Why it's important to verify your patients' eligibility and benefits for 2016 With the new year soon upon us, physicians are urged to be diligent in verifying patients' eligibility and benefits to ensure they will be paid for services rendered. The beginning of a new year means calendar year deductibles and visit frequency limitations reset. With open enrollment there may also be changes to patients’ benefit plans, or patients may even be covered by a new payor. The new year also brings a host of other challenges that could affect your ability to be paid: Medicare patients can modify ... December 7, 2015 Managed Care Eligibility, Covered California, United Healthcare 0 0 Comment Read More »
Physicians urged to preemptively file for meaningful use hardship exemptions Because of a delay in the publication of regulations governing the Medicare meaningful use program, physicians are being urged to preemptively file for a 2015 hardship exemption to avoid penalties in 2016. Physicians should apply for an exemption under the “extreme and uncontrollable circumstances” category, even if they are uncertain whether they will meet the program requirements this year. Doing so will not preclude physicians from receiving an incentive if they do meet meaningful use requirements, but applying can serve as a safety net in staving off a penalty. In order ... December 7, 2015 Medicare EHR, Meaningful Use, Medicare, CMS, Electronic Health Record 0 0 Comment Read More »
Anthem asking physicians to affirm participation in workers' comp MPNs by Dec. 31 Anthem Blue Cross recently sent a request to physicians who participate in various workers’ compensation medical provider networks (MPN) through their Prudent Buyer agreements, asking them to affirm their continued participation in each of these networks. This request is required as part of the reforms instituted under SB 863, which mandates that MPNs obtain written acknowledgement from each participating physician that the provider elects to be a member of the network. Under the resulting regulations, physicians who have entered into contracts with workers’ compensation payors prior to August 27, 2014, and ... December 7, 2015 Managed Care Medical Provider Networks, MPN, Workers' Compensation, Anthem Blue Cross 0 0 Comment Read More »
CMA to relaunch webinar program; first program on meaningful use scheduled for Jan. 13 Beginning in January, the California Medical Association (CMA) will relaunch its full webinar program, featuring two to three subjects each month. Geared toward both physicians and their staff, the topics will range from everyday practice management—including contracting with payors, claims and reimbursement, and customer service—to timely issues such as MACRA, meaningful use, CMA governance and HIPAA compliance, among many others. The webinars will take place during the lunch hour, from 12 to 1 p.m. Kicking off the new year and start of the 2016 webinar program will be "Patient Engagement ... December 7, 2015 General Patient Education, Webinars, Meaningful Use 0 0 Comment Read More »
United Healthcare issues amendment to physicians participating in Core network United Healthcare (UHC) recently issued a contract amendment to practices participating in the California health benefit exchange through its UHC Core network. The new contract language amends (or replaces) the prior Appendix 2 of the UHC participating physician agreements. UHC also advised the California Medical Association (CMA) that the only option for physicians who wish to opt out of the Core product network is to terminate the underlying UHC commercial agreement. There is no option to opt out of just the Core network. The Core network, introduced earlier this year, ... December 7, 2015 Managed Care Payor Contracting, United Healthcare, Covered California 0 0 Comment Read More »
New law requiring accurate provider directories includes provider obligation to update information On July 1, 2016, a new law will take effect that requires plans and insurers to comply with uniform standards, and provide timely updates, for their provider directories. The law (SB 137) includes multiple components aimed at providing patients with more accurate and complete information to identify which providers are in their payor’s network. Specifically, the law requires: Plans/insurers must offer an online provider directory available to the public, including physicians, without any restrictions or limitations. ... December 7, 2015 Managed Care Network Adequacy, Payor Contracting, Provider Networks, Commercial Payors 0 0 Comment Read More »
Survey: smoking rates remain high in many areas of California UCLA’s latest California Health Interview Survey shows high smoking rates in several large pockets across the state, despite an overall decrease in smoking. Aside from a brief uptick in smoking from 2009 to 2011, the number of smokers in California declined steadily from 15.3 percent in 2003 to 10.8 percent in 2014 — a figure that translates to about 3.4 million smokers currently. However, smoking remains rampant in many portions of the state. Areas with the highest percent of teen and adult smokers included Lake County (26 percent), Yuba County (21 ... December 7, 2015 General Smoking, Tobacco, Public Health, Tobacco Tax 0 0 Comment Read More »
AMA and CMA efforts to secure adequate funding for GME continue In an effort to increase the number of medical residency slots and to help address the national physician shortage, delegates to the American Medical Association (AMA) renewed their support for alternative funding sources for graduate medical education (GME). AMA also adopted policy to explore additional funding models for GME beyond those examined in the Institute of Medicine’s 2014 report on GME governance and financing. Under the new policy, AMA will encourage insurance payors and foundations to enter into partnerships with state and local agencies, as well as academic medical centers ... December 7, 2015 General Graduate Medical Education, Physician Workforce, GME, Physician Supply 0 0 Comment Read More »
ACA results in $2.4 billion in consumer rebates since 2011 American consumers have received more than $2.4 billion in premium rebates since 2011 because of the Affordable Care Act (ACA), according to a recent report from the Centers for Medicare and Medicaid Services (CMS) . The rebates are the result of the ACA provision that requires health insurance companies to spend at least 80 percent of premium dollars on health care. In 2014 over 5.5 million consumers received nearly $470 million in rebates, for an average of $129 per family. California consumers received approximately $98 million in rebates for a ... December 7, 2015 Managed Care Affordable Care Act, Medical Loss Ratio 0 0 Comment Read More »
CMA urgers CMS to implement less burdensome, physician-led MACRA payment models The California Medical Association (CMA) is urging the Centers for Medicare and Medicaid Services to adopt principles that will assure access to high-quality care for all Medicare patients during the transition to the alternative payment models included in the Medicare payment reform legislation. In April, President Obama signed into law the Medicare Access and CHIP Reauthorization Act (MACRA), which repeals the badly broken Medicare sustainable growth rate formula and replaces it with new payment systems. After more than a decade of fighting for change by CMA and others in organized ... December 7, 2015 Medicare MACRA, Medicare, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
