CMA urges CMS to simplify the Quality Payment Program The California Medical Association (CMA) has submitted comments to the Centers for Medicare and Medicaid Services (CMS) on the proposed changes to the Medicare Quality Payment Program for 2019. CMA is disappointed that CMS did not reduce the reporting burdens in the Merit-based Incentive Payment System (MIPS) program in a more meaningful way. We also oppose the confusing new scoring tiers (gold, silver and bronze) and have urged CMS to simplify and overhaul the complex MIPS scoring system. CMA strongly urges CMS to maintain the 10 percent weight of the cost ... October 16, 2018 CMA, General Advocacy, Public Payors 0 0 Comment Read More »
Noridian announces improvements to Medicare portal Noridian, the Medicare Administrative Contractor for California, recently announced improvements to the Noridian Medicare Portal (NMP) that will make it easier for providers to identify reasons behind eligibility-related claim denials. When a claim is denied for eligibility-related reasons, providers can select the link under Claim Status in the “Related Inquiries” portion of the page to access details to assist with determining their next steps. Effective July 27, 2018, all NMP users can also send secure online messages to Noridian regarding medical reviews or to voice concerns to be addressed by ... October 16, 2018 Medicare Practice Management, Public Payors 0 0 Comment Read More »
Annual Medicare preventative exams now include review of opioid use On August 28, the Centers for Medicare and Medicaid Services (CMS) published an update to the Initial Preventive Physician Examination and Annual Wellness Visit benefits, highlighting that a review of patient opioid use is now a component of medical and social history assessments. Per CMS, the review of opioid use during these annual preventative exams will help physicians identify patients using opioids, discuss alternative for non-opioid pain therapies, and assist in diagnosing and treatment for patients experiencing or at risk for opioid-use disorders. Additional CMS Resources Reducing opioid misuse The ABCs ... October 16, 2018 General Drug Prescribing/Dispensing, Public Payors 0 0 Comment Read More »
Mosquitoes test positive for West Nile virus San Bernardino Two mosquitoes collected in the City of San Bernardino tested positive for West Nile Virus. These are the first mosquitoes that tested positive in 2018 within the area served by the Division of Environmental Health Services Mosquito and Vector Control Program (MVCP). MVCP is taking steps to eliminate mosquito breeding hazards. People bitten by an infected mosquito may develop West Nile fever and experience flu-like symptoms which may include fever, body aches, skin rash, and fatigue. In some people, West Nile fever can develop into a more serious form of ... October 1, 2018 General Public Health 0 0 Comment Read More »
Coding Corner: CPT reporting for preventive medicine services CPR’s “Coding Corner” focuses on coding, compliance, and documentation issues relating specifically to physician billing. This month’s tip comes from John Verhovshek, the managing editor for AAPC, a training and credentialing association for the business side of health care. Preventive medicine services, or “well visits,” are evaluation and management (E/M) services provided to a patient without a chief complaint. The reason for the visit is not an illness or injury (or signs or symptoms of an illness or injury), but rather to evaluate the patient’s overall health, and to identify ... September 27, 2018 General, Managed Care Payor Issues and Reimbursement 0 0 Comment Read More »
CMA statement on proposed policy linking safety net benefits and immigration status Statement attributable to: Theodore M. Mazer, M.D., President of the California Medical Association (CMA) “CMA believes that everyone, regardless of immigration status, should have access to needed affordable and quality health care. The proposed policy makes utilizing health programs a disqualifier for immigration, and it would have a chilling effect on families accessing health care services while decreasing public health in communities across California. Health care should remain a safe place for all, and we urge the Trump Administration to rethink this irresponsible policy.” September 27, 2018 CMA, General Access to Care 0 0 Comment Read More »
DHCS receives approval on Medi-Cal supplemental tobacco tax payments for FY 2018-2019 The California Department of Health Care Services (DHCS) recently received federal approval on its plan to increase Medi-Cal fee-for-service physician payments for the 2018-2019 fiscal year. The supplemental payments—made possible by the Proposition 56 tobacco tax funding—will raise payments for a total of 23 CPT codes, including 10 new preventive CPT codes. DHCS will be increasing the supplemental payment for the previously eligible CPT codes to 85 percent of Medicare (a 40 percent average increase in payments for these eligible codes compared with 2017 – 2018 payment levels). The 10 ... September 21, 2018 Managed Care, Medi-Cal Advocacy, Payor Issues and Reimbursement, Practice Management 0 0 Comment Read More »
Have you received your supplemental Medi-Cal managed care payments? 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. While the California Department of Health Care Services (DHCS) began disbursing FY 2017-2018 supplemental fee-for-service payments in January 2018, federal approval of the supplemental Medi-Cal managed care payments was delayed. This resulted in delayed payment for Medi-Cal managed care services. DHCS began dispersing the FY 2017-2018 funds to the plans ... September 21, 2018 Managed Care, Medi-Cal Advocacy, Medi-Cal, Payor Issues and Reimbursement, Practice Management 0 0 Comment Read More »
Vote on Senate opioid package expected this week The U.S. Senate is expected to vote this week a bipartisan package of over 70 proposals intended to help combat the nation’s opioid crisis. Known as the Opioid Crisis Response Act of 2018, the package includes legislation intended to reduce opioid use, encourage recovery, support caregivers and families, and drive innovation and long-term solutions. The California Medical Association (CMA) is working with AMA and our other partners to resolve several outstanding issues, such as the mandate to e-prescribe opioids, despite the difficult DEA process. We have, however, successfully stopped all ... September 21, 2018 General Advocacy, Drug Prescribing/Dispensing 0 0 Comment Read More »
CMS identifies and corrects errors in MIPS scoring logic Centers for Medicare and Medicaid Services (CMS) recently released 2017 Merit-based Incentive Payment System (MIPS) performance scores and payment adjustment information for the 2019 payment year. Physicians have been able to request targeted reviews if they believe an error was made in the calculation of their performance score. The requests CMS received through targeted reviews led them to take a closer look at a few prevailing concerns. Those concerns included the application of the 2017 Advancing Care Information and Extreme and Uncontrollable Circumstances hardship exceptions, the awarding of Improvement Activity ... September 14, 2018 Medicare MACRA, Practice Management 0 0 Comment Read More »
