Blue Shield exchange/off-exchange plans leading to confusion among physicians The California Medical Association (CMA) has seen a large increase in calls from physicians confused about the plans/products offered by Blue Shield both on and off the exchange. As you may know, federal law requires that every plan offered in the exchange also be offered off the exchange, using the same network. This has resulted in a number of practices unknowingly seeing patients out-of-network for products that use the insurer's narrower exchange network. It has also created an additional level of confusion for physician practices when checking patients' coverage ... February 12, 2014 Managed Care Covered California, Health Benefit Exchange, Health Insurance Exchange, Insurance/Reimbursement, Managed Care, Blue Shield 0 0 Comment Read More »
Another delay for the Cal MediConnect project for dual eligibles The California Department of Health Care Services (DHCS) recently announced yet another delay for the Cal MediConnect project for dual eligibles. Implementation in Orange County has been delayed indefinitely, following a Centers for Medicare and Medicaid Services (CMS) audit of CalOptima—which is the county's only Medi-Cal managed care plan. The audit uncovered a number of serious issues that must be resolved before the duals transition can move forward in Orange County. Previously, Orange County was scheduled to begin passive enrollment on April 1, 2014. According to DHCS, implementation of Cal ... February 12, 2014 Medi-Cal, Medicare Medi-Cal, Medicare, Dual Eligible, Insurance/Reimbursement 0 0 Comment Read More »
DHCS pays over $100 million to primary care physicians in initial retroactive Medi-Cal rate increase payment The Department of Health Care Services (DHCS) has now made several retroactive interim payments to primary care physicians who have attested to their eligibility for the rate increases called for under the Affordable Care Act (ACA). These primary care payment increases have been put in place by the federal government in an effort to recruit more primary care physicians to treat low-income patients who will be newly eligible for health coverage in 2014. Although under the ACA the rate increases took effect on January 1, 2013, DHCS had been waiting ... February 7, 2014 Medi-Cal Affordable Care Act, Insurance/Reimbursement, Medi-Cal, ACA 0 0 Comment Read More »
Become an official opponent of anti-MICRA ballot initiative If you haven't already, please take a moment to sign up to be an official opponent of a possible November 2014 ballot measure being pushed by trial lawyers that would significantly weaken California's Medical Injury Compensation Reform Act (MICRA) and increase lawsuits against doctors, community clinics, health centers, hospitals and other health care providers. It only takes a moment to join and add your and/or your organization's name to the official list of opponents to this greed-fueled initiative. Once you do, you also will receive regular email updates from the ... February 7, 2014 General MICRA, Professional Liability, Grassroots Advocacy 0 0 Comment Read More »
CMA Foundation names Lisa Folberg as new president/CEO Sacramento – After nine years of service at the California Medical Association (CMA), Lisa Folberg has been tapped to head up the CMA Foundation. She replaces Carol Lee, who retired late in 2013. The CMA Foundation, dedicated to improving individual and community health through partnerships between leaders in medicine, health care stakeholders and community based organizations, was established in 1963 as a subsidiary of CMA. “I am thrilled to be joining the CMA Foundation,” said Folberg. “The work the CMA Foundation does in public health, access to care and improving quality ... February 7, 2014 General CMA Foundation 0 0 Comment Read More »
HHS announces new rule that gives patients direct access to lab test results Patients will soon be able to obtain their medical test results directly from the laboratory, rather than having to request a copy from their physician's office, according to a new rule announced Monday by the U.S. Department of Health and Human Services (HHS). The rule is part of a broader effort to give Americans more control over their health care. It supersedes state law and will have particular significance in 13 states that currently prohibit labs from releasing test results directly to patients. Current California law allows the release of ... February 7, 2014 General Diagnostic Testing, HIPAA, HIPAA Privacy Rule, Clinical Laboratories 0 0 Comment Read More »
Noridian sends out another wave of Medicare revalidation requests As called for under the Affordable Care Act (ACA), Medicare Administrative Contractors (MACs) have been requiring physicians to revalidate their Medicare enrollments. Between now and March 23, 2015, MACs will continue reaching out to physicians, notifying them of the need to revalidate. The most recent round of revalidations requests went out by December 30, 2013. The revalidation requirement is necessitated by new screening criteria called for under the ACA. Newly enrolling and revalidating providers will be placed in one of three screening categories representing the level of risk to the ... February 7, 2014 Medicare Affordable Care Act, Medicare, Noridian, PECOS, ACA, Provider Enrollment Chain and Ownership System 0 0 Comment Read More »
CMA releases fact sheets regarding Covered California grace period, updates toolkit Recognizing the Affordable Care Act’s “grace period” provision to be one of the most confounding provisions of the law, the California Medical Association (CMA) has published an FAQ sheet dedicated entirely to helping physicians make sense of the issue. The fact sheet, “Covered California: Understanding the Grace Period for Subsidized Exchange Enrollees," is available through CMA’s exchange resource center. Federal law allows Covered California enrollees who receive financial subsidies to keep their health insurance for three months, even if they have stopped paying their premiums. This is known as the “grace ... February 7, 2014 General Grace Period, Health Care Reform, Health Insurance Exchange, Covered California 0 0 Comment Read More »
CMS updates EFT authorization agreement The Office of Management and Budget recently approved changes to the CMS 588, Electronic Funds Transfer (EFT) Authorization Agreement. The revised EFT agreement is available on the CMS Forms List. As of January 1, 2014, new EFT authorization agreements submitted must be on the new form. Submissions on the old forms will be returned to the applicant. February 5, 2014 General CMS 0 0 Comment Read More »
Did you know you can request reconsideration if you're getting dinged with a 2% Medicare eRx penalty? Physicians and group practices who were not successful electronic prescribers under the 2012 or 2013 Medicare eRx Incentive Program will be subject to a negative payment adjustment of 2 percent in 2014 on all Medicare Part B claims paid under the physician fee schedule. The Centers for Medicare and Medicaid Services (CMS) has notified physicians and group practices that did not meet the requirements and will be subject to the 2014 payment adjustment. Some practices have reported that their meaningful use attestation was not taken into consideration as an exemption. ... February 5, 2014 General Health Information Technology, Insurance/Reimbursement, E-Prescribing, Medicare 0 0 Comment Read More »
