Advances in medicine depend on clinical trials conducted by public and private institutions. Physicians considering referring patients or participating in such clinical research studies should take st...

Under the provisions of the American Recovery and Reinvestment Act of 2009 (ARRA or the ...

The following questions and answers apply to physicians faced with the insolvency of a health plan or IPA, PPM, or other entity that contracts with a health plan to pay physician claims. This document...

Following is a discussion of the laws relating to private payors’ (non–Medicare/Medi-Cal) denials ofpayment for physician claims, including retrospective payment denials based on lack of m...

Some physicians’ bills are being discounted when the physicians believe they never agreed to a discount. This occurs because either: 1) the physician unknowingly authorized a PPO, IPA, health pl...

When rendering non-emergency services, payors may require the physician first to obtain confirmation that the patient is covered by the payor and/or pre-authorization for the particular service. Payor...

The following is some general information concerning the ability of a health plan to place physicians special claims review and seek copies of the physician’s medical records for the purposes of...

Physicians often contact CMA because managed care plans ask them to return monies allegedly overpaid on their claims. We understand that thousands of physicians have been unfairly asked to return paym...

This document addresses reimbursement issues that may arise when an out-of-network physician treats a patient with commercial health care coverage. The following also includes an analysis of Assembly ...

California hospitals are increasingly creating and operating outpatient clinics as vehicles to recruit new physicians or to retain existing physicians. By charging and receiving higher facilities (in ...

The California Health Benefit Exchange (hereafter ...

The following questions and answers apply to physicians faced with the bankruptcy of a health plan, independent practice association (IPA), physician practice management (PPM), or other entity that co...

For years, CMA has received numerous complaints from physicians and patients that managed care organizations that pay secondary to Medicare (in applying coordination of benefits provisions) are failin...

The discussion below sets forth answers to some frequently asked questions about obtaining authorization for emergency services and how physicians are to be paid for emergency services. Also included ...

Depending on the type of payor, physicians may be entitled to certain protections when payors fail to pay claims on time. The following provides guidance to deal with late payments by payors. For info...

The following discusses the general rules applicable to coordination of benefit (COB) provisions in private health plans between a physician and a payor. These provisions apply when the physician trea...

An “assignment of benefits” enables a physician who has provided services to an insured or managed care patient but has no contractual agreement with the payor to legally obligate the payo...

Physicians increasingly ask whether there is any law that prohibits them from having more than one fee schedule. The answer to this question depends on what contracts the physician has signed and what...

This document explains what ERISA plans are and how they work. It is designed to assist physicians in dealing with an ERISA plan and understanding ERISA plans’ general payment obligations. For a...

On April 16, 2015, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signed into law. (Pub.L.No. 114-10). This law repealed the Medicare Sustainable Growth Rate (SGR) formula, reaut...