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 »
Apple Valley pediatrician, Damodara Rajasekhar, M.D., San Bernardino pediatrician, honored with CMA membership award Apple Valley pediatrician Damodara Rajasekhar, M.D., has been named the 2018 recipient of the California Medical Association (CMA) Dev A. GnanaDev, M.D., Membership Award, which recognizes a special or unique effort toward membership recruitment. The award was announced today at CMA’s annual House of Delegates in Sacramento. Dr. Rajasekhar this year played a major role in continuing CMA’s partnership with Loma Linda University Medical Center, leading to a membership renewal for 440 Loma Linda physicians. “[Dr. Rajasekhar was] the vital spark that reignited the flame, creating an alliance between one of ... October 16, 2018 Awards, CMA Physician Leadership 0 0 Comment Read More »
IEHP completes termination of Vantage contract; three plans extend termination dates The California Medical Association (CMA) has confirmed that Inland Empire Health Plan (IEHP) completed its contract termination with Vantage on August 31, 2018. IEHP transitioned its 273,000 covered lives to the following delegated groups: Receiving Provider Group Number of Enrollees Alpha Care Medical Group 80,190 La Salle Medical Associates 74,428 IEHP Direct 74,176 ... October 16, 2018 General, Managed Care, Medi-Cal Commercial Payors, Practice Management 0 0 Comment Read More »
What you need to know about Blue Shield of California's Care1st integration On January 1, 2019, Blue Shield of California will complete the integration of Care1st Health Plan into its operations, and Care1st’s name will change to Blue Shield of California Promise Health Plan. The newly renamed health plan will remain a separate company and a wholly owned subsidiary of Blue Shield of California. Care1st physicians serving Medicare Advantage HMO, Medi-Cal or Cal MediConnect members will not need to contract with Blue Shield of California to continue providing services, and participating physicians will receive a mailed contract amendment later this year that ... October 16, 2018 General, Managed Care Commercial Payors, Payor Contracting, Payor Issues and Reimbursement 0 0 Comment Read More »
Updated payor profiles for 2018 now available The California Medical Association’s (CMA) Center for Economic Services is publishing updated profiles on each of the major payors in California including Aetna, Anthem Blue Cross, Blue Shield of California, Cigna, Health Net, UnitedHealthcare, Medicare/Noridian and Medi-Cal. Each profile includes key information on health plan market penetration; a description of the plan’s dispute resolution process; and the name and contact numbers for medical directors, provider relations, and other key contacts. Don’t waste your time searching the internet for this information – members can download CMA’s Payor Profiles free of charge ... October 16, 2018 CMA Commercial Payors, Public Payors 0 0 Comment Read More »
CMA proposes site-neutral payments for some physician services The Centers for Medicare and Medicaid Services (CMS) has proposed eliminating the Medicare site of service payment differential for physician services. Under the proposed policy, Medicare would pay the same amount for office visit services provided by physicians in “off-campus” hospital outpatient departments as it would for the same office visit service provided in a physician’s office. Currently, Medicare pays a “facility fee” that results in a much higher rate for the same service when performed in outpatient clinics owned by hospitals, rather than in a physician’s office. For example, ... October 16, 2018 Medicare Advocacy, Payor Issues and Reimbursement 0 0 Comment Read More »
CMA pushes back on CMS' proposed Medicare payment changes The California Medical Association (CMA) recently submitted comprehensive comments to the Centers for Medicare and Medicaid Services (CMS) on the proposed 2019 Medicare Physician Fee Schedule and MACRA Quality Payment Program rule. CMA is supporting CMS’s proposal to substantially reduce the Evaluation and Management (E/M) documentation requirements because it would reduce note bloat, improve workflow, and allow physicians to devote more time to their patients. However, CMA is strongly opposed to the proposal to restructure payment and coding for (E/M) office visits by collapsing the codes from five to two for ... October 16, 2018 Medicare Advocacy, Payor Issues and Reimbursement 0 0 Comment Read More »
