Prop. 56 webinar: Are you getting your share of the supplemental Medi-Cal funds? The California Health Care, Research and Prevention Tobacco Tax Act of 2016 (Prop. 56) created new revenues dedicated to the Medi-Cal program. Physicians receive supplemental payments in both fee-for-service and Medi-Cal managed care when providing Medi-Cal services under certain CPT codes. A total of $325 million was allocated for physician payments in the budget for 2017-18, with $488 million proposed for 2018-19. The California Medical Association (CMA) is hosting a webinar with the California Department of Health Care Services on Wednesday, November 7, to discuss the status of distribution of ... November 6, 2018 CMA, General, Medi-Cal Public Payors, Advocacy, Professional Development & Education 0 0 Comment Read More »
Coding Corner: Separate reporting of pre-intra- and post-procedure work “Coding Corner” focuses on coding, compliance, and documentation issues relating specifically to physician billing. This month’s tip comes from G. John Verhovshek, the managing editor for AAPC, a training and credentialing association for the business side of health care. The global surgical package includes all “necessary services normally furnished” by a provider “before, during, and after a procedure,” as defined by the Centers for Medicare & Medicaid Service (CMS). When a provider is responsible for only a portion of the global package (e.g., an emergency department physician initiates fracture care, ... November 6, 2018 CMA, General Payor Issues and Reimbursement, Practice Management 0 0 Comment Read More »
UnitedHealthcare to implement outpatient advanced radiology policy Effective January 1, 2019, UnitedHealthcare (UHC) will require prior authorization for certain advanced imaging procedures when performed in the outpatient hospital setting. As highlighted in the UnitedHealthcare Network Bulletin October 2018, certain magnetic resonance imaging, magnetic resonance angiography and computed tomography imaging procedures will now be subject to a site of care review when performed in the outpatient hospital under UHC’s Outpatient Radiology Notification/Prior Authorization Protocol. Site of care reviews will not be done as part of the prior authorization process if a procedure will be performed in a free-standing diagnostic ... November 6, 2018 General, Managed Care Commercial Payors, Interventional Radiology and Diagnostic Radiology 0 0 Comment Read More »
CDPH hosts webinar on California Parkinson's Disease Registry On July 1, 2018, the California Department of Public Health (CDPH) launched the California Parkinson’s Disease Registry, a statewide population-based registry that will be used to measure the incidence and prevalence of Parkinson's disease. MD’s, DO’s, PA’s, and NP’s who diagnose or treat Parkinson’s disease patients are required to report. The first deadline for data submission is March 29, 2019, for cases encountered during the first quarter the law was in effect (July 1 to September 30, 2018). Details on the reporting obligation can be found in the Implementation Guide, ... November 6, 2018 General Professional Development & Education, Public Health 0 0 Comment Read More »
CMA Applauds the Enactment of Federal Opioid Legislation The California Medical Association (CMA) applauded the enactment of H.R. 6 – a sweeping bipartisan bill that addresses nearly every component of the national opioid epidemic. The legislation would improve access to preventive services, opioid use disorder treatment programs, medication-assisted treatment (MAT) and non-opioid therapies, including mental health services. It would lift restrictions on using telemedicine for treatment of substance use disorders. To address the escalation in overdose deaths, it would also strengthen law enforcement efforts to crack down on international shipments of illicit drugs such as fentanyl. H.R. 6 ... October 26, 2018 General Drug Prescribing/Dispensing, Advocacy 0 0 Comment Read More »
Medicare publishes 2018-2019 influenza vaccine pricing The Center for Medicare and Medicaid Services (CMS) recently published an update on Medicare’s influenza vaccine payment allowances and effective dates for the 2018-2019 flu season. The Medicare Part B payment allowance limits for seasonal influenza and pneumococcal vaccines are calculated at 95 percent of the average wholesale price. Payment allowances and effective dates for the 2018-2019 flu season: Code Labeler Name Drug Name Payment Allowance Effective Dates 90653 Seqirus ... October 26, 2018 Medicare Public Health, Public Payors 0 0 Comment Read More »
Last day to change your Medicare participation status for 2019 is December 31 Once again, it’s time for physicians to decide if they want to make changes to their Medicare participation status. Physicians have until December 31, 2018, to make changes for the 2019 participation year. As always, physicians have three choices regarding Medicare: Be a participating provider; be a non-participating provider; or opt out of Medicare entirely. Details on each of the three participations options are as follows: A participating physician must accept Medicare-allowed charges as payment in full for all Medicare patients. A non-participating provider can make assignment decisions on ... October 26, 2018 Medicare Medicare, Public Payors 0 0 Comment Read More »
First-ever TRICARE open enrollment begins November 12 Beginning November 12 and running through December 10, 2018, TRICARE will initiate its first ever open enrollment period for beneficiaries to enroll in or change their TRICARE Prime or TRICARE Select health plan coverage. Beneficiaries already enrolled who want to continue with their current plan without changes do not need to do anything. Any changes made during the 2018 open enrollment will be effective January 1, 2019. Outside of open enrollment, beneficiaries enrolled in Prime or Select will only be able to make a plan change if they have ... October 26, 2018 General, Managed Care Commercial Payors, Practice Management 0 0 Comment Read More »
L.A. Care partially rescinds recoupment requests Between June and August of this year, L.A. Care issued a large number of overpayment requests to physicians. According to L.A. Care, it was requesting refunds on overpaid Medi-Medi claims. However, some of the requests were for very old claims, dating back to 2012. The California Medical Association (CMA) raised concerns with L.A. Care about the timeliness of some of the refund requests, as California’s Knox Keene act limits plans’ ability to request refunds to 365 days from the date of payment, except in cases of fraud or misrepresentation. After ... October 18, 2018 General Practice Management, Public Payors 0 0 Comment Read More »
Some Medi-Cal managed care plans slow to distribute Prop 56 funds In May, the California Department of Health Care Services (DHCS) distributed the Proposition 56 supplemental funds for FY 2017-2018 to the Medi-Cal managed care plans. At the California Medical Association’s request, DHCS specified that plans must distribute the funds to providers within 90 days. However, the 90-day window ended August 31 and CMA has received complaints from physicians that some plans have still not issued supplemental payments. The supplemental payments are a result of the California Health Care, Research and Prevention Tobacco Tax Act of 2016 (Prop 56), which created ... October 18, 2018 Managed Care, Medi-Cal Payor Issues and Reimbursement 0 0 Comment Read More »
