House committee releases bipartisan Medicare SGR reform bill Three congressional committees have been hard at work over the past few months on legislation that would eliminate the desperately broken Medicare sustainable growth rate (SGR) formula that is used to determine physician payment rates. On Friday, the health subcommittee of the U.S. House of Representatives Energy and Commerce Committee's health subcommittee released its bill to repeal the SGR. One Tuesday the bill was approved by the subcommittee and now heads to the full committee for consideration. The House Ways and Means Committee and the Senate Finance Committee have ... July 25, 2013 Medicare Insurance/Reimbursement, Medicare, SGR, Advocacy, Sustainable Growth Rate 0 0 Comment Read More »
CMA publishes Medicare quality reporting guide The Medicare Physician Quality Reporting System (PQRS) is a reporting program that uses a combination of incentive payments and payment reductions to promote reporting of quality information by eligible professionals. Up until now, this program has been voluntary and physicians have received bonuses for participating. That's about to change. Failure to participate now means physicians could face significant penalties in 2015 and beyond. Find out more in CMA's new guide, "Getting Started with the Medicare Physician Quality Reporting System." The guide is avaialble to members only. Contact: CMA's reimbursement help line, (888) ... July 25, 2013 Medicare Insurance/Reimbursement, PQRS, Medicare, Physicians Quality Reporting System 0 0 Comment Read More »
Get involved: Submit a resolution to the 2013 House of Delegates The most effective way an individual member can influence CMA's policies and activities is to submit resolutions to the House of Delegates, the association's legislative body. The delegates meet annually to debate and act on resolutions and reports dealing with myriad medical practice, public health, and CMA governance issues. This year's annual meeting is October 11-13 at the Disneyland Hotel in Anaheim, and the deadline to submit resolutions is August 12. Any CMA member may author a resolution, but a delegate, alternate delegate, component medical society, or specialty delegation must ... July 19, 2013 General House of Delegates, CMA Governance, CMA Policy 0 0 Comment Read More »
CMA Launches Exchange Resource Center In 2010, Congress passed historic sweeping health care legislation, the Patient Protection and Affordable Care Act (ACA), which reformed the individual and small group health insurance markets and, beginning in 2014, will provide health insurance to much of the nation's uninsured. Under the ACA, two-thirds of California's uninsured may be eligible to purchase coverage through the health benefit exchange. The exchange's goal is to begin open enrollment on October 1, 2013 – with coverage beginning on January 1, 2014. To help educate physicians about the exchange and ensure that they are ... July 16, 2013 General, Managed Care Covered California, health insurance exchange, Affordable Care Act (ACA) 0 0 Comment Read More »
Medicare Transition Update: Noridian adds additional Meet and Greet Workshops At the request of the California Medical Association (CMA) and other organizations in California, Noridian has added seven additional Meet and Greet Workshops throughout the state. Transition of the Medicare Administrative Contract from Palmetto GBA to Noridian is scheduled for September 16, 2013 (Part B). Following is the list of locations in California: July 9-11 ... July 9, 2013 Medicare Medicare, Noridian 0 0 Comment Read More »
Extra! Extra! Read all about it! New Medicare transition webpage available As the California Medical Association (CMA) has previously reported, administration of the Medicare contract will change to Noridian Healthcare Solutions effective September 16, 2013 (Part B). In response to this important change, CMA has created a dedicated Medicare transition webpage, www.cmanet.org/medicare-transition, offering practices the ability to access the most recent updates and important information regarding the transition in one easy-to-access to location. July 9, 2013 Medicare Noridian, Medicare 0 0 Comment Read More »
Attestation for Medi-Cal primary care rate increase to begin in July The Centers for Medicare & Medicaid Services (CMS) released regulations in early November 2012 implementing rate increases for primary care physicians who treat Medicaid patients. The goal of the increase is to recruit more physicians to treat low-income patients who will be newly eligible for health coverage under the Affordable Care Act (ACA). Under the ACA, primary care physicians will see their reimbursement rates raised to Medicare levels in 2013 and 2014. According to CMS, states must also incorporate the increased payment rates into their contracts with managed care ... July 9, 2013 Medi-Cal ACA, Affordable Care Act, Centers for Medicare & Medicaid Services, CMS, Medi-Cal 0 0 Comment Read More »
Next phase of Healthy Families to Medi-Cal transition scheduled for August 1 Phase 3 of the Healthy Families transition from fee-for-service to Medi-Cal managed care is scheduled for August 1, 2013. This phase will impact approximately 107,000 children who have a Healthy Families plan that does not offer Medi-Cal managed care or subcontract with a Medi-Cal managed care plan, thus requiring them to transition to a new plan. This is the first phase of the Healthy Families transition where patients may be required to change physicians. Enrollment will include consideration of the child’s primary care providers. Affected counties are: ... July 9, 2013 Managed Care, Medi-Cal Managed Care, Medi-Cal, Healthy Families 0 0 Comment Read More »
Update your NPI information before the Medicare transition to Noridian According to a new report by the U.S. Department of Health & Human Services Office of the Inspector General, 58 percent of the databases used to determine provider identities and help to prevent the occurrence of fraud are inaccurate or incomplete. The National Plan and Provider Enumeration System (NPPES), which houses National Provider Identifier (NPI) numbers, is not always consistent with information in the Provider Enrollment, Chain and Ownership System (PECOS). The national revalidation effort by the Centers for Medicare & Medicaid Services (CMS) is a big step in improving ... July 9, 2013 Medicare Medicare, NPI, Noridian 0 0 Comment Read More »
AMA's new "administrative burden index" ranks cost of doing business with commercial insurers The American Medical Association (AMA) recently unveiled its new Administrative Burden Index (ABI), which ranks commercial health insurers according to the level of unnecessary cost they contribute to the billing and payment of medical claims. The ABI reflects the overhead cost needed to bill and collect payment from each major payer and was introduced as part of AMA's annual National Health Insurer Report Card. AMA found that administrative tasks associated with avoidable errors, inefficiency and waste in the medical claims process resulted in an average ABI cost per claim of ... July 8, 2013 General Billing and Coding, AMA, Insurance/Reimbursement, Practice Management 0 0 Comment Read More »
