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California Orthopaedic Association |
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“Keeping You Active” |


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What’s New ….. |
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DWC Implements new QME/AME Regulations—Effective February 17, 2009 The California Division of Workers’ Compensation has revised the QME/AME Regulations. For a summary of the changes, click on the below links: COA summary of changes—Click Here Text of the revised regulations and new forms—Click Here DWC instructions in completing the new EAMS Forms—Click Here |
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COA joins the CMA in filing a lawsuit asking the courts to reject the DMHC Prohibition on Balance Billing Regulations In spite of opposition from hospital-based and on-call specialists, The Department of Managed Health Care approved regulations which declare it an “unfair billing pattern” for non-contracted providers rendering “emergency medical services” to balance billing patients for monies that are the responsibility of their insurance carrier. The regulations went into effect on October 15, 2008. CMA and other physician specialists including COA filed suit indicating that the regulations exceed DMHC’s authority. Unfortunately, the court ruled that the DMHC has the authority to define and “unfair billing pattern.” It was silent on whether they have enforcement authority. The California Supreme Court has also ruled in The Prospect case. Medicine believes that these regulations exceed the authority of the DMHC since their charge is regulating health plans, not physicians. The lawsuit seeks to have the regulations rejected. In this interim, the regulations did go into effect on October 15, 2008. CMA has prepared a Toolkit to help physicians understand the impact that the regulations will have on their practice. Click here to access the CMA Toolkit. |