Preorder the 2015 California Physician's Legal Handbook by April 15 and save 10% The California Medical Association (CMA) Center for Legal Affairs is happy to announce the upcoming release of the updated California Physician's Legal Handbook (CPLH) for 2015. CPLH is the premier California health law publication with 46 chapters of comprehensive legal information, including current laws, regulations and court decisions related to the practice of medicine. CPLH, available in a multi-volume print format, as an online subscription or a combination of print/online, is updated annually by CMA attorneys to include the most recent changes in health law. CPLH 2015 includes new and ... March 19, 2015 General CPLH, California Physician's Legal Handbook 0 0 Comment Read More »
Medicare RAC court case keeps collections on uncertain footing The U.S. Court of Appeals for the Federal Circuit issued a decision in early March in a case filed by one of the Medicare Recovery Audit Contractors (RAC) after the Centers for Medicare and Medicaid Services (CMS) changed the timing for the payment of contingency fees on collections. The decision means the auditing program will be put on hold until CMS determines how to contract with its RACs. The RAC program is responsible for identifying fraud and waste in the Medicare system by detecting improper Medicare payments. Since 2008, when ... March 18, 2015 Medi-Cal, Medicare Centers for Medicare and Medicaid Services, Medicare, Recovery Audit Contractor, Audits 0 0 Comment Read More »
New fee reduction for Workers' Compensation Independent Medical Review and Independent Bill Review submissions The California Department of Industrial Relations (DIR) announced that fees for submission of an Independent Medical Review (IMR) or Independent Bill Review (IBR) for workers’ compensation were reduced effective January 1, 2015. The following table summarizes the reduction in fees. Fee prior to December 31, 2014 ... March 17, 2015 General Insurance/Reimbursement, Department of Industrial Relations, Workers' Compensation 0 0 Comment Read More »
Anthem system error results in missing remittances In early February, the California Medical Association (CMA) began receiving reports from practices of missing Anthem Blue Cross remittances. CMA escalated the issue to the payor and has since learned that a system issue is to blame for the missing electronic remittance advices (ERA). Anthem reports that the problem began in mid-December and affected ERAs for exchange/mirror and Federal Employee Program (FEP) claims. Somehow, the ERA function was turned off in the Anthem system for these product types. So, while practices received the money for the affected claims through ... March 17, 2015 Managed Care Anthem Blue Cross, Insurance/Reimbursement, Managed Care 0 0 Comment Read More »
Is your Medicare practice information up-to-date? The February issue of CMA Practice Resources (CPR) contained an article discussing the importance of maintaining up-to-date practice demographic information with contracted managed care payors (see “Ensure your practice information is up-to-date with contracted payors”). This advice applies equally to government payors, such as Medicare, that you are enrolled in. Medicare administrative contractors (MAC), such as Noridian in California, obtain practice contact information from a practice’s Medicare enrollment application, from either the Internet-based Provider Enrollment, Chain and Ownership System (PECOS), or through a paper application. The MAC may contact ... March 17, 2015 Medicare Practice Resources, Medicare 0 0 Comment Read More »
DWC implements annual changes to workers' compensation physician fee schedule The California Division of Workers’ Compensation (DWC) has implemented its annual adjustments to the California workers’ compensation resource-based relative value scale (RBRVS) fee schedule effective for dates of service on or after March 1, 2015. Under the RBRVS Physician Fee Schedule regulations, located under “Physician services” on DWC’s Official Medical Fee Schedule (OMFS) webpage, the calculations to determine maximum allowable amounts for each code incorporate a number of factors, including the assigned relative value units for each code along with the yearly adjusted conversion factor determined by DWC. DWC ... March 17, 2015 General RBRVS, Resource Based Relative Value System, Workers' Compensation 0 0 Comment Read More »
DHCS identifies another glitch in issuing primary care rate increase for CHDP claims The California Department of Health Care Services (DHCS) has experienced various difficulties issuing the Affordable Care Act primary care rate increase funds on Child Health and Disability Prevention (CHDP) Program claims. Before the rate increases were implemented, some practices had been instructed by DHCS to bill CHDP claims at their Medi-Cal rates. This caused concern – based on DHCS’s pricing logic of paying the lesser of Medicare’s rate or the billed charges – that some practices would not qualify for the retroactive increases once the systems were updated to ... March 17, 2015 Medi-Cal, Medicare CHDP, Child Health and Disabilityh Prevention Program, Affordable Care Act, DHCS 0 0 Comment Read More »
Raising the smoking age to 21 could reduce tobacco use among next generation A report released today by the Institute of Medicine (IOM) said that raising the smoking age to 21 could reduce smoking by as much as 12 percent in the next generation. In addition, smoking-related deaths could be cut by nearly 10 percent. Tobacco use remains the leading cause of preventable death in this country. The U.S. Surgeon General estimates that 5.6 million youth alive today will lose their lives prematurely if we don’t do more to reduce current smoking rates. Roughly 90 percent of daily smokers first tried a cigarette before ... March 17, 2015 General Smoking Age, Tobacco, Institute of Medicine, Smoking 0 0 Comment Read More »
United Healthcare introduces Group Medicare Advantage PPO product Effective June 1, 2015, United Healthcare (UHC) will be introducing its Group Medicare Advantage PPO product in several southern California counties. The California Medical Association (CMA) has learned that contract amendments were mailed on February 24 to over 10,000 currently contracted UHC physician practices in Imperial, Orange, Los Angeles, Riverside, San Bernardino and San Diego counties that the payor intends on including in its provider network for this new product. The insurer states that the new product, offered exclusively to employer/union group retirees, will offer greater access to a national ... March 17, 2015 Medicare Contract Amendment, Payor Contracting, United Healthcare 0 0 Comment Read More »
Growing aging population will result in a shortage of 90,000 doctors by 2025 The U.S. could face a shortage of as many as 90,000 physicians because of a growing elderly population, according to a report published last week by the Association of American Medical Colleges (AAMC). The report also predicts that the greatest physician shortfall will be in the demand for surgeons who treat diseases in the elderly. The report says the growth in the insured population due to the Affordable Care Act will have little impact on the need for more physicians – just two percent of the projected growth in demand, ... March 17, 2015 General Physician Workforce, Residents and Fellows, Aging 0 0 Comment Read More »
