Fraud alert: recognizing relationships that may trigger fraud and abuse concerns for physicians The laws regarding fraud, abuse and anti-kickback violations can be complicated and difficult for physicians to navigate. However, it is increasingly important that physicians be aware of relevant prohibitions to avoid being implicated in a potentially fraudulent scheme. The California Medical Association (CMA) has received reports that some clinical laboratories, especially those testing for cardiovascular markers, are offering physicians cash incentives for blood draws of Medicare patients. Accepting such incentives could put physicians afoul of laws governing fraud and abuse. Anti-kickback laws prohibit physicians from offering or receiving anything of value ... February 18, 2015 General Fraud and Abuse, Self-Referral, Clinical Laboratories 0 0 Comment Read More »
Practice check-up: proactive patient communication As practices begin to schedule patients for their annual check-ups, remember that conducting an internal practice check-up is equally important. This is the first in a series of articles aimed at highlighting key areas practices should examine in an effort to improve practice performance. This month we focus on how clear, proactive patient communication can have a positive impact on both patient and practice satisfaction. Many practices take the important step of confirming patient appointments ahead of time. However, if you’re not also taking the time to inform your patients about ... February 18, 2015 General Practice Resources, Physician-Patient Relationship 0 0 Comment Read More »
2015 Palliative Care Conference Inland Empire Palliative Care Coalition & Hospital Association of Southern CA presents: 2015 Palliative Care Conference: Palliative Care from Concept to Collaboration March 12, 2015 | 8:30am – 4:30pm | Etiwanda Gardens, Etiwanda, CA Join executives, physicians, nurses and other front-line caregivers as they explore the latest strategies bridging the continuum of care. National and local speakers will present innovative supportive care models and personal stories of transformation that result in better care for patients and stronger partnerships for hospitals. The conference includes breakfast and lunch. Registration questions: ... February 13, 2015 General Inland Empire Palliative Care Coalition, palliative care 0 0 Comment Read More »
Children and Families in Crisis When Havens Become Horrow Stories - Dealing with child abuse in all its forms -- physical abuse, sexual abuse, trafficking, and more. A one day conference on Friday, April 10, 2015 at CSU San Bernardino at the Palm Desert Campus. For professionals whose work has an impact on children's well-being, knowing preventive strategies, having the ability to recognize the signs of harm, and knowing what to do when intervention is needed, are central to the goals of this conference. Keynote Speakers Dr. Ken Druck is one of the nation's leading experts in resilience ... February 10, 2015 General Child Abuse 0 0 Comment Read More »
United Healthcare to pursue EFT and ERA for all contracted physicians in 2015 United Healthcare (UHC) plans to move all contracted providers from paper checks and remittances to electronic funds transfer (EFT) and electronic remittance advices (ERA) in 2015 through Optum’s Electronic Payments and Statement (EPS) system. United Healthcare stated that moving to an electronic process for checks and explanation of benefits will reduce administrative costs. UHC advised the California Medical Association that they plan to send notice of the change to contracted providers sometime in April. Physicians will be required to select to receive payment either by Automated Clearinghouse (ACH) direct ... February 5, 2015 Managed Care Payment, United Healthcare, Insurance/Reimbursement 0 0 Comment Read More »
ICD-10 transition guide now available; new resource webpage available With eight months until the transition to ICD-10, will your practice be ready be October 1, 2015? To help physicians prepare for the transition, the California Medical Association (CMA) has published a new resource, “ICD-10 Transition Guide – What physicians need to know,” which includes an ICD-10 transition preparation checklist. CMA has also created an ICD-10 transition webpage, www.cmanet.org/icd10, that includes important news articles and other ICD-10 transition information. CMA will also be hosting a number of live training events to assist physicians with the transition, with details announced soon. February 5, 2015 General Insurance/Reimbursement, Practice Resources, ICD-10 0 0 Comment Read More »
Regulations requiring health insurers to have adequate networks and accurate directories go into effect Emergency regulations requiring health insurers regulated by the Department of Insurance to create and maintain adequate medical provider networks to provide timely access to medical care went into effect this week, after their approval by the Office of Administrative Law. California Insurance Commissioner Dave Jones issued the emergency regulations in early January. "Californians and California businesses deserve better than what they have gotten from most health insurers and HMOs,” Jones said. "This emergency regulation is necessary to make sure that health insurers establish and maintain adequate medical provider networks to meet ... February 5, 2015 General Medical Provider Networks, Network Adequacy, Out of Network Care, Department of Insurance 0 0 Comment Read More »
CMS announces it will work to reduce meaningful use reporting burden After repeated calls for changes from the American Medical Association (AMA), the California Medical Association (CMA) and other physician groups nationwide, the Centers for Medicare and Medicaid Services (CMS) announced that it would address the meaningful use issues raised by providers and make changes to the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program to “reduce the reporting burden, while supporting the long term goals of the program.” CMS said it would issue new rules governing the program this spring. Beginning January 1, 2015, Medicare physicians who have not ... February 5, 2015 Medi-Cal, Medicare CMS, EHR, Electronic Health Records, Meaningful Use, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
$10 million reasons to be a CMA member The California Medical Association’s (CMA) Center for Economic Services (CES) has now recouped $10 million from payors on behalf of CMA member physicians. These monies, recovered over the last five years, represent actual physician reimbursements that would have likely gone unpaid without the intervention of the CES team. Founded in 1999, CES provides CMA members with one-on-one assistance for billing, contracting and payment problems that may arise. With more than 125 years of combined medical practice operations experience, CES staff helps members with issues ranging from underpayment or denials ... February 5, 2015 General Payors, Reimbursement, Value of Membership, Advocacy 0 0 Comment Read More »
CMA survey finds workers' comp reform has brought new challenges for physicians California’s workers’ compensation system is arguably undergoing its biggest period of transformation since its enactment in 1914. Senate Bill 863, signed into law on September 19, 2012, initiated changes to the utilization review process, implementation of an independent medical review and independent bill review process, and a migration to a resource-based relative value scale payment system, among other changes. In late 2014, after hearing complaints from physicians that these changes have resulted in patient care roadblocks, the California Medical Association (CMA) initiated a survey to solicit physician feedback on ... February 5, 2015 General Insurance/Reimbursement, Workers' Compensation 0 0 Comment Read More »
