ACA meets goal of covering more Americans A little over 10 million uninsured have gained health care coverage throughout the U.S., either through Medicaid or state and federal exchanges, since the Affordable Care Act (ACA) coverage expansion programs opened for enrollment last year, according to a new report from U.S. Department of Health And Human Services’ (HHS). According to the report, the uninsured rate among adults ages 18 to 64, as of June 2014, was 15.1 percent, down 5 percent from September 2013. The percentage of those with health coverage improved most among blacks and Latinos throughout the ... November 14, 2014 General Affordable Care Act, ACA 0 0 Comment Read More »
Ask the Expert: Do I enter a qualifier in box 14 of the claim form if the patient has Medicare prime and a secondary insurance? Recently a number of practices have inquired as to whether Medicare requires the three-digit qualifier to be populated in item/box 14 when submitting a claim. Item/box 14, Date of Current Illness, Injury, or Pregnancy (LMP), identifies the first date of onset of illness, the actual date of injury, or the last menstrual period (LMP) for pregnancy, and contains a field allowing one of two qualifiers to be entered. 431: Onset of Current Symptoms or Illness 484: Last Menstrual Period The Medicare Claims Processing ... November 14, 2014 Medicare Medicare, Billing/Coding 0 0 Comment Read More »
Counting down to ICD-10 implementation With less than a year until the October 1, 2015, implementation date for ICD-10, physicians should be evaluating the readiness of their practices to transition to the new code set. The one-year delay in implementation came as a welcome reprieve for many physician practices that were struggling to meet the October 2014 deadline. The extent to which physician practices made positive use of the delay remains to be seen. ICD-10 (The International Classification of Disease tenth revision) is a system of coding created in 1992 as the successor to the ... November 14, 2014 General ICD-10 0 0 Comment Read More »
CMA names Luther Cobb, MD as 147th president Sacramento – Humboldt County physician Luther Cobb, M.D. has been installed as the 147th President of the California Medical Association (CMA), taking the reins from Immediate Past President Richard Thorp, M.D. Dr. Cobb takes office on the heels of the momentous defeat of Proposition 46, a campaign in which doctors and health care providers across California rallied together to oppose the measure that ultimately failed 33-67 percent. “What a thrilling time to be assuming the role of CMA president,” said Dr. Cobb. “The health care community has stood tall ... November 14, 2014 General Physician Leadership 0 0 Comment Read More »
Supreme Court to hear ACA subsidy case Last Friday, the U.S. Supreme Court unexpectedly said it will hear King v. Burwell—a case that questions whether premium subsidies can be provided under the Affordable Care Act (ACA) to individuals purchasing health insurance coverage on exchanges run by the federal government. The lawsuit has the potential to affect 36 states that use the federal health care exchange, but would not change the subsidies in states like California that run their own exchanges. The decision to hear the case comes just one week before the second exchange open enrollment ... November 14, 2014 General Affordable Care Act, Health Insurance Exchange, United States Supreme Court, ACA 0 0 Comment Read More »
CMA wants to hear from practices experiencing problems with the new prescription drug prior authorization form A new law recently took effect that streamlines and standardizes the prior authorization process for prescription drugs for most patients with PPO products. The new law (SB 866) requires all insurers, health plans (and their contracting medical groups/IPAs) and providers to use a standardized two-page form for prior authorizations of prescription medications. The law also requires plans and insurers to make a determination on prescription drug prior authorization requests within two days of receipt. If they fail to do so, the requests will be deemed authorized. The new law does ... November 14, 2014 Managed Care Prescription Drugs, Preauthorization 0 0 Comment Read More »
Blue Shield announces changes to 2015 exchange/mirror products On October 1, 2014, Blue Shield of California notified participating physicians that it was making changes to its Individual and Family Plan (IFP) EPO and PPO products, which are its exchange/mirror products. According to Blue Shield, the changes aim to expand access for EPO enrollees and reduce confusion by simplifying its plan names. Effective January 1, 2015, Blue Shield exchange/mirror EPO patients will have access to additional providers who are located outside of their county of residence. Previously, the Blue Shield IFP EPO limited in-network services to providers within ... November 14, 2014 Managed Care Covered California, Exchange Plans, Health Insurance Exchange, Blue Shield 0 0 Comment Read More »
CMA Foundation launches free antibiotic clinical guidelines mobile app The week of November 17-23, 2014, is "Get Smart About Antibiotics Week" – a campaign to highlight the problem of antibiotic resistance and the importance of appropriate antibiotic use. Every year at least 2 million Americans become infected with antibiotic resistant bacteria and at least 23,000 people die from these infections. This cold and flu season, the California Medical Association (CMA) Foundation's Alliance Working for Antibiotic Resistance Education (AWARE) project reminds physicians and patients to reduce the unnecessary use of antibiotics. To assist physicians and other clinicians in these efforts, ... November 14, 2014 General AWARE, CMA Foundation, Public Health, Antibiotic Resistance 0 0 Comment Read More »
Medi-Cal UCR web app for CHDP primary care rate increases now available; deadline to submit is Nov. 28 The California Department of Health Care Services (DHCS) has taken steps to correct a problem with the Affordable Care Act primary care rate increase unique to Child Health and Disability Prevention Program Services (CHDP) providers. Before the rate increases were implemented, some practices were previously instructed by DHCS to bill at their Medi-Cal rates. This caused concern—based on DHCS's pricing logic of paying the lesser of Medicare’s rate or the billed charges—that some practices would not qualify for the retroactive increases once the systems were updated to process claims at ... November 14, 2014 General, Medi-Cal Child Health and Disability Prevention Program, DHCS, Medi-Cal, Affordable Care Act 0 0 Comment Read More »
United issues new Premium Designation physician results United Healthcare recently sent California physicians their latest Premium Designation assessment results. These latest results will be released publicly via the payor's online physician directory beginning January 1, 2015. Physicians within the designated 27 specialty areas, including ear, nose and throat (ENT) and gastroenterology (new for 2015), will again be ranked by UHC on both national and specialty-specific measures for quality and various cost-efficiency benchmarks. Physicians meeting or exceeding these benchmarks will receive a Premium Designation notation on their physician profiles, marketed to UHC enrollees through the payor’s online physician ... November 14, 2014 General United Healthcare 0 0 Comment Read More »
