any home owner can attest, they help to turn a
house into a home.
Homeowners who missed the last refinancing
boom have been given another chance. Interest rates
are the lowest the country has seen since mid-2013,
and remain close to their lowest level in 50 years.
Whether you’re a first-time home buyer or current
homeowner it’s a good idea to speak with an experi-
enced mortgage professional to determine if the pre-
scription of homeownership is right for you.
Prescription for Home OwnershipBY ARMEN LEONARDO KARAPETIAN, SENIOR LOAN ADVISOR, RPM MORTGAGE INC.
INDEED, THERE’S NO PLACE LIKE HOME. For some first-time homebuyers, though, the
process of buying a home can be downright overwhelming. However, when these same first-time
homebuyers are educated in the advantages of purchasing a home, they may decide that the risk
and effort involved are minimal when compared to the benefits of home ownership. Let’s examine
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13. FEBRUARY 2015 | W W W.PHYSICIANSNE WSNE T WORK.COM 11
BILLING,CASHFLOW&ICD-10|FEATURE
BILLING,
CASH FLOW
& ICD-10BY MARION WEBB
With its October deadline approaching, ICD-10
implementation is at the top of the list of physi-
cian concerns for 2015. For many physicians, es-
pecially for those working out-of-network, know-
ing how to maximize recovery of pay will be a key
consideration. In this article, we will address how
you can prepare now to improve collections, and
we will provide helpful tips and resources for get-
ting on track to maximize your revenue.
14. 12 PHYSICIAN M AGA ZINE | FEBRUARY 2015
LAYING THE GROUNDWORK FOR
A SUCCESSFUL TRANSITION
Current ICD-9-CM diagnosis codes do not pro-
vide sufficient clinical specificity to describe the
severity or complexity of various diseases, accord-
ing to Physicians Practice. ICD-10 will add more
than 68,000 codes, compared to ICD-9’s maximum
of 13,000 codes. The new codes will be different in
their organization, structure, detail and composition
and seek to improve operational capabilities of clin-
ics and practices.
Physicians will be able to better determine the
severity of illnesses and therefore quantify the level
of care more accurately. The codes will also create
an electronic trail of documentation, which will help
doctors receive proper payment and ensure that their
reputation remains in good standing, wrote Mike Pa-
tel, CEO of Meditab Software, in an article published
on the Advance Healthcare Network website. With
the importance and significance of this transition, Pa-
tel said, it’s crucial that providers are amply prepared.
FEATURE|BILLING,CASHFLOW&ICD-10
vs.ICD-9
3-4 characters in length
14,025 diagnosis codes
3,824 procedure codes
3-5 characters
Outdated technology
Generic, non-specific codes
Not used by other countries
ICD-10
3-7 characters in length
68,000+ diagnosis codes
71,924 procedure codes
3-7 characters
Current technology
Specificity improves accuracy
and depth of data
Allows data exchange
15. FEBRUARY 2015 | W W W.PHYSICIANSNE WSNE T WORK.COM 13
1 CREATE AN IMPACT CHART: Practices
should create an impact assessment chart and
capture key information in a spreadsheet including
the area impacted, needed changes in workflow,
how the new system will impact assigning of code,
vendor information and contingency plans.
2 TRAINING: To maintain their certifications, all
medical coders must take a minimum number
of ICD-10-specific CEUs before the compliance
date.Toensurethatyourstaffisadequatelytrained,
the experts suggest conducting a gap analysis
to determine your team’s knowledge of medical
terminology, pharmacology, pathophysiology,
anatomy and physiology and review samples from
different types of medical records to see whether
the current level of documentation contains
enough detail for ICD-10 coding. Physicians also
have a learning curve, and those with specialty
tools will be in the best position to make sure they
aren’t negatively impacted financially.
3 TEST, TEST, TEST: Make sure your staff is up
to speed and practices with active claims by
coding them in the old system and the new to see
if they are getting the right information.
4 CLEAR DOCUMENTATION: Ensure that your
patient records are clear and complete in
order to submit accurate claims and avoid delays
in payment.
5 COST-EFFECTIVE RESOURCES: Visit the
Centers for Medicare and Medicaid Services
website as a resource. cms.gov/Medicare/Coding/
ICD10/index.html?redirect=/icd10
6 SOFTWARE: In addition to impacting practice
systemsandelectronichealthrecordsoftware,
the move to ICD-10 may require that practice
software needs to be updated or replaced. To do
this takes time and resources.
7 REGULATIONS: Know and identify all other
regulations and changes so you won’t get
behind as you approach ICD-10 implementation.
8 FILTERING: Filter out the codes you will be
using the most for greater efficiency.
9 COMMUNICATE:Ensureclearcommunications
with payers and clearinghouses to ensure that
the system is ready to go, and ask if they are ready
for the transition as well.
10 PAYERS: Find out if payers have adopted
contractual changes regarding coding
specificity that could affect how you process
claims.
11 EXTRA EXPENDITURES: Plan for
unforeseen expenses in time and resources
such as training of staff, IT upgrade costs, business
process analysis of health plan contracts and
documentation, and cash flow disruptions due to
the ICD-10 transition.
12 OUTSOURCING VS. IN-HOUSE BILLING:
If billing is handled in-house, the cost
of keeping employees on staff may be higher
than the cost of hiring a third-party biller. Here
are some questions to consider in making the
decision: What are some of the financial benefits
in hiring a third-party biller that your practice
currently does not get? How will your practice pay
for the third-party biller and what hidden expenses
will come up (postage or processing fees)? Also,
ask yourself how will billing services be affected
as your practice continues to grow, given that
many revenue cycle management firms are paid a
percentage of collections?
13 TURNOVER: Ask yourself if your billing
department has a high turnover rate. If the
answer is 20% or more, you may have inefficiencies
that either need to be addressed in-house or may
lead you to consider outsourcing.
14 HIRECOUNSEL:Becausepaymentdisputes
are possible, providers should proactively
address ICD-10 issues in their current negotiations.
The attorneys at Epstein Becker & Green suggest
that any provisions addressing group changes that
address ICD-10, and those referencing “revenue
neutral” requirements and provisions dealing
with policy and manual compliance, should be
carefully considered in contract reviews. Finally,
the attorneys also recommend a clear, fair dispute
resolution provision for ICD-10 conversion.
BILLING,CASHFLOW&ICD-10|FEATURE
TIPS TO ENSURE ICD-10 READINESS AND MAXIMIZE INCOME
Here is a checklist of 14 tips from the experts to get on track with ICD-10 compliance and maximize rev-
enue along the way. Experts include Patel as well as Robert Tennant, Health IT policy director for the Medical
Group Management Association, and such online sources as Physicians Practice and Peoriamagazines.com.
ICD-10 codes
will create an
electronic trail of
documentation,
which will help
doctors receive
proper payment
and ensure that
their reputation
remains in good
standing.
16. 14 PHYSICIAN M AGA ZINE | FEBRUARY 2015
Consultants advise doctors to keep three months of cash flow in reserve to prepare for any delays in pay
as ICD-10 implementation gets closer. While some groups continue to push for additional delays, saying the
mandate comes at a time when physicians are already dealing with several other technology requirements
and risk penalties, several experts recommend that physicians who aren’t ready to comply put themselves
at a financial risk.
INCREASING YOUR CASH FLOW EARLY
While some organizations continue to wait to see
if the compliance date of Oct. 1 will truly stand, some
experts caution that waiting for the final date could
put your revenue at risk. Robert Wergin, MD, presi-
dent of the American Academy of Family Physicians,
expressed confidence that the Oct. 1 deadline will
stick.
“This time, it looks like the real thing,” Dr. Wer-
gin told Medscape. He agrees that doctors’ anxiety
remains high over what it will take to implement the
new coding system and what it will mean for doctors
in terms of income.
“There is concern that the technology won’t work
when the systems start up,” he said.
He also noted that providers might not get paid
right away.
The best way to prepare for any delays, the experts
say, is to increase your cash flow early.
Five Ways to Increase Cash Flow Now:
1 CLEAR EXISTING BLOCKAGES: With the move by health plans to increase deductibles, more
patients face higher out-of-pocket costs. Rather than waiting to be reimbursed, by tapping
into the payers’ systems, practices can assess the status of a patient’s deductible and accurately
predict out-of-pocket expenses at the time of their visit. They then can obtain authorization right
away to charge a patient’s credit card once the insurance claim is settled.
2 USE NEW TECHNOLOGIES: Using new technologies such as lockbox services, remote
deposit, electronic funds transfer, sweep accounts and online bill payments for all expenses
allows practices to get payments into their accounts faster. Combining claims into one
outsourcing solution and a single electronic database rather than tracking them separately also
helps improve cash flow.
3 COORDINATE CARE IN YOUR PRACTICE: In the old days, long wait times were seen as
a sign of a physician’s popularity, but today any obstructions in a practice’s scheduling
process will likely leave patients to seek care elsewhere. To keep your clients coming back and
keep your reputation as an efficient and effective practice intact, you want to optimize care,
which will ultimately translate into optimized cash flow.
4 IDENTIFY ERRORS EARLY: Post-service revenue cycle management opportunities abound,
giving you tools to identify and correct errors before you submit a claim to your insurer.
Also, training your staff to monitor claim denials to spot trends and fix problems at their source is
key. Common preventable causes of claim denials include lack of insurance company-required
referrals or prior authorization, inaccurate demographic or insurance information, claims that
weren’t filed in a timely manner, and incorrect modifier, procedure and diagnosis codes.
5 RULE OUT FRAUD: With large sums of cash coming in, it’s critical that you hire honest
employees. It takes only one dishonest worker to disrupt your cash flow. Consider paying
vendors with a business credit card instead of checks. Banks offer business credit cards to medical
practices for internal use as well as credit card merchant processing for payments. Segregate
banking duties among staff so no one person has access to all bank accounts. Ask your bank to
send account statements directly to your accountant and limit online banking access. Put strong
cash controls in place and log all funds collected on site and total them at the end of each work
shift. Invest in periodic audits of internal controls performed by an accountant or an auditor who
specializes in detecting fraud.
FEATURE|BILLING,CASHFLOW&ICD-10
17. FEBRUARY 2015 | W W W.PHYSICIANSNE WSNE T WORK.COM 15
EFFECTIVE
REVENUE
RECOVERY
TECHNIQUESBY SHANA NISSANOFF, CHIEF EXECUTIVE OFFICER OF ECURE
(EMERGENCY CARE UNDERPAYMENT RECOVERY EXPERTS)
THE NUMBER ONE MISTAKE
made by medical practices is to
fail to implement a claims audit-
ing process. Even if the practice
sends out a perfectly scrubbed
bill, health insurers will still in-
appropriately deny, delay and
significantly reduce payments.
They may even request refunds
for claims they have overpaid.
By implementing claims auditing
processes, a physician’s practice
can ensure that health insurances
pay appropriately. It’s a two-step
process. Appropriate documen-
tation for patients to sign must be
front-loaded, and denial letters
to health insurers should contain
a legal framework rebutting the
specific denial at hand. This pro-
tects your rights for claims being
underpaid. (continued)
BILLING,CASHFLOW&ICD-10|FEATURE
18. 16 PHYSICIAN M AGA ZINE | FEBRUARY 2015
FEATURE|BILLING,CASHFLOW&ICD-10
The first step in ensuring proper payment is to
make sure that you understand as a physician or
healthcare provider if you are a contracted provider.
Often a healthcare provider thinks they are not
contracted and find out later, unbeknownst to them,
that their contract was assumed or sold to another
carrier, or a “Silent PPO.”
If you happen to be contracted, then you are
bound by the terms of your contract. If you are not,
then you are not bound by any terms of anyone’s con-
tract; rather, the carriers are actually bound by the
terms of the law in the state of California. Those legal
rules differ for elective cases and for emergent/urgent
cases.
In a nutshell, if you are
contracted, then based on
the benefits that are allowed
to the patient in the patient’s
benefits contract, you will
collect only the amount
that has been agreed on be-
tween you and the carrier.
Because there are so
many insurance companies
and so many different plans
within each insurance com-
pany, this is almost impos-
sible to follow except on a
case-by-case basis.
If you are not contracted with a carrier for an elec-
tive case, then the patient is ultimately responsible for
the care they received, unless you verified benefits
with the carrier and they told you otherwise. The car-
rier, as a general rule, needs to pay for only the ben-
efits documented in the patient’s benefit plan. How-
ever, when a physician goes into the emergency room
or consults on a patient in the hospital, and he is not
a participating provider in that particular healthcare
plan, then that healthcare plan’s benefits do not pre-
vail.
What does prevail is called “usual, customary and
reasonable” (UCR) reimbursement. If the payment
isn’t paid in full by the carrier (minus the co-pay and
deductible), then you, as a non-contracted provider,
can have a claim directly against the carrier for your
underpaid balances.
The UCR reimbursements are based on a very
specific law that entails many factors, including what
other physicians in the geographical area bill out,
what that specific provider who performed the proce-
dure typically bills out, what specific circumstances
are involved, the physician’s experience and specialty
and many other factors that are non-tangible. Hence,
if at any time a commercial carrier such as an HMO
or a PPO does not pay a provider his usual, custom-
ary and reasonable reimbursement and reduces it to
a different number called the “allowable,” then the
provider has the ability to seek further payment.
Once the physician figures out if he is bound by
the participating plan’s contract or not, then the next
step is to streamline the claims management revenue
cycle — your practice’s internally designated work
flow that includes the steps you take to prepare, sub-
mit and collect the claim
correctly.
The documentation in
your notes needs to be all-
encompassing. It needs to
specify exactly what was
done in the text of the note.
Furthermore, you cannot
rely on billers to read the
note and make a decision
on your behalf as to what
the CPT code should be. It
is incumbent on you to fig-
ure out what you did and
look up the CPT code that
clearly reflects the evaluation, management or proce-
dure that you performed in order to be able to submit
appropriate claims and not receive a denial.
The carriers are always looking at the CPT codes
and then comparing it to actual documentation. If the
documentation itself does not reflect the description
in the CPT code, they will deny the bill, or worse,
consider it fraudulent billing and request a refund if
they have already paid it. Again, you cannot rely on
any biller to code for you.
The next step is to streamline your claims audit
and appeals procedures, i.e., your practice’s internal
controls that detect health insurance payment errors
and manage submitted claims, and perform the ap-
propriate collection efforts to ensure that the health
insurer’s processes adjudicate and pay your claims
accurately. In other words, the first time an EOB (ex-
planation of benefits) comes back to the biller with an
explanation as to how the carrier paid that claim, if
it was not paid in full, then it needs to be evaluated
and deciphered as to why it was not paid in full. Was
the entire bill offset because of the patient’s deduct-
Often a healthcare provider
thinks they are not contract-
ed and find out later, unbe-
knownst to them, that their
contract was assumed or
sold to another carrier, or a
“Silent PPO.”
19. CONTACT US AT:
844.834.8141
info@ecurehealth.com
15525 Pomerado Rd #E6
San Diego, CA 92064
DATA REVIEW
We collect, sort, and
organize all of your
past unpaid or under-
paid out-of-network
emergency room
claims within the last
three years.
ANALYSIS
We determine how
much was underpaid,
why it was underpaid,
and what portion is
recoverable. This is
done through a line-
by-line examination
of your claims by our
team of experts.
RECOVERY
Our team of experts is trained
extensively in medical collec-
tions law and recovery tech-
niques. They work tirelessly
to recuperate the money
owed to you through appeals,
phones calls, and if neces-
sary, subsequent legal ac-
tion against the carriers. We
expand on the work already
done by your existing staff
and billing company to create
a mutually beneficial relation-
ship between our company
and yours.
We start where
your billing
and collection
company stops.
We work to
recover your
money from
insurance
plans. We put
YOUR money
back in your
pocket at no
cost to you!
ecurehealth.com
We generate an average of $100,000 per year per
doctor for claims that were already written off.
20. 18 PHYSICIAN M AGA ZINE | FEBRUARY 2015
FEATURE|BILLING,CASHFLOW&ICD-10
ible? Did the patient meet their out-of-pocket maxi-
mum allowable for the year, in which case the carrier
should have paid 100 percent of the claim? Did the
carrier just indiscriminately decide to pay you as a
non-contracted provider the contracted rates that they
usually contract with other providers who otherwise
get volume discounts for signing those contracts that
you are not entitled to?
Until you can deter-
mine why the bill was not
paid appropriately, you
will not know how to ap-
peal it correctly. This docu-
ment will explain how to
simplify your claims audit
and appeals process and
reduce the administra-
tive burden, demystify the
health insurance claims
appeal process and ex-
plain what to do when the
insurance carrier flat out
denies the appeal.
Physician practices are
entitled to fair reimburse-
ment and appropriate payment for the procedures
and services they provide when they have coded and
documented the procedure or services appropriately.
A BILLER IS NOT A COLLECTOR
OR AN APPEALS SPECIALIST
Most practices either hire billers internally or send
the billing to an outsourced company. Most provid-
ers pay a percentage of claims, on an average 5% to
10% of what is collected. Most providers think that
the biller is incentivized to collect as much as he pos-
sibly can as he is on a percentage basis, and the more
that he collects for you, the provider, the more he will
keep in his pocket.
This is far from the truth.
A biller’s job is to bill. His job is not to collect.
The more claims he bills out correctly, the more bills
will eventually be paid. His job, and his incentive, is
to bill correctly as many claims as possible one time
for each claim.
If the bills go out correctly and they get paid inap-
propriately, he still gets his percentage of those pay-
ments. If he spent time, effort and energy trying to
collect monies that were underpaid or not paid, he
would make far less at the same percentage rate than
he would just finding more clients to keep on billing
out initial billings.
For example, if a doctor has a $1,000 bill and the
biller takes 5%, it will take him about five minutes
to bill out the $1,000. If only $100 was collected,
he will collect $5, which is 5% of 100. Five dollars
for five minutes equates to $60 an hour. If he now
tries to collect the balance
of the billings that he has
done, which is now $900
($1,000 minus the $100
collected) with no guaran-
tee that he will ever see a
penny of that $900 from
that insurance carrier, he
may spend two to three
hours trying to collect it.
Even if he collects the
full amount, which is rare,
then he would have spent
three hours of his time —
at $60 an hour, or $180 —
but he is only making 5%
of the $900, which equates
to $45. This is not economically advantageous to a
biller to try to even collect your monies. Therefore
you must understand that there is significant differ-
ence between a biller and biller’s incentives and a
collector and a collector’s incentives.
A collector usually charges anywhere from 30%
to 50% of what he collects. There is a reason for his
high percentage: It takes so much more time, effort
and energy with higher risks of not collecting from
the carriers, as the bills have already been billed out
correctly, and initial payments have been made.
A practice needs to understand that after the bill-
ing is done, the next step is to either send it to an
in-house collector or outsource it to a collector that is
separate from the biller.
The provider will have to expect that the percent-
age he will give to this collector will be substantially
higher than the biller would be getting because oth-
erwise there would be no reasonable incentive for
the collector to collect these monies and spend long
hours on the phone, sending letters of appeals, etc.
Even after the collectors have pursued claims
against the carriers, they too fail in many ways. The
carriers understand that for out-of-network emergen-
cy services, they are obligated by law to pay the usu-
Most providers think that the
biller is incentivized to collect
as much as he possibly can as
he is on a percentage basis,
and the more that he collects
for you, the provider, the more
he will keep in his pocket.This
is far from the truth.
21. FEBRUARY 2015 | W W W.PHYSICIANSNE WSNE T WORK.COM 19
BILLING,CASHFLOW&ICD-10|FEATURE
al, customary and reasonable rates for these services.
They rarely ever do. They understand the econom-
ics. They understand that most practices have billers
that just bill and never appeal. For those practices,
there is a statute of limitations as to how long before
those claims can never be pursued again by law. There
is a small percent of practices that actually send their
claims that were not paid on the initial billing out to
collectors who then appeal those decisions appropri-
ately citing case law and attaching supportive docu-
mentation to their appeal for the appropriate payments.
There are times when the insurance companies
will pay these, but again, most of the time they will
not pay the bill in full as they realize that, as the ex-
ample above, the $900 underpaid claim will never be
taken to court. Therefore they effectively have nothing
to worry about. A lawyer will cost a physician any-
where from $250 to $500 an hour, and it will take
anywhere from 10 to 100 hours to try to collect and
litigate for $900. The math here does not work either.
WHAT TO DO WHEN YOU ARE
NOT PAID YOUR FULL BILL
So what is a physician/provider to do when the car-
rier underpays the biller, does not pay or continues to
underpay the collector? The first answer is to complain
to the Department of Managed Care, which has an
ombudsman who reviews these billings with appropri-
ate documentation and makes a determination that is
binding on the carrier. Over the past several years of
reviewing the percentages of the Department of Man-
aged Care’s decisions, it appears that about 50% of the
time they do find in favor of the provider. They too are
not always correct, but this is an avenue that needs to
be addressed by the provider and by the collector.
An alternative to the Department of Managed
Care, which can take up to 18 months to get a re-
sponse, is to sell the outstanding accounts receiv-
able to companies that actually purchase them at a
somewhat discounted rate, or purchase them based
on a percentage of what they collect in the future.
By doing this, the physician has absolved himself
of any and all costs associated with collections and
has monetized his zeroed-out balances and dead
accounts receivable. These companies consolidate
claims from multiple providers, and as an example,
they take a thousand providers that have $900 bal-
ances, and now have a case that they litigate against
the carrier for $900,000. In this situation the econom-
ics actually makes sense. They create a mini class ac-
tion lawsuit against the carrier, and the attorney fees
and costs now are economically beneficial and rea-
sonable to the litigated case at hand.
One of these companies is ECURE out of California.
They will purchase and take assignment of claims and
consolidate them with other providers in order to cre-
ate an economically beneficial case against the carrier.
Once this actually happens and the company
that purchased the accounts receivables is successful
in either settling or winning a case in the courts of
California, the carriers usually will start paying those
providers appropriately, understanding that their legal
fees are going to exceed the cost of paying the pro-
viders appropriately from the get-go. This is the only
way to turn the tables on the carriers and have them
follow the rules and force them to follow the rules of
the law.
For more information contact ECURE at (844) 834-8141.
22. 2 0 PHYSICIAN M AGA ZINE | FEBRUARY 2015
FIVE SMART WAYS TO
Cut Your Income
Taxes in 2015BY DAVID DENNISTON, CFA
TODAY’S WORLD IS an incredibly tax-unfriendly environment for physicians. And
by increasing your taxes due to the provisions of the Affordable Care Act, Uncle
Sam is out to get even more! The good news is that there are several steps that you
can take to be proactive and keep more money in your pocket. Here’s how you can
minimize your tax burden and improve your specific situation.
23. FEBRUARY 2015 | W W W.PHYSICIANSNE WSNE T WORK.COM 21
Pay Yourself First | Start contributing to your 401(k)
plan (or 403(b) plan if you work for a nonprofit) as well
as a 457(b) and a Health Savings Account (HSA) if they
are available. Contributing boosts your retirement sav-
ings and lowers your income taxes as well. This money
comes right out of your paycheck, withheld by your
employer.
By contributing to your 401(k), every dollar you put
in gives you a discount on your federal income taxes.
For example, if you are in the 35% bracket, and you
contribute $10,000, you have just lowered your taxes
by $3,500. That’s like a 35% rate of return on your
money today that can grow tax-free until you withdraw
it someday, when it will be taxed likely at a lower rate.
Be sure to contribute at least up to the maximum
match your employer provides. If your employer
matches dollar-for-dollar, this is like an automatic
100% return. Even if your employer matches 50 cents
or 25 cents on the dollar, that is still a 50% or 25%
return just for contributing.
Get close as you can to maxing out your contribu-
tion. If you are under 50 years old, the maximum you
can put in the 401(k) is $18,000 in 2015. If you are
over 50 years old, you may do an additional catch-up
contribution of $5,500 for a total of $23,500.
Set Up a Business or Moonlight as a Consultant |
The American tax code is set up to benefit one person:
the business owner. There are many potential write-
offs, including using a home office, which allows for
many deductions. For instance, you could remodel
your basement as a tax-deductible home office, and
deduct 100% of all costs, such as utilities, insurance
and depreciation, related to the office. Keep in mind,
you don’t have to be the business owner; it can be your
spouse.
AvoidTax-Inefficient Funds | You can control capital
gains and dividends when you own individual stocks
and exchange-traded funds,, because you can sell them
anytime. Unfortunately, it is much more difficult to
control them with mutual funds. Mutual funds will dis-
tribute capital gains even when you haven’t sold any-
thing, a phenomenon called “phantom capital gains.”
As assets come into a fund, the portfolio manager will
buy stocks or other securities. Then, when investors re-
deem their money, the manager will have to sell stocks
or other securities, creating taxable distributions. This
can be bad news for tax efficiency. If you are in a “hot
fund” that had capital gains from unsold positions that
the manager bought years earlier (before you invested
in the fund), and investors start pulling out dough, you
could be left with a big tax bill.You could actually lose
money in a mutual fund and still get caught with a big
capital-gain distribution. Be very careful which mutual
funds you invest in. Some managers are incredibly tax-
efficient, but many are not.
Harvest Capital Losses | The idea of tax harvesting
is to purposely create capital gains or capital losses to
maximize your tax advantages. Of course, the govern-
ment has no ceiling on the amount it can tax you for
capital gains. However, it does it have a floor on capi-
tal losses: $3,000 per year. Net losses above $3,000
must be carried over into the following year. Perhaps
you have no carry-forward losses and you have real-
ized some capital gains. Instead, you may have some
capital losses that you can harvest to offset the gains
and perhaps even create a loss for the year. It’s simply a
matter of selling one or more losers while holding onto
your winners.
Be Charitable | By donating to charity, you can get a
tax deduction by unleashing your giving spirit. If you
can get your itemized deductions above the amount
of the standard deduction, you can have a higher tax
write-off than many Americans. Remember your state
income taxes are counted towards your itemized de-
ductions, as well as mortgage interest. By adding some
charitable giving to the mix, most of us can easily
exceed the standard deduction limits and be able to
itemize instead. There’s no minimum to the amount of
charitable gifts you can report. However, if your contri-
bution entitles you to merchandise, goods, or services,
including admission to a charity ball, banquet, theat-
rical performance, or sporting event, you can deduct
only the amount that exceeds the fair market value
of the benefit received. For a contribution of cash,
check, or other monetary gift (regardless of amount),
you must maintain as a record of the contribution a
bank or credit-card record or a written communication
from the qualified charity containing the name of the
organization, date of the contribution, and the amount.
As a physician, you’ve made a commitment to helping
others and your community.
Now you need to make a similar commitment to
your finances.
You can fight back at Uncle Sam through focusing
on reducing your taxes by contributing to your retire-
ment, setting up your own business, harvesting losses,
avoiding tax-inefficient funds, and being charitable.
By being proactive with your tax situation, you can
then do the things you’ve long dreamed of doing and
be well down the road to financial independence.
About the Author: Dave Denniston, Chartered Financial Analyst (CFA), is a
professional wealth manager and financial advisor located in Bloomington,
MN. He is also the author of 5 Steps to Get out of Debt for Physicians,
The Insurance Guide for Doctors, The Tax Reduction Prescription,
and his upcoming book The Freedom Formula for Physicians. You can
contact him at (800) 548-1820, at dave@daviddenniston.com, or visit his
website at www.DoctorFreedomBook.com to get a copy of The Freedom
Formula for Physicians.
24. 2 2 PHYSICIAN M AGA ZINE | FEBRUARY 2015
UNITEDWESTAND|ATWORKFORYOU
The California Medical Association (CMA) recently submitted
comments to the California Department of Health Care Services
(DHCS) on the state’s next 1115 Section Medicaid Waiver, telling
DHCS that increasing reimbursement rates is absolutely impera-
tive prior to implementation of any new program reforms. Cali-
fornia’s current Medi-Cal rates often do not even come close to
the cost of providing care.
California is in the last year of its current Section 1115 waiv-
er, which was approved by the federal government so California
could expand Medi-Cal coverage in accordance with the Afford-
able Care Act in 2010 and implement a variety of delivery reform
projects like the duals demonstration project.
The state’s current five-year waiver is set to expire October
2015. CMA has participated in a number of work groups de-
signed by DHCS to receive feedback on what new projects the
state would implement in the next waiver. The state convened
work groups in order to explore ways to implement incentive
payments to providers participating in the Medi-Cal program and
how to increase and maintain the physician workforce in the
state of California.
CMA commented that the 10 percent provider reimbursement
cut authorized by AB 97, on top of California’s already abysmally
low provider reimbursement rates, which have not been adjusted
for increasing costs in two decades, and the discontinuation of
the Affordable Care Act’s pay bump for primary care providers,
makes it very difficult for physicians to accept new Medi-Cal
patients—placing roadblocks for patient access to care.
CMA made it clear that increasing rates is a prerequisite to
implementing incentive payment reforms. CMA called for the
state to conduct an independent, third-party assessment on re-
imbursement rates, stating that such an assessment is a critical
component in determining both the baseline rates and the level
of incentive payments required.
CMA also commented on workforce development, calling
for the funding of new residency programs and the expansion
of Song-Brown and Steven M. Thompson Physician Corps Loan
Repayment Programs.
DHCS is expected to enter into negotiations with the Center
for Medicare and Medicaid Services on the new waiver in the
spring of 2015.
CMA TELLS DHCS
Medi-Cal Payments Must Be Raised
BEFORE IMPLEMENTING ANY NEW REFORMS
CMA Elects New Chair
for Board of Trustees
The California Medical Association
(CMA) has elected David H. Aizuss, MD,
David H. Aizuss, M.D. as the new Chair
of the Board of Trustees. This is the
first time in twenty years a Los Angeles
County Medical Association (LACMA)
member has been elected CMA chair.
A board-certified ophthalmologist
who practices in Los Angeles, Dr. Ai-
zuss exclusively places focus on direct
patient care. He has served as vice chair of the CMA board since
2011 and was a former president of the LACMA and the California
Academy of Eye Physicians and Surgeons.
“I am honored to have been elected. The association is dedi-
cated to serving its members and advancing the public health of
the citizens of California,” said Dr. Aizuss. “CMA is the single most
effective voice for physician advocacy in our state Legislature and
before state regulatory bodies.”
Pedram Salimpour, MD, president of LACMA, applauded the
electoral results. “We are proud to have one of our own serving on
such a highly regarded board,” Dr. Salimpour said. “Dr. Aizuss is
one of the most highly respected clinicians and physician leaders in
California, and I take very personal pride in that he has been a close
associate of my family’s for many years.”
“I am proud of the physicians who put their reputations and
pocketbooks on the line in the interest of their patients. To have
such a compassionate and dedicated physician as the new chair
of CMA strengthens our voice in our advocacy for the patients our
physicians serve,” stated Rocky Delgadillo, chief executive officer of
LACMA, after hearing of the electoral results.
AMA Asks Feds to Decouple EHR
Certification from Meaningful Use
The American Medical Association (AMA)
has sent a letter to the National Coordinator for
Health Information Technology, Karen B. De-
Salvo, MD, urging that the certification of elec-
tronic health records (EHR) be decoupled from
meaningful use certification requirements. “Un-
fortunately, we believe the meaningful use cer-
tification requirements are contributing to EHR
system problems, and we are worried about
the downstream effects on patient safety,” the
letter said.
“Many physicians find these systems cum-
bersome, do not meet their workflow needs,
decrease efficiency, and have a limited, if any, in-
teroperability,” the letter said. ”Most important-
ly, certified EHR technology can present safety
concerns for patients.”
AMA believes there is an urgent need to
change the current certification program to bet-
ter align end-to-end testing to focus on EHR us-
ability, interoperability and safety.
The letter was also signed by 35 medical so-
cieties and specialty societies.
26. 2 4 PHYSICIAN M AGA ZINE | FEBRUARY 2015
ASSOCIATIONHAPPENINGS|LACMANEWS
CEO’s LETTER
THIS FEBRUARY, LACMA is excited to continue to serve, expand and provide new offerings
to its rising numbers of distinguished physician members.
As part of our ongoing outstanding series of events and efforts to keep physicians on the
cutting edge of knowledge and learning during this time of change in the health sector, we
are thrilled to highlight three programs you don’t want to miss this February.
Kicking off our February series on Feb. 7 is a seminar on “Disruptive Behavior and the
Medical Staff’s Response” presented by the California Public Protection and
Physician Health Inc.
Speakers Tom Curtis, an attorney with Nossaman LLP, and Karen Miotto,
MD, chair of the UCLA Medical Staff Health Committee, will discuss key is-
sues every member and staff of physician health committees in hospitals,
medical groups, county medical societies and specialty societies need to be
aware of when addressing disruptive behavior.
Curtis has more than 35 years of experience representing clients in the
healthcare sector on a wide range of issues. Dr. Miotto is an expert on issues
pertaining to well-being and emotional health of physicians. She frequently
talks about the rising stress of practicing in the changing health environment
and the alarming rise of physician burnout to physician leaders and groups.
On Feb. 11, LACMA is proud to present another event, the “Ambulatory
Care Centers Committee Panel Discussion,” which will focus on such topics
as accreditation of surgery centers, reimbursement of claims and physician
intimidation.
This event will take place from 7-9 p.m. in Beverly Hills at a location that
will soon be announced on the LACMA events website.
Our distinguished Women Physicians Action Committee is proud to pres-
ent a topic that is near and dear to every woman’s heart—namely how to best
manage finances and plan for the now and the future to ensure financial
stability and security.
The experts on money issues will delve into accounting, financial planning and contract
negotiation issues specifically as they pertain to female physicians.
Whether you’re a female physician working in your own practice, are employed or have
employees, this seminar will pave the way to your successful financial planning for 2015.
As always, you will find more information and registration details on LACMA’s website in
the events section.
In our efforts to continually serve you better, we are currently researching a new address
in the downtown area of LA as our lease expires.
I look forward to seeing many of you during an upcoming event and am excited about the
many opportunities as well as challenges that will present themselves during this new year.
Rocky Delgadillo
Chief Executive Officer
27. FEBRUARY 2015 | W W W.PHYSICIANSNE WSNE T WORK.COM 2 5
LACMANEWS|ASSOCIATIONHAPPENINGS
THE DISTRICT 2 ALLIANCE celebrated its
75th anniversary in style with an event
held in a doctor’s beautiful garden and a
delicious catered dinner and wonderful
entertainment enjoyed by 115 physicians,
spouses and friends of medicine.
Success in achieving camaraderie across the
full medical specialty spectrum and turf lines was
dramatically evident. The Pasadena Symphony
Quartet performance was a special bonus.
California Assemblyman Chris Holden and
California Representatives in the U.S. Congress
Adam Schiff and Judy Chu provided congratula-
tory certificates. A hand-painted scroll from LA
Supervisor Mike Antonovich wowed the crowd
as it was presented by Helen Chen, MD, radiolo-
gist at City of Hope Cancer Center in Southern
Pasadena and a former intern with Holt
Rose, MD, cho-emcee of the event. Lois
Matthews, Huntington Hospital Board,
praised District 2 president Halaine Rose
and her active all-volunteer organization.
At the party, the D2 Alliance in honor of
its diamond anniversary, raised $5,000 for
HMRI migraine research led by Mike Har-
rington, MD, and $3,200 for the District 2
Alliance MD student scholarship fund.
Co-emcee Dr. Holt Rose commended
D2 Alliance—greater Pasadena region—for
working vigorously to educate colleagues
and other voters to preserve the Medical
Injury Compensation Reform Act by voting
“No on 46.”
A presentation by Gordon Sasaki, MD,
and Halaine Rose, plus Halaine’s archival
photo books, gave insight into the stellar
record of Alliance D2 in health education,
legislative advocacy, physician and patient
support.
Special thanks to Joanne and Gordon
Sasaki, MD, Cathy and William Caton, MD,
Halaine and Holt Rose, MD, for financial
and diamond input, Team 75 -- hosts Nancy
and Dave Rhodes, MD, co-emcee Vivien
and Willaim Foran, MD, Marilyn and Eden
Henderson, Georgiana Wu, Sara Gaspard,
MD, Jan and Dave Moritz, MD, and Debra
Fallon.
DISTRICT 2 ALLIANCE
75th Diamond AnniversaryBY HALAINE ROSE
Dr. Helen Chen (second from right) presents painted scroll from LA County Board of Supervi-
sors honoring 75 years of health, education and community service of D2 Alliance to current
president Halaine Rose (center) and former presidents (left to right) Betty Falk, Joan Dietrick
and Carole Roback.
28. 2 6 PHYSICIAN M AGA ZINE | FEBRUARY 2015
JOBBOARD|CLASSIFIEDS
TO PLACE A CLASSIFIED AD VISIT WWW.PHYSICIANSNEWSNETWORK.COM
OR CONTACT DARI PEBDANI AT DPEBDANI@GMAIL.COM OR 858-231-1231.
OPENINGS—PHYSICIANS
LOCUM TENENS AVAILABLE
RADIOLOGIST
Board certified. Have own malpractice
insurance. Available for part-time posi-
tion or film reading. Call 310-477-4257.
OPPORTUNITY WANTED
CONSULTING & SERVICES
Practice Appraisal & Sales
Partnership Buy-In / Buy Out
Supporting Southern California
Physicians Since 1983
Call for a Courtesy Consultation
818-693-7055
Shorr Healthcare
Consulting
Consultants to Healthcare Providers
avishorr@gmail.com
HIPAA
"For your peace of mind --- we do it all for you"
For annual required
Risk Analysis
Staff training
Call now 310 273-7569
COMPUTER HELPER
Since 1990
TRACY ZWEIG
ASSOCIATES, INC.
• Physicians
• Nurse Practitioners
• Physician Assistants
LOCUM TENENS
PERMANENT PLACEMENT
800-919-9141 • 805-641-9141
FAX: 805-641-9143
email: tzweig@tracyzweig.com
www.tracyzweig.com
PRACTICE FOR SALE/LEASE
OB-GYNECOLOGY
PRACTICE FOR SALE
at Los Angeles suburb. Please write to
dagny1@juno.com
TRACY ZWEIG
ASSOCIATES, INC.
• Physicians
• Nurse Practitioners
• Physician Assistants
LOCUM TENENS
PERMANENT PLACEMENT
800-919-9141 • 805-641-9141
FAX: 805-641-9143
email: tzweig@tracyzweig.com
www.tracyzweig.com
OPPORTUNITY OFFERED
PHYSICIAN –
FAMILY MEDICINE
Located in Vista, California, Vista
Community Clinic is a private,
nonprofit outpatient community
clinic located in North San Diego
County serving people who expe-
rience social, cultural or economic
barriers to health care in a com-
prehensive, high quality setting.
POSITION: Full-time, Part-time
and Per Diem Family Medicine
Physicians.
RESPONSIBILITIES: Provides
outpatient care to clinic patients
and ensures quality assurance.
Malpractice coverage is provided
by Clinic.
REQUIREMENTS: California li-
cense, DEA license, CPR certifica-
tion and board certified in fam-
ily medicine. Bilingual English/
Spanish preferred.
CONTACT US: Visit our website
at www.vistacommunityclinic.org
Forward resume to hr@vistacom-
munityclinic.org or fax resume to
760 414 3702.
EEO/AA/M/F/Vet/ Disabled
OFFICE SPACE FOR LEASE
MEDICAL OFFICE
SPACE AVAILABLE
• Panorama City
• Arleta
• Highland Park
• Pasadena
• Inglewood
• Compton
• West Covina
• Pomona
• Ontario
• San Bernardino
• Riverside
• Colton
1,000-7,000 SQ.FT.
FOR DETAILS, CALL:
323-653-3777
TURN-KEY OFFICE
CARMEL VALLEY
Class A medical office building avail-
able in prime location in Carmel Val-
ley, San Diego. Full or Part Time oc-
cupancy for medical or allied health
professional. Dedicated free park-
ing garage for patients/clients. Fully
equipped and furnished. Suite 1000
sq feet with 2 large treatment rooms,
breakroom, photography and recep-
tion area. Rates dependent on use.
Contact mobyrne61@gmail.com or
619-218-8980. PRACTICE SERVICES
CME PROGRAM
ACCREDITATION
ASSISTANCE
If you need assistance getting your
CME program accredited in your hos-
pital, medical group, IPA and/or ACO,
contact shengchangmd@gmail.com.
Place Your Classified Ad
Today!
PhysiciansNewsNetwork.com
29. FEBRUARY 2015 | W W W.PHYSICIANSNE WSNE T WORK.COM 27
CLASSIFIEDS|JOBBOARD
ADVERTISER INDEX
Cooperative of American Physicians.................................3
Fenton Law Group.........................................................25
Kinecta.............................................................................5
Mercer...........................................................................C4
Nelson Hardiman...........................................................19
NORCAL .......................................................................23
Office Ally......................................................................C3
RPM Mortgage.................................................................9
UCLA.............................................................................C2
TO PLACE A CLASSIFIED AD VISIT WWW.PHYSICIANSNEWSNETWORK.COM
OR CONTACT DARI PEBDANI AT DPEBDANI@GMAIL.COM OR 858-231-1231.
PM Marketplace
• Full or part-time
positions
• Competitive Pay
• Add revenue to your
current practice
• Flexible schedule,
complete autonomy
• No Call
Surgeons Needed for Expanding
Nationwide Surgical Practice
PLEASE CONTACT US FOR MORE INFORMATION:
Phone: 1-877-878-3289 Fax: 1-877-817-3227
or email CV to: Jobs@AdvantageWoundCare.org
www.AdvantageWoundCare.org
ONLINE.
IN PRINT.
ONE PRICE.
Place Your Classified Ad
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PhysiciansNewsNetwork.com
THE 28TH
ANNUAL “HIV/AIDS
ON THE FRONT LINE”
CONFERENCE
UC Irvine
Student Center,
Irvine, CA
Wednesday,
April 22, 2015
8:00am-5:00pm
This activity is approved
for a maximum of 6.5 AMA
PRA Category 1 credit
Topics Include: HIV Update,
Global Epidemiology, Hep
C, Retention & Care, STD’s,
Acute HIV Care, Incarcera-
tion & HIV, and Prevention
For more information
& to register, please
visit:
WWW.HIVCONFERENCE.ORG
Blanca Guardado
(714) 456-7734
CME
30. scorescore
TOP10REASONSFOR JOINING LACMA AND CMA
Working together, the Los Angeles County
Medical Association and the California Medical
Association are strong advocates for all
physicians and for the profession of medicine.
Of the many reasons for joining LACMA and
CMA, 10 stand out.
LACMA/CMAISTHEVOICEOFPHYSICIANS
1
Legislative Advocacy
LACMA and CMA are distinguished by their
successes. Dual membership provides for unparalleled
legislative advocacy to end abusive practices. In
addition, LACMA has sued health care plans on behalf
of members to stop intimidation tactics.
two
FREE Reimbursement Assistance
Tired of fighting with payors? CMA’s
Economic Services experts have recovered
nearly $8 million for members since 2010!
3 FREE Jury Duty Assistance
LACMA can help you:
• Reschedule your date
• Relocate for your convenience
• Reduce number of call-in days from 5 to 1!
27% in AVERAGE SAVINGS
Through an exclusive partnership
with Medline, LACMA saves members a
guaranteed minimum of 10% on their medical
supplies and equipment. Find out how one
member saved $31,000 for his practice!
4
Benefits & Discounts
Aimed at meeting both your professional and
personal needs, LACMA offers you additional
discounts and savings on Auto & Home
Insurance, UPS services, Staples office
supplies, Financial Planning, HIPAA
Compliance Kits, and more!
five
FREE CME & Educational Resources
CMA develops toolkits, guides, webinars,
and resources on all things related to today’s changing
healthcare landscape—all FREE with membership. In
addition, LACMA provides access to important and local
CME-accredited events.
6
seven
8
FREE Networking & Referral Events
• Socialize and network with members of the medical community
• Find or create opportunities for your practice
• Engage with legislators and policymakers
Unlimited Access to Legal Experts
Save time and money by consulting with
a CMA legal expert before hiring a lawyer.
Services include HIPAA Compliance, ACOs,
Buying and selling a practice, Upkeep of
medical records, and much more!
9 State-of-the-Art Communication
Information is power. LACMA and CMA produce
several publications full of valuable information
including the award-winning Physician Magazine,
Physicians’ News Network, and CMA Practice
Resources, full of tips and tools for your practice.
tenAccess to your Physician Advocates
When you join LACMA and CMA, you hire a professional staff
that serves as an extension of your practice. We are here to help
you reach your goals and connect to the resources you need
most. Whatever you need—be it help with a problematic payor,
or details about your member discounts—just call the member
helpline at (800) 786-4262 or visit www.lacmanet.org
LOS ANGELES COUNTY MEDICAL ASSOCIATION
707 WILSHIRE BLVD, SUITE 3800
LOS ANGELES, CA 90017
PHONE: (213) 683-9900
FAX: (213) 226-0353
For more information on member benefits and resources,
visit www.lacmanet.org/Membership
RIGHT NOWis the best time to join LACMA and CMA
31.
32. DentalLongTermDisabilityLevelTermLifeEmployment
LongTermCareBusinessOwnersPolicyGroup
ProfessionalLiabilityWorkers’CompensationAcc
Mercer provides a wide range of health insurance options and guidance to
members of the Los Angeles County Medical Association. We connect you with
the top group insurance carriers and help you choose the coverage that best fits your
needs and budget.We offer flexibility and value so you can provide quality health, dental,
life and disability plans to your employees.
Small Group (2 to 50 employees) coverage is available for all business forms that include
at least one non-spouse W-2 employee in addition to the owner(s). Tax form verification
of your status as a small group is required. We can help you to determine whether your
business structure and enrollment will qualify for small group coverage if you are not sure.
Plus, members who purchase their group health insurance through Mercer, the
Association’s sponsored insurance program broker and administrator, are eligible
to receive Mercer Select H&B KnowHow. Developed by Mercer, a leader in human
resource consulting, outsourcing and investments, Mercer Select H&B KnowHow is
a tool that helps provide employers with important human resources information such
as the latest health and benefit requirements for California, and it provides the forms
needed for compliance.
For more information, contact a Mercer Client Advisor at 800-842-3761, or visit
www.CountyCMAMemberInsurance.com.
Are you aware that small groups can change their
health insurance at any time throughout the year?
70829 (2/15) Mercer Health & Benefits Insurance Services LLC • CA Ins. Lic. #0G39709
Copyright 2015 Mercer LLC. All rights reserved. • 777 South Figueroa Street, Los Angeles, CA 90017 • 800-842-3761
CMACounty.Insurance.service@mercer.com • www.CountyCMAMemberInsurance.com
Sponsored by:
Health Insurance
Group
