AMA delegates affirm commitment to health insurance coverage for all Americans At the interim meeting of the American Medical Association (AMA) House of Delegates this weekend in Florida, delegates from the California Medical Association and more than 170 state and specialty medical societies from across the country affirmed their commitment to health insurance coverage for all Americans. “Using a comprehensive policy framework that has been refined over the past two decades, AMA will actively engage the incoming Trump Administration and Congress in discussions on the future direction of health care," said Andrew W. Gurman, M.D., AMA president. "AMA remains committed to ... November 21, 2016 General American Medical Association, Health Care Reform 0 0 Comment Read More »
Save the date for 2017 California Immunization Summit in Riverside The California Immunization Coalition (CIC) annual California Immunization Summit will be returning to Riverside on April 3-4, 2017. The summit is an opportunity for physicians to learn about community-based programs that have increased vaccination rates, and how to adapt and apply key lessons from successful programs. The summit is presented by CIC, a public-private partnership dedicated to achieving and maintaining full immunization protection for all Californians to promote health and prevent serious illness. Check www.immunizeca.org/about/cic-summit for speaker and registration updates in 2017. November 21, 2016 General Immunization, Public Health, Vaccination 0 0 Comment Read More »
State's high court rules health plans cannot negligently delegate payment responsibility The California Supreme Court today ruled that health plans cannot absolve themselves of the responsibility to pay claims for emergency care by noncontracted providers by negligently delegating that responsibility to a risk-bearing organization that it knows—or should have known—to be financially insolvent. "Today's ruling is a huge victory for physicians," said Francisco Silva, Senior Vice President and General Counsel for the California Medical Association (CMA). "California's high court is unequivocally telling health plans they cannot get away with this morally blameworthy behavior. They cannot irresponsibly delegate risk and leave physicians ... November 21, 2016 Managed Care Amicus Briefs, California Supreme Court, Health Net, Legal Advocacy 0 0 Comment Read More »
Q1 resolutions now accepting testimony As part of its policy-making process, the California Medical Association (CMA) allows members to submit resolutions for debate and discussion throughout the year. These resolutions will be considered by the standing Councils and Subcommittees, and will be presented to the Board of Trustees for consideration to be adopted as policy for the association. There are now nine new resolutions online for consideration in the first quarter of 2017. They are posted at www.cmanet.org/hod and will be available for testimony until December 9, 2016. After testimony closes, the resolutions and all the ... November 21, 2016 CMA House of Delegates 0 0 Comment Read More »
New online Medi-Cal provider enrollment portal to launch Friday The California Department of Health Care Services (DHCS) is ready to launch its new online Medi-Cal provider enrollment portal. The system, called the Provider Application and Validation for Enrollment (PAVE), will transform provider enrollment from a manual paper-based process to a web-based portal that providers can use to complete and submit their applications and verifications and to report changes. The new portal will go live this Friday, November 18, 2016. Initially, PAVE will be available for most physician and allied providers who enroll to serve fee-for-service beneficiaries directly through the ... November 16, 2016 Medi-Cal Medi-Cal, Medi-Cal Provider Enrollment, PAVE 0 0 Comment Read More »
CMA Foundation joins international effort to bring awareness to appropriate use of antibiotics The California Medical Association (CMA) Foundation this week joins hundreds of organizations across the globe including the Centers for Disease Control and Prevention (CDC) in raising awareness about appropriate antibiotic use in honor of “Get Smart About Antibiotics Week.” Educating physicians and patients about appropriate use of antibiotics has been a priority of the CMA Foundation for the past 15 years, through its Alliance Working for Antibiotic Resistance Education (AWARE) project. The AWARE project was formed in 2001 when the CMA Foundation, together with the California State Parent Teacher Association, ... November 16, 2016 CMA, General Antibiotic Resistance, AWARE, CMA Foundation (CMAF), Public Health 0 0 Comment Read More »
Know Your Rights: Timely filing denials CMA’s “Know Your Rights” series summarizes vital protections under state and federal law that physicians should be aware of in their dealings with payors. Health plans typically impose claim filing deadlines, which require physicians to submit claims within a certain time period after the date of service. If the physician fails to meet the deadline, the health plan will not pay for the service provided. However, California law prohibits commercial health plans and insurers from imposing claim filing deadlines that are less than 90 days after the date of service ... November 16, 2016 General Denials, Know Your Rights 0 0 Comment Read More »
AHIP conducting follow-up survey on Provider Directory Pilot America's Health Insurance Plans (AHIP) is conducting a follow-up survey of providers to evaluate the process and results of its earlier Provider Directory Pilot program. This program was aimed at meeting the requirements of California Senate Bill 137, which requires that physician directories are more accurate and up-to-date. AHIP has contracted with independent research organization NORC, at the University of Chicago, to reach out to providers as part of the evaluation phase of the provider directory pilot. Outreach to providers will include an online survey of provider office staff who ... November 16, 2016 General, Managed Care Network Adequacy, Provider Directories, Provider Directory Accuracy Law 0 0 Comment Read More »
United to issue new 2016-2017 Premium Designation physician results In its October Network Bulletin, United Healthcare (UHC) announced that the next iteration of its Premium Designation assessment results will be sent to physicians in early November. These results will be released publicly via the payor's online physician directory beginning January 4, 2017. Physicians within 16 specialties (allergy, cardiology, ENT, endocrinology, family medicine, gastroenterology, general surgery, internal medicine, nephrology, neurology, neurosurgery, OB/GYN, pediatrics, pulmonology, rheumatology and urology) and their 47 credentialed sub-specialties will again be ranked by UHC on both national and specialty-specific measures for quality and various cost-efficiency benchmarks. ... November 16, 2016 Managed Care United Healthcare 0 0 Comment Read More »
New Health Laws 2017: Are you ready? The California Legislature had an active year, passing many new laws affecting health care. In particular, there was a strong focus on health care coverage, drug prescribing, public health and workers’ compensation issues. The California Medical Association has published a summary of the most significant new health laws of interest to physicians. For more details, see "Significant New California Laws of Interest to Physicians for 2017." November 16, 2016 General California Physician's Legal Handbook 0 0 Comment Read More »
