Health plans begin transitioning patients from troubled Nivano The California Medical Association (CMA) has learned that two health plans—Blue Shield and UnitedHealthcare (UHC)—have recently terminated their delegated agreements with Nivano Physicians Medical Group and are in the process of transferring patients from Nivano to alternative networks. Nivano, also known as Northern California Physicians Medical Group with enrollees in Placer, Nevada, Sacramento, Yuba and Colusa counties, is currently on a corrective action plan with the Department of Managed Health Care (DMHC) for failure to meet financial solvency criteria. CMA has also received a surge of complaints about delays in ... August 9, 2017 Managed Care Blue Shield, UnitedHealthcare 0 0 Comment Read More »
CMA Doc: Richard Pan, M.D. Senator Pan presenting Senate Bill 277 in Senate Health Committee "Vaccines are so effective that parents, and even many younger physicians, have never seen many vaccine preventable diseases. This lack of personal experience with these diseases has created opportunities for anti-vax charlatans to spread misinformation and create anxiety and doubt about vaccines for their own personal gain." --Sen. Richard Pan, M.D. As a physician, I have witnessed first-hand how vaccines protect our children and communities from dangerous diseases. I attended medical school at the University of Pittsburgh, where I learned microbiology ... August 9, 2017 CMA, General California Senate, CMAdocs, Pediatrics, Vaccination 0 0 Comment Read More »
CMS now accepting QPP hardship applications for 2017 The Centers for Medicare and Medicaid Services (CMS) is now accepting hardship exceptions from the Medicare Quality Payment Program (QPP) for the 2017 reporting year. Beginning with this reporting year, physicians who do not participate in QPP will see a negative 4 percent payment adjustment in 2019. Physicians who do participate may qualify for bonus payments. Physicians and groups that qualify for the QPP’s Merit-Based Incentive Payment System (MIPS) can submit a hardship exception application for one of the following reasons: Insufficient internet connectivity ... August 9, 2017 Medicare CalHIPSO, Centers for Medicare and Medicaid Services, CMS, MACRA, Medicare, Medicare Quality Payment Program (QPP), Merit-Based Incentive Payment System (MIPS) 0 0 Comment Read More »
California congressmen introduce bills to address physician shortage Two important bills have been introduced in Congress to address our state’s serious physician shortage and improve access to care in California. The first bill, the Training the Next Generation of Primary Care Doctors Act of 2017 (HR 3394), would reauthorize for an additional three years the Teaching Health Center Graduate Medical Education (GME) program that was established by the Affordable Care Act (ACA). The Teaching Health Center program is a community-based primary care physician training program that has been extremely successful in expanding the physician workforce in underserved areas. ... August 9, 2017 General Federal Legislation, Federal Legislative Advocacy , Graduate Medical Education, Physician Workforce, Primary Care, Rural Health, Underserved Communities 0 0 Comment Read More »
Has a contracted payor stopped paying claims? The California Medical Association (CMA) has recently received an increased number of calls from physicians reporting concerns that some of the entities with whom they contract may have run into financial difficulties. One of the symptoms of an insolvent health plan, IPA or other payor is the failure to pay claims in a timely manner. Another indication of financial distress is a payor that cuts checks within the statutory timeframes, but does not release the checks in a timely manner. If you are experiencing repeated payment delays, you should investigate the ... August 9, 2017 General Commercial Payors, Payor Insolvency, Payor Solvency, Payors 0 0 Comment Read More »
Physicians apprehensive regarding requests for provider directory information The California Medical Association (CMA) continues to receive inquiries from practices concerned about the validity of requests for payors to confirm physician demographic information. The requests are related to the new provider directory accuracy law that took effect on July 1, 2016 (SB 137). Under the new law, physicians are required to respond to plan and insurer notifications regarding the accuracy of their provider directory information either by confirming the information is correct or by updating demographic information as appropriate. As with any request for protected information, practices should verify ... August 9, 2017 General Medical Provider Networks, Network Adequacy, Prov ider Directories, Provider Directory Accuracy Law, Provider Networks 0 0 Comment Read More »
Register today for CMA webinar on mental health in young adults The California Medical Association (CMA) is hosting a one-hour webinar about depression treatment and suicide prevention in young adults on Wednesday, August 16, from 12:15 to 1:15 pm. The presenter, Michelle Famula, M.D., is an Assistant Clinical Professor at the UC Davis School of Medicine Department of Public Health. She has spent the past 30 years providing young adult primary care and developing her interests in sexual, transgender and mental health care. This webinar, "The Pursuit of Happiness: A Practical Approach to Depression Treatment and Suicide Prevention in Young Adults," ... August 9, 2017 CMA, General Depression, Mental Health, Suicide, Webinars 0 0 Comment Read More »
CMS dedicates new webpage to Medicare Beneficiary Identification number change The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires the Centers for Medicare and Medicaid Services (CMS) to remove Social Security numbers from Medicare cards to prevent identity theft. CMS has said it will in 2018 begin issuing new Medicare cards that replace the current identification number—which is the beneficiary's Social Security Number—with an all-new Medicare Beneficiary Identification (MBI) number. CMS has developed a new webpage to help physicians navigate the transition to the new MBI number, including a recently developed resource on how to talk to your ... August 8, 2017 Medi-Cal, Medicare CMS, Medicare, Centers for Medicare and Medicaid Services, MACRA 0 0 Comment Read More »
Survey shows physicians feel unprepared for the business side of medicine A recent LinkedIn survey found that many physicians feel that their clinical training does not adequately prepare them for the reality of the business side of a career in medicine. The survey, conducted in early February, asked 511 physicians about their professional goals and the non-clinical skills that they believe are most essential to their careers. Three-quarters of respondents indicated that non-clinical business skills are more important than they were in the past because of how deeply and rapidly the health care industry is changing. More than two-thirds said their career ... August 8, 2017 General Running a Practice 0 0 Comment Read More »
Join CMA to learn how to challenge the interim payment for out-of-network services at in-network facilities On July 1, 2017, a new law (AB 72) took effect that changes the billing practices of non-participating physicians providing covered, non-emergent care at in-network facilities including hospitals, ambulatory surgery centers and laboratories. The law was designed to reduce unexpected medical bills when patients go to an in-network facility but receive care from an out-of-network doctor. The new law requires fully insured commercial plans and insurers to make “interim payments” to non-contracted physicians for non-emergent services performed at in-network health facilities, and places limitations on the ability of physicians in ... August 8, 2017 CMA AB72, Out of Network Care, Regulatory Advocacy, Webinars 0 0 Comment Read More »
