Noridian posts updated Medicare Physician Fee Schedule California's Medicare contractor, Noridian, has posted an updated 2016 Medicare Physician Fee Schedule on its website. Last week, Noridian had removed the fee schedule because it contained several technical errors that needed to be fixed. This update is not expected to cause any delays in reimbursement for physicians, because under current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt. The updated fees are valid for dates of service from January 1 through December 31, 2016. To see the ... January 25, 2016 Medicare Medicare, Noridian, Fee Schedule 0 0 Comment Read More »
CMA Capitol Insight: Jan. 19, 2016 CMA Capitol Insight is a biweekly column by veteran journalist Anthony York, reporting on the inner workings of the state Legislature. __________________________________________________________________________________________________________________ The Budget Battle Begins Gov. Jerry Brown introduced his budget this month, and it was about what was expected for anyone watching the governor in recent years. Brown did propose a solution to the fight over the managed care organization (MCO) tax, though no final deal has been announced. Passing such a tax would require a two-thirds vote, and Republicans have said they’re skeptical of the need for the tax. If ... January 25, 2016 General Anthony Yorki, CMA Capitol Insight 0 0 Comment Read More »
IMQ's Stepping Up to Leadership early-bird pricing ends Feb. Early-bird pricing for the Institute for Medical Quality (IMQ) Stepping Up to Leadership conference ends February 9. The program, offered in conjunction with the University of California at San Diego PACE Program, is a practical hands-on training for medical staff leaders. The 2016 Stepping Up to Leadership program, widely recognized as the “go to” course for acquiring knowledge and skills to successfully lead a medical staff, will take place March 10-11 in San Diego. The conference offers unique hands-on and interactive learning opportunities, as well as excellent faculty and course work ... January 15, 2016 General IMQ, Institute for Medical Quality, Conferences 0 0 Comment Read More »
UHC to introduce new primary care assessment program United Healthcare (UHC) recently notified approximately 800 contracted primary care physicians, introducing them to its new educational performance evaluation program. Slated to run concurrently with the UHC Premium Designation program, primary care physicians whose claims data demonstrates a high utilization rate in one of the following measures will receive a performance evaluation report: Emergency department utilization Inpatient admission utilization Average length of stay Laboratory/pathology utilization Levels 4 and 5 visits Modifier ... January 15, 2016 Managed Care United Healthcare 0 0 Comment Read More »
New approval timeframes for prescription drug prior authorizations took effect Jan. 1 A new law took effect Jan. 1, 2016, that requires health plans and health insurers to respond to prescription drug prior authorization requests within 72 hours for non-urgent requests and 24 for urgent requests. The law (SB 282) deems such requests to be granted if the payor fails to respond within these timeframes. A previous law (SB 866) had required a determination within two business days or the request was deemed approved. SB 282 also requires the Department of Managed Health Care and the Department of Insurance to create a ... January 15, 2016 General Department of Managed Health Care, Preauthorization, Prescription Drugs, Department of Insurance 0 0 Comment Read More »
HHS modifies HIPAA Privacy Rule as part of executive actions to curb gun violence Last week, the Obama Administration unveiled a number of executive actions to address gun violence in the United States, including an amendment to the Health Insurance Portability and Accountability Act (HIPAA) that would make it easier for mental health providers to disclose the identities of individuals who are disqualified from shipping, transporting, possessing or receiving a firearm. Both the Brady Handgun Violence Prevention Act of 1993 and the Gun Control Act of 1968 prohibit gun ownership and gun sales to individuals that have been involuntarily committed to a mental institution ... January 15, 2016 General Guns, HIPAA, HIPAA Privacy Rule, Mental Health, Public Health, CPLH 0 0 Comment Read More »
AMA publishes guide to physician-focused alternative payment models The legislation that repealed the Medicare sustainable growth rate—the Medicare Access and CHIP Reauthorization Act (MACRA)—created major new opportunities to advance alternative payment models (APM). Starting in 2019, MACRA will provide a 5 percent annual bonus payment to physicians who participate in APMs and it exempts them from participating in the fee-for-service meaningful use and quality reporting programs (MACRA's Merit-Based Incentive Payment System). In addition to accountable care organizations, medical homes and bundled payments for hospital-based episodes, MACRA also provides for the development of “physician-focused” APMs. The American Medical Association ... January 15, 2016 Medicare AMA, American Medical Association, Medicare, Alternative Payment Models (APM) 0 0 Comment Read More »
Governor Brown's 2016-17 budget proposal includes new MCO tax deal On January 7, the Governor unveiled a $122.6 billion budget proposal for the 2016-17 fiscal year, including a new approach to replacing a soon-to-expire tax on managed care organizations (MCO). The current MCO tax will expire this summer if legislators cannot agree on a replacement. Since 2005, the state has taxed MCOs and used the money to cover the costs of the Medi-Cal program. However, federal officials in 2014 informed California that its MCO tax structure was not compliant with federal requirements. Since then, the California Department of Health Care ... January 15, 2016 Managed Care California State Budget 0 0 Comment Read More »
Campaign to recall Dr. Pan fizzles A campaign to recall California Senator Richard Pan, M.D., the pediatrician who carried Senate Bill 277 in the California state legislature, has failed to gain any support. Proponents of the recall had until December 31, 2015, to collect 35,926 verified signatures from the 436,318 registered voters in his district. According to the Yolo County Clerk Recorder, opponents of the effort did not even file one signature. SB 277, co-sponsored by the California Medical Association (CMA), removed the personal belief exemption from vaccination requirements—allowing only for medical exemptions. The effort drew ... January 15, 2016 General Physician Leadership, Political Advocacy, vaccination, Immunization 0 0 Comment Read More »
Immunization summit coming to Sacramento April 24-25 The 2016 California Immunization Coalition (CIC) Summit, “Celebrating Healthier Tomorrows,” is scheduled for April 24-25 at the Hyatt Regency Sacramento. This annual meeting brings together a wide range of immunization partners from throughout California and beyond to share ideas, discuss issues and learn from one another. The summit is presented by the California Immunization Coalition, a public-private partnership dedicated to achieving and maintaining full immunization protection for all Californians to promote health and prevent serious illness. Speakers for the 2016 event include: Carolyn Bridges, M.D., Associate Director of ... January 15, 2016 General Seminars, Vaccination, Immunization 0 0 Comment Read More »
