CMS unveils new Medicare Beneficiary Identification cards The Centers for Medicare and Medicaid Services (CMS) recently unveiled the newly designed Medicare card, which will contain the unique, randomly assigned Medicare Beneficiary Identification (MBI) number replacing the current Social Security-based number. CMS will begin mailing the new cards to people with Medicare benefits in April 2018, with the deadline for replacing all existing Medicare cards by April 2019 as required under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). CMS will allow a 21-month transition period beginning no sooner than April 2018, where health care providers ... October 19, 2017 Medicare Medicare 0 0 Comment Read More »
UnitedHealthcare delays consultation services payment policy change UnitedHealthcare (UHC) announced in its October 2017 Network Bulletin that it will indefinitely delay changes to its consultation services payment policy, which would have discontinued reimbursement for CPT codes 99241-99245 and 99251-99255. Citing alignment with a policy implemented by the Centers for Medicare and Medicaid Services, and in response to misuse of consultation service codes, UHC had previously announced that it would no longer reimburse consultation services for commercial product lines effective October 1, 2017. In lieu of a consultation service code, physicians would have been required to bill utilizing ... October 19, 2017 General, Managed Care Consultation Codes, UnitedHealthcare 0 0 Comment Read More »
UnitedHealthcare to issue latest cycle of Peer Comparison Reports UnitedHealthcare (UHC) has announced that the next iteration of its Peer Comparison Reports will be sent to physicians beginning in November. The Peer Comparison Reports, formerly known as performance reports, contain analysis of a physician’s UHC paid claims data in comparison to nationally-based and risk-adjusted benchmarks. Only physicians whose paid claims data shows patterns that vary significantly from the identified benchmarks will receive a Peer Comparison Report. According to UHC, approximately 550 physicians in the following specialties will receive a Peer Comparison Report notification indicating that their paid claims data ... October 19, 2017 General, Managed Care UnitedHealthcare 0 0 Comment Read More »
Anthem Blue Cross to implement restrictive outpatient advanced radiology policy Effective December 1, 2017, Anthem Blue Cross will implement a new policy restricting outpatient advanced radiologic imaging procedures in the hospital setting. The updated policy, originally scheduled to become effective October 1 but recently delayed, indicates that advanced radiologic imaging procedures in the hospital outpatient department are only considered medically necessary under the follow circumstances: If services are only available in the hospital setting; or The patient requires obstetrical observation; or The patient is receiving perinatology services; or ... October 19, 2017 General, Managed Care Anthem Blue Cross, Radiology 0 0 Comment Read More »
California physicians condemn changes to Affordable Care Act birth control mandate The Trump Administration today announced an interim final rule that permits employers and insurers to claim a religious exemption to the Affordable Care Act’s (ACA) “Birth Control Mandate.” The California Medical Association (CMA), representing over 43,000 physicians in all specialties and modes of practice, issued the following statement, condemning this policy change on the grounds that it undermines the availability of preventative health care for California women. “Access to contraception is a basic preventative health care service that millions of Californians rely on,” said CMA President Ruth Haskins, M.D. “The ... October 13, 2017 General Affordable Care Act, ACA, Federal Legislation, Health Care Reform, Reproductive Issues, Women's Health 0 0 Comment Read More »
Physicians have until December 1 to dispute 2016 PQRS and QRUR findings The Centers for Medicare and Medicaid Services (CMS) recently released data that indicates which physicians will be subject to the 2018 payment penalties associated with the Physician Quality Reporting System (PQRS) and Value-Based Payment Modifier (Value Modifier) programs. Physicians who have concerns about the findings in their report(s) have until December 1, 2017, to file for an informal review of their data. The penalties stem from policies in effect prior to the enactment of the Medicare Access and CHIP Reauthorization Act (MACRA). Failure to successfully report on PQRS in 2016 ... October 13, 2017 Medicare Medicare, Physician Quality Reporting System, PQRS, Quality Reporting, Value-Based Payment Modifier 0 0 Comment Read More »
Blue Shield updates fee schedule effective December 1 Blue Shield of California recently announced changes to its physician fee schedule that will take effect December 1, 2017. While the notice indicated that the new rates would be available on the Blue Shield website by October 1, CMA has learned that Blue Shield experienced technical difficulties that will delay the availability of the new rates on the website, until October 9, 2017 (tentatively). The rates will be located under "Helpful Resources," then “Professional Fee Schedule,” then click “Search the Claims Fee Schedule” using a “Date of Service” of December ... October 13, 2017 Managed Care Blue Shield, Payor Contracting 0 0 Comment Read More »
FDA says harm of untreated opioid addiction outweighs risks of concomitant benzodiazepine use Medication-assisted treatment (MAT) for opioid addiction is an important tool that has the potential to help millions of Americans with an opioid use disorder. In fact, patients receiving MAT cut their risk of death from all causes in half, according to the Substance Abuse and Mental Health Services Administration. However, health care providers and patients face significant challenges when determining how best to treat opioid use disorder, especially when the MAT drugs contain methadone or buprenorphine – which are also opioids. The U.S. Food and Drug Administration (FDA) recently issued ... October 13, 2017 General Drub Abuse, Drug Prescribing, Medical Solutions to Drug Abuse, Opioids 0 0 Comment Read More »
CMA, AMA and organized medicine were united in opposing Graham-Cassidy Last week, the latest effort to repeal the Affordable Care Act (ACA) collapsed, after three Republican Senators announced their opposition—Susan Collins (R-ME), Rand Paul (R-KY) and John McCain R-AZ). Further action is unlikely this year, as Senate Republican Leader Mitch McConnell (R-KY) said the Senate would now turn its focus to overhauling the tax code. However, several Republicans vowed to continue to work into next year to repeal the ACA. The California Medical Association (CMA), the American Medical Association (AMA) and all of organized medicine were united in opposing this ... October 13, 2017 CMA, General, Managed Care, Medi-Cal ACA, Affordable Care Act, Affordable Care Act (ACA) Repeal, Covered California, Federal Legislation, Federal Legislative Advocacy, Medicaid, Medi-Cal 0 0 Comment Read More »
State suspends clinical lab license fees for two years Governor Brown signed a bill (AB 658) on Sept. 28 that suspends the state's clinical laboratory license renewal fees for two years, 2018 and 2019. The bill is a result of an audit that found that the California Department of Public Health (CDPH) had collected millions more in laboratory fees than it had spent operating the Laboratory Field Services (LFS) branch. The fund’s current reserves exceed $22 million. Under existing state law, however, CDPH could not suspend or refund these fees. This bill only suspends renewal fees and will not apply ... October 13, 2017 General Accreditation, Clinical Laboratories, State Legislation, State Legislative Advocacy 0 0 Comment Read More »
