Anthem to require NDC on claims for certain physician-administered drugs On September 30, Anthem Blue Cross notified physicians that effective January 1, 2015, it will require all professional providers to bill using the 11-digit National Drug Code (NDC) for drugs administered in a physician’s office. In the notice, Anthem says that currently, the lack of uniform coding system for drugs can result in inaccurate payments. The payor also states the change will allow it to be more consistent with Medicaid requirements and maintain consistent claims billing guidelines across all Anthem products. While the notice said the NDC would be required ... November 14, 2014 General Billing/Coding, Prescription Drugs, Anthem Blue Cross 0 0 Comment Read More »
Guidelines for Prescribing Controlled Substances for Pain News Release Thursday, November 13, 2014 Contact: Cassandra Hockenson Medical Board of California (916) 263-2394 Medical Board of California's Revised Guidelines for Prescribing Controlled Substances for Pain Sacramento - The Medical Board of California (Board) announces its release of its revised Guidelines for Prescribing Controlled Substances for Pain (Guidelines). These Guidelines were approved by the Board at its quarterly Board Meeting on October 24, 2014. The Board recognizes that the inappropriate prescribing of controlled substances, including opioids, is a consumer protection issue, and the Board takes this matter very seriously. The Board is aware that some ... November 14, 2014 General Consumer Protection, Pain Guidelines, Prescribing Controlled Substances 0 0 Comment Read More »
United Healthcare to host webinars about its Premium Designation Program for contracted physicians At the request of the California Medical Association, United Healthcare (UHC) is inviting physicians and practice administrators to attend a special webinar presentation about its Premium Designation program in California. The webinars will be offered in mid-November and will provide an overview on the background and methodologies of the Premium Designation program and allow physicians an opportunity to ask specific questions they may have. The webinars will take place on the following dates and times. Participants will need to register with UHC prior to attending. Click the registration links below ... November 10, 2014 Managed Care Insurance/Reimbursement, Managed Care, Webinars, United Healthcare 0 0 Comment Read More »
Supreme Court delays hearing ACA subsidy case The U.S. Supreme Court has declined to hear King v. Burwell—a case the 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 states that use the Federal health care exchange, but would not change the subsidies in states like California that run their own exchanges. The question asked in King v. Burwell is whether the language of the ACA law allows consumers to receive premium tax ... November 6, 2014 General Affordable Care Act, Health Insurance Exchange, ACA 0 0 Comment Read More »
Don't miss out on increased Medi-Cal payments - deadline to attest is December 31 The Department of Health Care Services (DHCS) reports that eligible physicians who have already attested have received over $283 million for services provided to fee-for-service Medi-Cal enrollees under the Affordable Care Act (ACA) primary care rate increase. Don't miss out! Remember, to qualify for enhanced payments for fee-for-service Medi-Cal and Medi-Cal managed care plans, you must first self-attest to your eligibility. The deadline to attest, if you haven't already done so, is December 31, 2014. Practices that have attested but have not yet received any additional funds are encouraged to ... November 6, 2014 Managed Care, Medi-Cal Attestation, DHCS, Medi-Cal, Department of Health Care Services 0 0 Comment Read More »
Online testimony for 2014 House of Delegates opens Friday at 5 p.m. The California Medical Association's (CMA) 2014 House of Delegates (HOD) will convene in San Diego, December 5-7. The HOD is CMA's legislative body, which establishes the policies that govern the association. At this year's meeting, physicians from across the state will debate and set policy on important health care issues. During the three-day meeting, more than 500 delegates will address nearly 100 resolutions on key issues that affect the practice of medicine. CMA invites all members to visit its online forum starting this Friday, November 7, at 5 p.m., to discuss ... November 6, 2014 General House of Delegates, CMA Policy 0 0 Comment Read More »
Health Net modifying exchange/mirror products Health Net recently announced changes to its exchange/mirror products offered for 2015. In a notice mailed to select physicians, the insurer said it will be offering an Exclusive Provider Organization (EPO) and a Health Care Service Plan (HSP) for its individual exchange/mirror products effective January 1, 2015. Though not explicitly stated in the notice, the California Medical Association (CMA) has confirmed the insurer will not be offering a PPO product in the individual exchange/mirror market. The EPO will be called PureCare One and the HSP will be called PureCare. Patients will ... November 5, 2014 Managed Care Health Insurance Exchange, Health Net, Covered California 0 0 Comment Read More »
CMA urges Congress to exempt medical textbooks and journals from Sunshine Act The California Medical Association (CMA) has joined the American Medical Association (AMA) and 70 other medical associations in support of H.R. 5539, which would exempt medical textbooks and journals, as well as indirect payments that pharmaceutical and device manufacturers offer to CME providers, from Sunshine Act reporting requirements. In a joint letter the organizations said that “passage of this bill is urgently needed to remedy onerous and burdensome reporting obligations imposed by the Centers for Medicare and Medicaid Services (CMS) that have already chilled the dissemination of medical textbooks, peer-reviewed ... November 5, 2014 General Physician Payment Sunshine Act 0 0 Comment Read More »
Are you interested in joining Anthem's Medi-Cal managed care network? In an effort to expand its Medi-Cal managed care provider network across the state, Anthem Blue Cross is reaching out to California Medical Association (CMA) member physicians who are interested in joining the insurer's network. "Anthem welcomes CMA member physicians into its growing network during this time of exciting and unprecedented Medi-Cal member growth," says Steve Melody, president of Anthem's Medicaid Health Plan for California. Physicians who would like to learn more about this opportunity are asked to provide CMA with some basic information by filling out this brief form. Anthem ... November 5, 2014 Medi-Cal Medi-Cal, Provider Networks, Anthem Blue Cross 0 0 Comment Read More »
CDPH publishes quarantine guidelines for travelers at risk of contracting or spreading Ebola The California Department of Public Health (CDPH) yesterday published statewide guidelines for quarantining individuals with suspected cases of Ebola and those who are at high risk of contracting or spreading the disease. These rules are consistent with the Centers for Disease Control and Prevention (CDC) guidelines and include a mandatory 21-day quarantine for any travelers who had contact with an Ebola patient, whether or not the travelers are showing symptoms. However, the state said it would allow local health authorities to enforce the order on a “case-by-case” basis, with varying ... November 5, 2014 General Ebola, Infectious Diseases, Public Health, CDC 0 0 Comment Read More »
