CMA urges swift action to renew Children's Health Insurance Program The California Medical Association (CMA) is urging Congress to reauthorize the successful Children’s Health Insurance Program (CHIP), which is set to expire on September 30, 2017. Although the 20-year-old program has historically had bipartisan support, there has been some concern that the CHIP reauthorization could get caught up in the partisan bickering surrounding other priority issues, including attempts to repeal the Affordable Care Act (ACA). CMA has urged Congress to reauthorize the program for at least five years at current funding levels to give states the stability to engage ... September 27, 2017 General Federal Legislation, Federal Legislative Advocacy, Maternal and Child Health, State Children's Health Insurance Program 0 0 Comment Read More »
LAST CHANCE: Free online course helps providers identify child abuse and understand reporting obligations Thanks to a grant from the California Governor’s Office of Emergency Services, the California Medical Association’s Institute for Medical Quality has been able to offer, free of charge, an online educational program on child abuse prevention, recognition and reporting. The course is designed for California physicians, nurses and other health care professionals who regularly or occasionally treat pediatric patients. If you haven’t had a chance to take this free 75-minute course, do so now before the grant expires on September 30, 2017. Physicians and other health care professionals are mandated by ... September 27, 2017 General Child Abuse, CME, Continuing Medical Education, IMQ, Institute for Medical Quality 0 0 Comment Read More »
CMS National Provider Calls include discussions on PQRS and Physician Compare in September The Centers for Medicare and Medicaid Service’s (CMS) September 2017 National Provider Call topics include the Physician Quality Reporting System (PQRS) on September 26 and on Physician Compare on September 28. PQRS provider call: While 2016 was the last program year for PQRS and the final data submission time frame for reporting 2016 PQRS quality data to avoid the 2018 payment penalty was January through March 2017, this call will cover PQRS penalties, feedback reports, and the informal review process for 2016 results and 2018 payment adjustment determinations. For more information ... September 27, 2017 Medi-Cal, Medicare CMS, Physician Compare, Physician Quality Reporting System, PQRS 0 0 Comment Read More »
Save the Date: MGMA annual conference is October 8-11 The Medical Group Management Association (MGMA) is hosting its annual conference on October 8-11, 2017, in Anaheim. The conference, geared toward all levels of medical practice leadership, will offer attendees a multitude of tools and resources to help guide them to success including: Using structural tension leadership to help lead your organization through change. Analyzing the types of conversations that leaders must have to compel teams to rise above stress and disagreements to better serve patients. Distinguishing possible physician-held risk ... September 25, 2017 General Management, Running a Practice 0 0 Comment Read More »
Anthem Blue Cross offering fall seminars on 2017 operational updates Throughout October, the Anthem Blue Cross Provider Network Education Team will offer live seminars to discuss 2017 operational updates. Topics will include participation in the California health care marketplace, Blue Cross and Blue Shield alpha prefix change, and details on the new website for radiology services. Each seminar runs from 8:30 a.m. to 12 p.m. The first session is slated for October 3 in San Mateo, and the series will conclude on October 26 in Fresno. Practices interested in attending should register on the Anthem website. Click here for the ... September 25, 2017 Managed Care Anthem Blue Cross, Seminars 0 0 Comment Read More »
Experiencing a delay in workers' compensation utilization review decisions? File a complaint The California Division of Workers’ Compensation (DWC) has finalized regulations to ensure that utilization reviews (UR) are conducted in compliance and within specified timeframes (see chart below). The regulations authorize DWC to conduct periodic reviews of all utilization review organizations (URO), including a review of any credible complaints against the organization received by the DWC Administrative Director. The California Medical Association (CMA) encourages physicians experiencing delays in the receipt of workers’ compensation UR decisions to be diligent in submitting complaints to DWC to highlight organizations that fail to meet the ... September 25, 2017 General Division of Workers' Compensation, Utilization Review, Workers' Compensation 0 0 Comment Read More »
Updates to prior authorization form for prescription medications and new timelines for response now in effect On July 1, 2017, two new laws affecting the standardized prescription drug prior authorization form took effect. SB 282 required the Department of Managed Health Care (DMHC) and the Department of Insurance to create a standard electronic prior authorization request form. A second related law (AB 374) required the agencies to include on the updated form the option for physicians to request an exception to the plan/insurer’s step therapy process. Previously, SB 866 had required use and acceptance of a paper uniform prior authorization form. The form was updated in December ... September 25, 2017 General Drug Prescribing, Preauthorization, Prescription Drugs 0 0 Comment Read More »
Webinar: How to challenge the AB 72 interim payment for out-of-network services 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. Under the new law, plans/insurers are required to make “interim payments” to non-contracted physicians for covered, non-emergent services performed at in-network health facilities. The interim payment is the greater of either the plan/insurer’s average ... September 25, 2017 General, Managed Care AB 72, Out of Network Care, Webinars 0 0 Comment Read More »
Physicians report Anthem not complying with AB 72 interim payment rules The California Medical Association (CMA) has received reports from physician offices that Anthem Blue Cross is not paying the “interim payment” as required under the recently effective law (AB 72) limiting out-of-network billing for covered, non-emergent services performed at an in-network facility. 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 such circumstances to collect their full billed charges. The interim rate defined in AB 72 ... September 25, 2017 General, Managed Care AB 72, Anthem Blue Cross, Out of Network Care 0 0 Comment Read More »
Noridian reports spike in provider deactivations and lost revenue Noridian, Medicare’s administrative contractor for California, has seen a spike in the number of providers deactivated for not responding to Medicare revalidation notices, resulting in a gap in billing privileges and lost revenue for physicians. Noridian will send revalidation notices via email two or three months prior to the revalidation due date. Revalidation notices sent via email will indicate "URGENT: Medicare Provider Enrollment Revalidation Request" in the subject line to differentiate from other emails. If the email is returned as undeliverable, only then will Noridian will send a paper revalidation ... September 25, 2017 Medicare Medicare, Noridian, Provider Enrollment Chain and Ownership System 0 0 Comment Read More »
