OIG issues fraud alert regarding physician compensation arrangements The Office of Inspector General (OIG) in the Department of Health and Human Services released a Fraud Alert in early June to caution physicians who may be engaged in fraudulent compensation arrangements. The anti-kickback statute prohibits arrangements that result in "improper remuneration" for physicians, such as accepting payment in exchange for referrals. The OIG Alert follows a recent settlement between the OIG and 12 physicians involved in "questionable" medical directorships and office staff arrangements with a chain of diagnostic centers in Texas. Physician compensation allegedly took into account the volume ... June 26, 2015 General U.S. Department of Health and Human Services, Fraud and Abuse 0 0 Comment Read More »
CMS rule reduces Meaningful Use burdens; CMA advocates for more change On June 15, the California Medical Association (CMA) submitted comments to the Centers for Medicare and Medicaid Services (CMS) on proposed rules modifying Stage 1 and Stage 2 Meaningful Use criteria of the federal electronic health records (EHR) incentive programs. Under the federal EHR incentive programs, qualifying Medicare and Medi-Cal providers are eligible to receive incentive payments for adopting and demonstrating “Meaningful Use” of certified health information technology. The proposed rule aligns Stage 1 and Stage 2 Meaningful Use objectives and measures for 2015 through 2017 with proposed Stage 3 ... June 26, 2015 Managed Care, Medi-Cal, Medicare CMS, EHR, Electronic Health Record, HIT, Meaningful Use 0 0 Comment Read More »
Practice Check-Up: Marketing your practice This is the third in a series of articles aimed at highlighting key areas practices should examine in an effort to improve practice performance. This month we focus on how effectively managing the appointment schedule can have a positive impact on both patient and practice satisfaction. Even with the influx of approximately 6.5 million newly insured patients in California as a result of health reform, many physicians in small and solo practice are concerned that they will be unable to compete with the large groups and large health care ... June 26, 2015 General Practice Resources 0 0 Comment Read More »
New Paid Family Leave benefits form required July 1 In fall 2014, the Employment Development Department (EDD) revised the Claim for Paid Family Leave (PFL) Benefits form (DE 2501F). The initial deadline to discontinue use of the old form (12-03) was May 1, 2015; however, this date was extended to July 1, 2015. Effective July 1, 2015, only the new form, DE 2501F Rev. 1[7-14], will be accepted. To order new forms, practices can visit the EDD Forms and Publications page or call (877) 238-4373 FREE. Physicians are also reminded that they can certify claims for State Disability Insurance (SDI) ... June 26, 2015 General State Disability Insurance (SDI), Paid Family Leave (PFL) 0 0 Comment Read More »
Vaccination bill clears Asembly Health Committee after nearly five hours of discussion, testimony Senate Bill 277, which would bar parents from skipping school vaccination requirements due to personal philosophies, passed its first test in the state Assembly on Tuesday. Policymakers in the Assembly Health Committee approved the bill on a 12-6 vote. SB 277 would allow only medical exemptions for children entering public school by removing the option to file a personal belief exemption (PBE). The bill would not pertain to families who homeschool or utilize independent study. As in previous hearings, both proponents and opponents of SB 277 filled up the room to ... June 26, 2015 General Advocacy, Immunization, Public Health, State Legislation, Vaccination, I Heart Immunity 0 0 Comment Read More »
What is commercial risk adjustment? Over the past few months, CMA has received several calls from practices who had received requests for medical records from various payors stating the records are needed for “risk adjustment.” The records requests are a result of the commercial risk adjustment program created by Section 1343 of the Affordable Care Act. The primary goal of the risk adjustment program is to spread the financial risk borne by payors more evenly in order to stabilize premiums and provide issuers the ability to offer a variety of plans to meet the ... June 26, 2015 General, Managed Care Payors, Medical Records 0 0 Comment Read More »
CMS announces transition of single sign-on IACS system The Centers for Medicare and Medicaid Services (CMS) established the Individuals Authorized Access to the CMS Computer Services (IACS) as a means to provide a single user ID for business partners to access multiple CMS applications. For physician offices, this consists primarily of the Physician Quality Reporting System (PQRS)/eRx Physician Quality Reporting System and E-Prescribing Incentive Programs. CMS has announced that, on July 13, 2015, authorized users of the IACS system will be transitioned to the existing Enterprise Identity Management (EIDM) system. The EIDM system will allow a single ... June 26, 2015 General CMS, PQRS, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
Anthem Special Investigations Unit may be recouping beyond statutory timeframe In 2011, the California Medical Association (CMA) raised concerns with Anthem’s attempts to recoup money from physicians beyond the statutory timeframe. Through its Special Investigations Unit (SIU), Anthem was pursuing physicians for refunds of payments made outside of the 365-day period allowed by California law. That law permits recoupment of claims older than a year only if the payment was made based on fraud or misrepresentation. CMA determined that Anthem was employing a definition of “misrepresentation” that was much broader than what is allowed under law. CMA thus filed ... June 26, 2015 General, Managed Care Department of Managed Health Care, Recoupment, Anthem Blue Cross 0 0 Comment Read More »
CMA President's Message: A Critical Year for Health Care We haven’t quite hit the halfway mark, but 2015 is already shaping up to be an important year for health care. In just these past few months, legislators have repealed the Medicare sustainable growth rate (SGR), saving physicians from an imminent 21 percent payment cut, and have considered an abundance of new bills aimed at solving several major health issues across the state. The topic of health has been filling front-page headlines at every leading newspaper in California recently, reaffirming my belief that this is truly an exciting time to be ... June 15, 2015 General, Medi-Cal, Medicare President's Message, Physician Leadership 0 0 Comment Read More »
CMA Capitol Insight: June 10, 2015 CMA Capitol Insight is a biweekly column by veteran journalist Anthony York, reporting on the inner workings of the state Legislature. Long legislative days, dry summer nights It was a frantic week in Sacramento, with hundreds of bills passed by the Senate and Assembly as the Capitol wrestled with deadline week. Last week, it was the house of origin deadline. All bills that started in the Assembly or Senate had to clear that house by Friday. The results were long legislative days, swarms of lobbyists huddled outside the Assembly and Senate chambers, ... June 15, 2015 General CMA Capitol Insight, Anthony York 0 0 Comment Read More »
