Health Net announces significant policy changes to Medicare Advantage and Medi-Cal managed care product lines Health Net recently announced several new payment policies for its Medicare and Medi-Cal lines of business, effective May 16, 2018. The California Medical Association (CMA) is very concerned with the adverse impact these policies would have on physician practices. The new policies would: Reduce reimbursement of evaluation and management (E&M) services when billed with modifier 25 under the following circumstances: When a minor surgical procedure code is reported on the same day as an E/M code by the same physician, payment for the E/M ... April 5, 2018 General, Managed Care Payor Contracting, Health Nedt 0 0 Comment Read More »
Patient outcomes shortchanged by prior authorization More than nine in 10 physicians (92 percent) say that prior authorizations programs have a negative impact on patient clinical outcomes, according to a new physician survey by the American Medical Association (AMA). The survey results further bolster a growing recognition across the entire health sector that prior authorization programs must be reformed. According to the AMA survey, which examined the experiences of 1,000 patient care physicians, nearly two-thirds (64 percent) report waiting at least one business day for prior authorization decisions from insurers—and nearly a third (30 percent) said ... April 5, 2018 Managed Care American Medical Association, Managed Care 0 0 Comment Read More »
Tip: Get ready for the new Medicare beneficiary cards and ID numbers The Centers for Medicare and Medicaid Services (CMS) will begin mailing new identification cards to California Medicare beneficiaries between April and June 2018, as required under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The new cards will contain a unique, randomly assigned Medicare Beneficiary Identification (MBI) number replacing the current Social Security-based number. CMS will allow a 21-month transition period beginning April 2018, where health care providers will be able to use either the patient’s current Medicare number or the patient’s new Medicare number. CMS has developed ... April 5, 2018 Medicare Medicare, Tip of the Month 0 0 Comment Read More »
CMA advocacy results in DHCS revaluing two CPT codes The California Medical Association (CMA) received a call from a physician member with concerns that the California Department of Health Care Services (DHCS) had priced a CPT code for destruction of up to 14 benign skin lesions (CPT 17110) at a higher level than it priced a more complex procedure for the destruction of 15 or more lesions (CPT 17111). CMA escalated the issue to DHCS so it could investigate. Upon further inspection and months of discussions, DHCS announced in October that it was increasing reimbursement on both codes, resulting ... April 5, 2018 CMA, General, Medi-Cal Dermatology, DHCS, Economic Advoacy, Billing/Coding, CPT, Department of Health Care Services, Medi-Cal 0 0 Comment Read More »
Physicians encouraged to warn patients of new Medicare scam Seniors in California are being targeted by a new Medicare card phone scam. Medicare beneficiaries are getting calls from scammers telling them their new Medicare card will arrive between April and June 2018, which is true. However, they go on to state beneficiaries must first buy a temporary card for $5.00 to $50.00 and provide personal information before they receive their new Medicare card. THIS IS NOT TRUE. It is true that Medicare is issuing a newly designed Medicare card, which will contain the unique, randomly assigned Medicare Beneficiary Identification (MBI) ... April 5, 2018 Medicare Medicare, Scams 0 0 Comment Read More »
Slate of SBCMS Leadership 2018-2019 The Nominating Committee held a conference call on January 22, 2018 at 6:00 p.m. Members in attendance were Michael Sequeira, MD (Chair); Eric Hansen, DO; Mark Bai, MD; Christopher Tsai, MD; Marti Baum, MD; SBCMS Staff Alison Elsner, Linda Sue Myers, Jenise Solorio, and Soteria Cobb. The final vote to approve this slate will take place at the SBCMS board of directors' meeting on March 26, 2018. Click here for the slate of nominees. OFFICERS: Damodara Rajasekhar, M.D. as President – Pediatrician, Apple Valley Mark Bai, M.D. as President-Elect:- Family Medicine, So. Cal Permanente Christopher ... March 12, 2018 General Nominating Committee, Nominations 0 0 Comment Read More »
10 Things to Do and Know About MIPS Reporting Deadlines Deadlines are fast approaching if you plan to submit data for the 2017 Merit-based Incentive Payment System (MIPS) performance period. Don’t wait until the last minute to submit your data. Submit early and often. The two key dates are: March 16 at 8 pm Eastern time for group reporting via the CMS web interface March 31 for all other MIPS reporting, including via qpp.cms.gov Now is the time to act. Here are the top 10 things you need to do and know ... February 8, 2018 General Center for Medicare & Medicaid Services, CMS, MACRA , MIPS, QPP, quality payment program 0 0 Comment Read More »
CMS proposes 1.84% Medicare Advantage payment increase The Centers for Medicare and Medicaid Services (CMS) has proposed increasing baseline Medicare Advantage payment rates for 2019 by an average of 1.84 percent. According to CMS, the proposed payment increase is based on better use of encounter data and changes to the risk adjustment model used to pay for aged and disabled beneficiaries. Medicare Advantage is at an all-time high, with approximately one-third of all Medicare beneficiaries enrolled in a Medicare managed care plan. Enrollment has more than doubled over the past decade. CMS is accepting comments on the proposal until ... February 5, 2018 Medicare Medicare Advantage 0 0 Comment Read More »
New Anthem anesthesia policy can have blinding consequences A policy change made by health insurer Anthem, Inc. could result in increased risk for many patients – up to and including blindness – if not immediately rescinded, according to physicians’ groups. The California Academy of Eye Physicians and Surgeons (CAEPS) and the California Society of Anesthesiologists (CSA) have sent letters to Anthem Inc. requesting that they immediately rescind a new policy that deems Monitored Anesthesia Care (MAC) “not medically necessary” during “routine” cataract surgery – a move seen as endangering patients. These were followed up with complaints to the ... February 5, 2018 General, Managed Care Advocacy, Anesthesiology, Anthem Blue Cross, California Academy of Eye Physicians and Surgeons, California Society of Anesthesiologists, Ophthalmology 0 0 Comment Read More »
Register today for IMQ's Stepping Up to Leadership Conference The Institute for Medical Quality’s (IMQ) Stepping Up to Leadership conference will be held at the Paradise Point Resort and Spa in San Diego on February 22-23, 2018. This program is widely recognized as the “go to” course for acquiring knowledge and skills to successfully lead a medical staff. Offered in conjunction with the University of California, San Diego PACE Program, the program was developed in response to a commonly expressed need for better, more practical hands-on training for medical staff leaders. In addition to interactive training in communicating and handling ... February 5, 2018 General IMQ, Institute for Medical Quality, Organized Medical Staff Section, Hospital Medical Staff, Medical Staff, Organized Medical Staff, Physician Leadership 0 0 Comment Read More »
