Ask the expert: How long does TRICARE have to request a refund? Recently, physicians may have started to receive TRICARE requests for refunds related to overpayment from the governmental health carrier. As a result, the California Medical Association’s Center for Economic Services has compiled a list of the most frequently asked questions and answers related to these TRICARE refund requests. How long does TRICARE have to request a refund? Pursuant to federal law, TRICARE is authorized to seek refunds of overpayment for dates of service as far back as 10 years, per Title 32: Subtitle A, Chapter: 1, Subchapter M, Part 199.11 - ... September 4, 2014 General Refund Requests, Tricare, Practice Resources 0 0 Comment Read More »
Feds propose compromise to ACA birth control rule to accommodate religious groups Last week, the Obama administration proposed a compromise to provide contraceptive coverage under the Affordable Care Act (ACA) to employees of whose employers object on religious grounds to providing contraceptives to their employees. The administration is hoping to quell the controversy around the ACA contractive coverage that has yielded dozens of lawsuits, while ensuring that all women are able to get coverage of recommended preventive services without cost sharing, as intended under the health care law. “Women across the country deserve access to recommended preventive services that are important to ... September 3, 2014 General ACA, Contraception, Affordable Care Act 0 0 Comment Read More »
Products that contain hydrocodone reclassified to Schedule II The federal government published new rules last week that will govern hundreds of medicines containing hydrocodone. These drugs will be reclassified as Schedule II substances, in line with oxycodone and morphine. This reclassification will apply to all drugs that contain both hydrocodone, which by itself was already classified a Schedule II drug, and specified amounts of other substances, such as acetaminophen or aspirin. As Schedule II drugs, patients will be limited to up to a 90-day supply of medication and will have to see a provider to get a refill. ... September 3, 2014 General Prescription Drugs, Drug Prescribing 0 0 Comment Read More »
Family Medicine & Internal Medicine Job Opportunity in Barstow, CA Barstow Healthcare Management MSO is seeking a Family Medicine or Internal Medicine physician for a full-time employment opportunity within a start-up practice. The clinic's, Barstow Health Partners, website is http://barstowhealthpartners.com/. This opportunity offers a competitive and comprehensive recruitment package that is hard to walk away from. Internal Medicine Listing: http://www.practicelink.com/jobs/377976/physician/internal-medicine/california/barstow-healthcare-management-mso/ Family Practice Listing: http://www.practicelink.com/jobs/377858/physician/family-medicine/california/barstow-healthcare-management-mso/ For more information regarding either position, please contact Rhonda Lynch at (760) 957-3224. August 27, 2014 General Barstow Health Partners, Employment , Barstow Healthcare Management 0 0 Comment Read More »
Anthem and Blue Shield to partner in the creation of California's largest health information exchange Two of California's largest health insurers – Anthem Blue Cross and Blue Shield of California are investing a total of $80 million to develop a not-for-profit health information exchange database called Cal INDEX, which is expected to go live in November. It is expected to house the medical records of 9 million patients, about a quarter of California’s population. The initial $80 million stake will get the exchange through the first three years, the insurers said. After that, they expect funding will come from participating health plans and providers who ... August 25, 2014 General Blue Shield, Health Information technology, HIT, Anthem Blue Cross 0 0 Comment Read More »
Huge chunk of data excluded from Open Payments website because of inaccuracies According to several news sources, the Centers for Medicare & Medicaid Services (CMS) has rejected about one-third of the "Open Payment" records submitted by manufacturers and group purchasing organizations (GPOs) because of "intermingled data." When the data goes public next month, those records will not be included. CMS says it will not publish the withheld data until June 2015, when it expects that manufacturers will have had time to correct the inaccuracies. Physician Payments Sunshine Act is a provision of the Patient Protection and Affordable Care Act. Drug and medical ... August 21, 2014 Medi-Cal, Medicare CMS, Physician Payment Sunshine Act, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
State audit finds DHCS may have paid $93.7 million for fraudulent Medi-Cal drug treatment A California State Auditor’s report issued today found the Department of Health Care Services (DHCS) failed to properly administer the Medi-Cal Drug Treatment Program and may have paid at least $93.7 million for fraudulent drug treatment. The program provides substance abuse services to Medi-Cal beneficiaries when physicians determine they are medically necessary. The focus of the report was on outpatient drug-free services. The audit was requested by Assemblyman Ted Lieu after stories appeared in the media revealing that substance abuse clinics were fraudulently billing for patients who did not use ... August 21, 2014 Medi-Cal DHCS, Drug Abuse, Medi-Cal, Insurance/Reimbursement 0 0 Comment Read More »
CMS must provide better oversight to prevent duplicate audits says GAO study A newly released study by the federal General Accounting Office (GAO) found that the Centers for Medicare and Medicaid Services (CMS) needs to provide better oversight and guidance for provider payment auditors to prevent duplicative post-payment claims review audits. Several types of Medicare contractors conduct postpayment claims reviews to help reduce improper payments: Medicare Administrative Contractors, which process and pay claims; Zone Program Integrity Contractors, which investigate potential fraud; Recovery Auditor Contractors, tasked with identifying on a postpayment basis improper payments not previously reviewed by other contractors; and the Comprehensive ... August 21, 2014 General CMS, Insurance/Reimbursement, Medicare, Audits 0 0 Comment Read More »
CMA urges United to make meaningful changes to Premium Designation program Citing physician confusion and complaints as well as additional concerns with the rollout of the United Healthcare (UHC) Premium Designation program, the California Medical Association (CMA) has, again, urged the insurer to make meaningful and necessary changes to the program prior to the next assessment this fall. "In its current form, the program will not only confuse patients but will also fail to provide them with meaningful information that could actually assist them in making important health care decisions,” wrote CMA President Richard Thorp, M.D., in an August 13, 2014, ... August 21, 2014 Managed Care Managed Care, United Healthcare, Insurance/Reimbursement 0 0 Comment Read More »
Cyclosporiasis and Ebola Virus - Dept. of Public Health The California Department of Public Health (CDPH) urges medical providers to specifically request Cyclospora testing. Cryptosporidiosis is an intestinal illness caused by the microscopic parasite Cyclospora cayetanensis. In the United States, foodborne outbreaks of cyclosporiasis have been linked to various types of imported fresh produce. Click here for more information and recommendations to medical providers.. The risk of the spread of Ebola virus disease (Ebola) in California is low. While the risk is low, state and local public health officials in California are monitoring the situation closely and taking steps ... August 13, 2014 General Ebola Virus, Public Health, Cyclospora 0 0 Comment Read More »
