California Orthopaedic Association

“Keeping You Active”
Text Box: Orthopaedic On-Call Emergency Room Survey COA White Paper to help members determine their actual costs of serving on-call. Click here to obtain a copy of the Paper. Text Box: NEW PRACTICE OPPORTUNITY: CalPERS Independent Medical Examiners Orthopaedic Surgeons Need for Evaluations The California Public Employees' Retirement System (CalPERS) maintains a database of physicians willing to perform disability retirement evaluations for State of California employees. These evaluations are for non-work-related injuries. CalPERS is seeking orthopaedic surgeons who would be willing to perform these disability evaluations. The evaluations do not involve apportionment issues and; therefore, do not utilize the AMA Guides or the Workers' Compensation Appeal's Board rating system. Reimbursement for the orthopaedic evaluation and report is $1,000. Additional reimbursement is possible based on the volume of medical records to be reviewed and for needed diagnostic tests. Click on the following links for more information: Notice describing the CalPERS IME Program IME Eligibility Requirements IME Application and Sample Report Worker’s Compensation News COA Develops Tools to Assist Members in Utilization Review Appeals. Click here for UR assistance. DWC begins work to develop post-surgical rehabilitation treatment guidelines in anticipation of COA-sponsored legislation being signed into law. (AB1073 –Nava). The Lewin Group is awarded a contract to transition the Official Medical Fee Schedule—physician services to an RBRVS system. It is too early to tell what this means for reimbursement. COA is opposed to any reductions and seeks an increase in reimbursement to compensate physicians for the additional work involved in treating injured workers. DWC begins discussions on revising the Ground Rules. COA participates in the work group meetings. A copy of the first Lewin report can be obtained on the DWC website: http://www.dir.ca.gov/dwc/RBRVSReport/RBRVS_May2008.pdf

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What’s New …..

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

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.