$10 million reasons to be a CMA member The California Medical Association’s (CMA) Center for Economic Services (CES) has now recouped $10 million from payors on behalf of CMA member physicians. These monies, recovered over the last five years, represent actual physician reimbursements that would have likely gone unpaid without the intervention of the CES team. Founded in 1999, CES provides CMA members with one-on-one assistance for billing, contracting and payment problems that may arise. With more than 125 years of combined medical practice operations experience, CES staff helps members with issues ranging from underpayment or denials ... February 5, 2015 General Payors, Reimbursement, Value of Membership, Advocacy 0 0 Comment Read More »
CMA survey finds workers' comp reform has brought new challenges for physicians California’s workers’ compensation system is arguably undergoing its biggest period of transformation since its enactment in 1914. Senate Bill 863, signed into law on September 19, 2012, initiated changes to the utilization review process, implementation of an independent medical review and independent bill review process, and a migration to a resource-based relative value scale payment system, among other changes. In late 2014, after hearing complaints from physicians that these changes have resulted in patient care roadblocks, the California Medical Association (CMA) initiated a survey to solicit physician feedback on ... February 5, 2015 General Insurance/Reimbursement, Workers' Compensation 0 0 Comment Read More »
United Healthcare amendment introduces narrow network product Setting the stage for its potential future entrance into California’s Exchange, Covered California, United Healthcare (UHC) has begun the process of building its provider networks by amending physician contracts. United Healthcare has advised CMA that its new Core plan, which will be marketed to employer groups seeking lower premiums and used for its potential future exchange product, will access a significantly narrowed network of approximately 45 percent of UHC’s current PPO provider network. UHC plans to send amendment notices to physicians selected to participate in the Core network sometime in ... February 4, 2015 Managed Care United Healthcare, Provider Networks 0 0 Comment Read More »
Ensure your practice information is up-to-date with contracted payors Every practice understands the importance of collecting up-to-date demographic information from patients, including changes to a patient’s address, phone number, insurance, and eligibility and benefits. Ensuring that these items are up-to-date guarantees that the practice can quickly communicate with the patient about test results or other medical issues, as well as schedule and confirm appointments. Accurate patient insurance, eligibility and benefits information also helps to prevent unnecessary denials delays in payment, and goes a long way toward ultimately saving time and money for the practice. It is equally important ... February 4, 2015 General Insurance/Reimbursement, Payors 0 0 Comment Read More »
NEJM study shows primary care rate increase for Medicaid patients increased access to care A study published in the New England Journal of Medicine last week shows that the increase in Medicaid reimbursement for primary care providers, a key provision of the Affordable Care Act (ACA), resulted in a 7.7 percent increase in new patient appointment availability without longer wait times. The study, conducted by the University of Pennsylvania and the Urban Institute, used “secret shoppers” to call primary care doctors offices seeking new appointments in 10 states: Arkansas, Georgia, Illinois, Iowa, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania and Texas. Calls were made in ... February 4, 2015 Medi-Cal Affordable Care Act, ACA, Medi-Cal, We Care for California 0 0 Comment Read More »
California School Immunization Law California School Immunization Law California Health and Safety Code, Sections 120325-120375: Under these statutes, children in California are required to receive certain immunizations in order to attend public and private elementary and secondary schools, child care centers, family day care homes, nursery schools, day nurseries, and developmental centers. Schools, child care centers, and family child care homes are required to enforce immunization requirements, maintain immunization records of all children enrolled, and submit reports. California Code of Regulations Title 17 Division 1, Chapter 4, Subchapter 8. These regulations specify California school immunization requirements ... February 2, 2015 General Public Health, Immunizations 0 0 Comment Read More »
