United Healthcare finally completes PacifiCare recontracting effort after 2006 merger The California Medical Association (CMA) recently learned that United Healthcare (UHC) in April sent notices to over 800 practices that still held contracts under PacifiCare, which merged with UHC in 2006. The notice advised affected physicians that their continued participation status with UHC hinged on signing the new agreement, which includes a new fee schedule. For physicians who chose not to sign the agreement by June 15, the notification served as the required 90-day notice of termination. UHC had first initiated a recontracting of physicians contracted with PacifiCare back in ... August 7, 2014 Managed Care Hunited Healthcare, Insurance/Reimbursement, Managed Care, PacifiCare, Advocacy 0 0 Comment Read More »
CMS issues proposed 2015 Medicare payment rule The Centers for Medicare and Medicaid Services (CMS) recently published the 2015 proposed Medicare physician payment rule in the Federal Register. The proposal contains several notable changes. The rule expands the services eligible for telemedicine reimbursement (psychotherapy services and the annual wellness visit). It also extends the new payment policies for non-face-to-face care coordination. It allows primary care physicians to be paid for care management of Medicare beneficiaries with two or more chronic conditions. These are tasks (including managing lab and imaging reports, medications and care plans in addition ... August 4, 2014 Medi-Cal, Medicare Insurance/Reimbursement, Medicare, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
IOM report says financing for physician residency programs needs overhauling to meet nation's needs A report by the Institute of Medicine shows that the U.S. should significantly reform the federal system for financing physician training and residency programs to ensure that the public’s $15 billion annual investment is producing the doctors that the nation needs. Current financing – provided largely through Medicare – requires little accountability, allocates funds independent of workforce needs or educational outcomes, and offers insufficient opportunities to train physicians in the health care settings used by most Americans, the report says. For decades, teaching hospitals have received the majority of Medicare's funding ... August 4, 2014 General Insurance/Reimbursement, Physician Workforce, Residents and Fellows, Medicare 0 0 Comment Read More »
California among six states that pay the least for Medicaid beneficiaries, says GAO report According to a report released this week by the U.S. Government Accountability Office (GAO), California is one of six states that spends less than $6,000 per Medicaid (Medi-Cal in California) enrollee per year. The other states include Illinois Alabama, Arkansas, Mississippi and Tennessee. In contrast the report found that eight states, including New York, spend at least $10,500 per beneficiary. The report also found that Medi-Cal fee-for-service pays on average 61 percent of what private insurers in the state pay for the same evaluation and management services, with Medi-Cal ... July 22, 2014 Medi-Cal Insurance/Reimbursement, Medicaid, Access to Care, Medi-Cal 0 0 Comment Read More »
Change in mailing address for Medi-Cal TAR submissions Effective for dates of service on or after July 1, 2014, all paper treatment authorization requests (TAR) currently being mailed to the Los Angeles Field Office and the Northern and Southern Pharmacy Sections should be mailed to the following address: West Sacramento TAR Processing Center 820 Stillwater Road West Sacramento, CA 95605-1630 Updated provider manual sections will be published in a future Medi-Cal Update. July 15, 2014 General Treatment Authorization Request, Insurance/Reimbursement, Medi-Cal, TAR 0 0 Comment Read More »
Despite CMA concerns, United moves forward with Premium Designation program Sidestepping concerns voiced by the California Medical Association (CMA), United Healthcare is proceeding with the rollout of its "Premium Designation" physician performance program in California. Physicians who wish to request a reconsideration of their Premium Designation status before the results are displayed publicly in the insurers’ network directory on August 6, must do so no later than July 16. CMA had urged United Healthcare to delay implementation for a minimum of six months to allow time for the insurer to address deficiencies with the program and to allow physicians the ... July 1, 2014 Managed Care Managed Care, United Healthcare, Insurance/Reimbursement 0 0 Comment Read More »
What does the ICD-10 delay mean for physicians? The ICD-10 compliance date will be delayed by at least one year, based on a provision in a federal law signed Tuesday that pushes the date to no sooner than October 1, 2015. It is unclear at this time how this unexpected delay will impact the health care industry, which has been feverishly working to prepare for the transition to the new code sets, previously scheduled for October 1, 2014. The International Classification of Disease tenth revision (ICD-10) is a system of coding created in 1992 as the successor to ... April 16, 2014 General ICD-10, Insurance/Reimbursement, Practice Management 0 0 Comment Read More »
Aetna seeks to terminate its proposed $120 million class settlement over use of Ingenix to underpay out-of-network claims Late last year, Aetna, Inc. announced a proposed class settlement of up to $120 million over its use of the flawed Ingenix database. The nationwide settlement would have required Aetna to reimburse providers and Aetna PPO subscribers for losses arising from Aetna's underpayment for out-of-network medical care. A hearing had been scheduled for March 18, 2014, in the U.S. District Court in New Jersey for the court to determine whether final approval of the settlement should be granted. Less than a week before the hearing, however, Aetna notified the ... March 27, 2014 General Ingenix, Insurance/Reimbursement, Legal Advocacy, Aetna 0 0 Comment Read More »
CMA surveys health plans on implementation plans for CMS 1500 claim form The California Medical Association (CMA) surveyed the major payors in California to find out which of them will follow the Centers for Medicare and Medicaid Service’s (CMS) lead and require submission of paper claims on the new CMS 1500 form (version 02/12 OMB control number 0938-1197). CMS will no longer accept claims on the old forms effective April 1. CMA’s survey found that some health plans will require the new 1500 version on April 1, others will allow for continued submission of the previous version. To view a detailed breakdown ... March 27, 2014 Medi-Cal, Medicare ICD-10, Practice Resources, CMS, Insurance/Reimbursement 0 0 Comment Read More »
CMS suspends RAC audits, sets up physician safeguards Physicians and hospitals will get a short reprieve from Medicare’s recovery audit contractors (RAC) until next fall, according to the Centers for Medicare & Medicaid Services (CMS). The agency says it is temporarily halting audits as it reevaluates its contracts and implements improvements for physicians. The RAC program is responsible for identifying fraud and waste in the Medicare system by detecting improper Medicare payments. Last month, CMS announced it would pause any new additional document requests (ADR) from RACs until new contracts are settled, in order to reduce provider confusion ... March 19, 2014 Medicare Medicare, RAC, Recovery Audit Contractor, Insurance/Reimbursement 0 0 Comment Read More »
