Anthem Blue Cross begins medical chart reviews for exchange patients In July, Anthem Blue Cross began chart reviews on enrollees who purchased an individual exchange or mirror product. Similar to the Medicare Risk Adjustment Audit process, and as required by the Affordable Care Act (ACA), the audit is designed to identify the health status and demographic characteristics of exchange/mirror product enrollees. Blue Cross will review diagnosis code data obtained from the medical records of exchange patients. This is not a typical audit on the physician practice; rather, Blue Cross is looking to identify conditions/illnesses that demonstrate patients who are at ... August 7, 2014 Managed Care Anthem Blue Cross, Covered California, Health Insurance Exchange, Health Care Reform 0 0 Comment Read More »
Blue Shield mailer to physicians on exchange On July 11, 2014, Blue Shield mailed additional informational packets to physicians contracted for its exchange/mirror products. Blue Shield also sent separate packets to the corresponding office managers for which they had contact information. While Blue Shield has sent out several communications to contracting exchange providers, the plan reports this informational packet was developed based on feedback from practice staff and includes sample ID cards for Covered California and mirror products, a product guide, laminated map indicating which products are offered in each county, and step-by-step instructions on how to ... August 7, 2014 Managed Care Covered California, Health Insurance Exchange, Blue Shield 0 0 Comment Read More »
United Healthcare finally completes PacifiCare recontracting effort after 2006 merger The California Medical Association (CMA) recently learned that United Healthcare (UHC) in April sent notices to over 800 practices that still held contracts under PacifiCare, which merged with UHC in 2006. The notice advised affected physicians that their continued participation status with UHC hinged on signing the new agreement, which includes a new fee schedule. For physicians who chose not to sign the agreement by June 15, the notification served as the required 90-day notice of termination. UHC had first initiated a recontracting of physicians contracted with PacifiCare back in ... August 7, 2014 Managed Care Hunited Healthcare, Insurance/Reimbursement, Managed Care, PacifiCare, Advocacy 0 0 Comment Read More »
CMA Capitol Insight: August 5, 2014 CMA Capitol Insight is a biweekly column by veteran journalist Anthony York, reporting on the inner workings of the state Legislature. -------------------------------------------------------------------------------- They’re Baaaaack After a month-long recess, the California state legislature is back in session, ready for the final month of the legislative year. Gov. Jerry Brown is also back after a four-day trip to Mexico with a massive delegation of business leaders and state officials, preaching the gospel of climate change at every turn. Now that everyone has returned to Sacramento, we are all bracing for the sprint that marks the ... August 7, 2014 General Anthony York, Advocacy, State Legislative Advocacy 0 0 Comment Read More »
Congress allows veterans to seek care outside VA system Congress yesterday sent a $17 billion landmark bill to President Obama that will help U.S. veterans avoid long waits for health care within the U.S. Department of Veterans Affairs (VA). There was overwhelming support in both the Senate (91-3) and House (unanimous) for the bill, which will provide $10 billion in emergency spending over the next three years to allow veterans to seek care from private doctors and other health professionals due to delays in the VA system. Veterans would have access to private doctors if they could not get ... August 4, 2014 General Hospitals/Health Care Facilities, Quality of Care, Veterans, Federal Legislation 0 0 Comment Read More »
Two federal courts issue conflicting rulings on ACA premium subsidies Two federal appeals courts issued conflicting rulings last week on 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 rulings will not, however, impact states like California that run their own exchanges. The U.S. Court of Appeals for the District of Columbia Circuit, in a 2 to 1 vote, majority opinion said that the ACA’s language unambiguously restricts premium subsidies to insurance purchased on exchanges “established by the State,” and that the IRS’ ... August 4, 2014 General Affordable Care Act, Health Insurance Exchange, ACA 0 0 Comment Read More »
CMS issues proposed 2015 Medicare payment rule The Centers for Medicare and Medicaid Services (CMS) recently published the 2015 proposed Medicare physician payment rule in the Federal Register. The proposal contains several notable changes. The rule expands the services eligible for telemedicine reimbursement (psychotherapy services and the annual wellness visit). It also extends the new payment policies for non-face-to-face care coordination. It allows primary care physicians to be paid for care management of Medicare beneficiaries with two or more chronic conditions. These are tasks (including managing lab and imaging reports, medications and care plans in addition ... August 4, 2014 Medi-Cal, Medicare Insurance/Reimbursement, Medicare, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
Medicare's financial outlook improves Trustees overseeing Medicare’s Hospital Insurance Trust Fund, which finances about half the health program for seniors, said Monday in a report that the program won’t run out of money until 2030 – that’s four years later than projected last year and 13 years later than projected at the passage of the Affordable Care Act (ACA). The outlook for Medicare improved largely because of lower-than-expected hospital spending and savings resulting from the ACA. The effect of the new law encouraged providers and Medicare Advantage insurers to deliver care more cost-effectively and ... August 4, 2014 Medicare Affordable Care Act, Medicare, ACA 0 0 Comment Read More »
IOM report says financing for physician residency programs needs overhauling to meet nation's needs A report by the Institute of Medicine shows that the U.S. should significantly reform the federal system for financing physician training and residency programs to ensure that the public’s $15 billion annual investment is producing the doctors that the nation needs. Current financing – provided largely through Medicare – requires little accountability, allocates funds independent of workforce needs or educational outcomes, and offers insufficient opportunities to train physicians in the health care settings used by most Americans, the report says. For decades, teaching hospitals have received the majority of Medicare's funding ... August 4, 2014 General Insurance/Reimbursement, Physician Workforce, Residents and Fellows, Medicare 0 0 Comment Read More »
