CMA/AMA responding to proposed Medicare payment rule On July 12, 2018, the Centers for Medicare and Medicaid Services (CMS) released the proposed 2019 Medicare Physician Fee Schedule and MACRA Quality Payment Program (QPP) rule. This is the first year that CMS is combining the Medicare fee schedule and QPP rules. There are a number of positive elements in the proposed rule. These include: New payments for physician services that are not part of a face to face office visit (virtual check-ins, remote consults of patient videos and photographs, and online consultations with other physicians) ... August 7, 2018 CMA, Medicare Advocacy, MACRA, Public Payors 0 0 Comment Read More »
Medical board releases physician license alert app for patients The Medical Board of California recently released its first mobile app, currently available on Apple iOS devices. The technology notifies patients about changes to their physician’s license status, rather than patients having to actively seek out that information. Physician profiles have long been available to the public on the board’s website. The new app will notify users when their physician’s license is updated or there are changes to the physician’s address, practice status, specialty, disciplinary actions and much more. The California Medical Association (CMA) has long advocated for a comprehensive, effective ... August 7, 2018 General Professional Development & Education 0 0 Comment Read More »
Coding Corner: NCCI Policy Manual updates: Part 2 CPR’s “Coding Corner” focuses on coding, compliance, and documentation issues relating specifically to physician billing. This month’s tip comes from G. John Verhovshek, the managing editor for AAPC, a training and credentialing association for the business side of health care. Each year, the Centers for Medicare and Medicaid Services (CMS) releases an updated version of the National Correct Coding Initiative (NCCI) Policy Manual. The annual updates reflect changes to the CPT® and HCPCS code sets, as well as new and revised coding guidelines. This month, we’ll discuss the most significant, ... August 3, 2018 General Payor Issues and Reimbursement, Practice Management 0 0 Comment Read More »
Noridian to present in-person Medicare seminars in Irvine and Sacramento Noridian, the Medicare administrative contractor for California, has announced several in-person seminars around the state in September. The all-day presentations will be divided into morning and afternoon sessions, including information on the following: Morning Session: 8:30 a.m. to 12 p.m. What's New Preventive Services Telehealth Incident to Services Top A/B Errors Afternoon Session: 1-4:30 p.m. NCDs/LCDs Review Entities Documentation/Signature Requirements Education Corner The seminars are ... August 3, 2018 Medicare Public Payors, Practice Management, Professional Development & Education 0 0 Comment Read More »
United Healthcare releases latest Premium Designation physician results United Healthcare (UHC) recently released its latest Premium Designation assessment results to California physicians on July 20. The Premium Program Version 11 results, based on claims data from January 1, 2015, through February 28, 2018, will be released publicly via the payor's online physician directory beginning September 2018. Physicians within 16 specialty categories, encompassing 47 subspecialties including pediatric internal medicine (new for 2018), will again be ranked by UHC on both national and specialty-specific measures for quality and various cost-efficiency benchmarks. Physicians meeting or exceeding these benchmarks will receive a ... August 3, 2018 Managed Care Commercial Payors, Practice Management 0 0 Comment Read More »
New Medicare ID card mailing completed in California The Centers for Medicare and Medicaid Services (CMS) recently completed mailing new Medicare ID cards to California beneficiaries. The new Medicare ID cards, required under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), contain a unique, randomly assigned Medicare Beneficiary Identification (MBI) number, which replaces the previous Social Security-based number. CMS has prepared a “Still Waiting for Your New Card?” handout (in English or Spanish) to provide to patients who did not receive a new Medicare ID card. Patients may be directed to the MyMedicare.gov website or to ... August 3, 2018 Medicare Medicare, Patient Privacy, Public Payors 0 0 Comment Read More »
United Healthcare Smart Edits go live August 16 UnitedHealthcare (UHC) will implement its Smart Edits program for professional claims for all of its commercial, Medicare Advantage and Community Plans effective August 16, 2018. UHC notified physicians in its 2018 United Healthcare network bulletin that it would implement Smart Edits, a new functionality introduced into the electronic data interchange (EDI) workflow allowing the payor to autodetect claims with potential errors in the claims pre-adjudication phase. Once a potential error has been identified, UHC will notify the physician (via the 277CA report) within 24 hours, returning the claim to ... August 3, 2018 General, Managed Care Commercial Payors, Payor Issues and Reimbursement, Practice Management 0 0 Comment Read More »
Best practices: Review your monthly capitation reports Participation in capitated reimbursement contracts (financial arrangements where physicians are paid a fixed amount for each patient assigned to them) can offer physicians a routine and sustained source of monthly income for their practice. Capitation, however, can be a complicated process. It is essential that physicians monitor their monthly capitation reports to ensure they are being paid per the terms of their agreements. Under many capitation arrangements, physicians are typically paid a fixed amount per member/per month for each patient assigned to them, regardless of whether the patient receives care ... August 3, 2018 General Practice Management 0 0 Comment Read More »
Choice Medical Group looking for a Primary Care Physician Choice Medical Group is a group of primary care and specialty physicians dedicated to serving the High Desert area, serving our members for over 25 years in Apple Valley, Adelanto, Barstow, Big Bear, Hesperia and Victorville, California. We are looking for a Primary Care Physician to join our team to deliver superior care to the High Desert Community. Competitive Salary Comprehensive Benefit Package Malpractice Insurance Coverage Excellent Retirement Plans This is just a quick overview but hopefully we ... August 2, 2018 General Choice Medical Group, Primary Care Physician 0 0 Comment Read More »
CMA joins California Department of Insurance in opposing CVS/Aetna Merger Today, the California Medical Association (CMA) applauded the finding of the California Department of Insurance that the proposed merger between CVS Health and Aetna, Inc. would significantly reduce competition in California’s health insurance market and calls on the U.S. Department of Justice to block the merger from proceeding. In a letter submitted to the U.S. Attorney General and Assistant Attorney General for the Antitrust Division, Insurance Commissioner Dave Jones concluded that the proposed merger would create anti-competitive conditions in the Medicare Part D market, the Pharmacy Benefit Manager services market ... August 2, 2018 General, Managed Care Advocacy, Commercial Payors, Payor Issues and Reimbursement 0 0 Comment Read More »
