Has a contracted payor stopped paying claims? The California Medical Association (CMA) has recently received an increased number of calls from physicians reporting concerns that some of the entities with whom they contract may have run into financial difficulties. One of the symptoms of an insolvent health plan, IPA or other payor is the failure to pay claims in a timely manner. Another indication of financial distress is a payor that cuts checks within the statutory timeframes, but does not release the checks in a timely manner. If you are experiencing repeated payment delays, you should investigate the ... August 9, 2017 General Commercial Payors, Payor Insolvency, Payor Solvency, Payors 0 0 Comment Read More »
Physicians apprehensive regarding requests for provider directory information The California Medical Association (CMA) continues to receive inquiries from practices concerned about the validity of requests for payors to confirm physician demographic information. The requests are related to the new provider directory accuracy law that took effect on July 1, 2016 (SB 137). Under the new law, physicians are required to respond to plan and insurer notifications regarding the accuracy of their provider directory information either by confirming the information is correct or by updating demographic information as appropriate. As with any request for protected information, practices should verify ... August 9, 2017 General Medical Provider Networks, Network Adequacy, Prov ider Directories, Provider Directory Accuracy Law, Provider Networks 0 0 Comment Read More »
Register today for CMA webinar on mental health in young adults The California Medical Association (CMA) is hosting a one-hour webinar about depression treatment and suicide prevention in young adults on Wednesday, August 16, from 12:15 to 1:15 pm. The presenter, Michelle Famula, M.D., is an Assistant Clinical Professor at the UC Davis School of Medicine Department of Public Health. She has spent the past 30 years providing young adult primary care and developing her interests in sexual, transgender and mental health care. This webinar, "The Pursuit of Happiness: A Practical Approach to Depression Treatment and Suicide Prevention in Young Adults," ... August 9, 2017 CMA, General Depression, Mental Health, Suicide, Webinars 0 0 Comment Read More »
CMS dedicates new webpage to Medicare Beneficiary Identification number change The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires the Centers for Medicare and Medicaid Services (CMS) to remove Social Security numbers from Medicare cards to prevent identity theft. CMS has said it will in 2018 begin issuing new Medicare cards that replace the current identification number—which is the beneficiary's Social Security Number—with an all-new Medicare Beneficiary Identification (MBI) number. CMS has developed a new webpage to help physicians navigate the transition to the new MBI number, including a recently developed resource on how to talk to your ... August 8, 2017 Medi-Cal, Medicare CMS, Medicare, Centers for Medicare and Medicaid Services, MACRA 0 0 Comment Read More »
Survey shows physicians feel unprepared for the business side of medicine A recent LinkedIn survey found that many physicians feel that their clinical training does not adequately prepare them for the reality of the business side of a career in medicine. The survey, conducted in early February, asked 511 physicians about their professional goals and the non-clinical skills that they believe are most essential to their careers. Three-quarters of respondents indicated that non-clinical business skills are more important than they were in the past because of how deeply and rapidly the health care industry is changing. More than two-thirds said their career ... August 8, 2017 General Running a Practice 0 0 Comment Read More »
Join CMA to learn how to challenge the interim payment for out-of-network services at in-network facilities 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. 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 ... August 8, 2017 CMA AB72, Out of Network Care, Regulatory Advocacy, Webinars 0 0 Comment Read More »
UnitedHealthcare plans to discontinue payment for consultation services Citing alignment with a policy implemented by the Centers for Medicare and Medicaid Services (CMS), and in response to misuse of consultation service codes, UnitedHealthcare (UHC) has announced that it will no longer reimburse consultation services for commercial product lines effective October 1, 2017. Consultation services previously represented by CPT codes 99241-99245 and 99251-99255 will now need to be billed utilizing the appropriate evaluation and management (E/M) procedure code that describes the office visit, hospital care, nursing facility care, home service or domiciliary/rest home care. The California Medical Association (CMA), ... August 8, 2017 General Consultation Codes, UnitedHealthcare 0 0 Comment Read More »
FAQ: Can I maintain a drug-free policy in my office? With the ongoing implementation of California's Medical Cannabis Regulation and Safety Act of 2015 and passage of the Adult Use of Marijuana Act (AUMA) in 2016, physician offices may increasingly find themselves unsure of whether they are required to make accommodations for employees' use of marijuana, either for medical or recreational purposes. California law does not require any accommodation of the use of medical cannabis on the property or premises of any place of employment or during the hours of employment. Further, the California Supreme Court, in Ross v. Ragingwire ... August 8, 2017 General Adult Use of Marijuana, Drug Testing, Medical Cannabis, Medical Marijuana 0 0 Comment Read More »
Free CME: Patients' right of access under HIPAA The U.S. Department of Health and Human Services Office for Civil Rights (OCR) has launched a new training module for providers on patients' right of access under the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. With limited exceptions, the HIPAA Privacy Rule provides individuals with the right to see and receive copies upon request of the information in their medical and other health records maintained by their health care providers and health plans. The new module provides an in-depth review of the components of the HIPAA right of access ... August 8, 2017 General Continuing Medical Education, CME, HIPAA, HIPAA Privacy Rule, Medical Records 0 0 Comment Read More »
August is National Immunization Month August marks National Immunization Awareness Month (NIAM), a national effort to promote vaccinations and protect children and adults from serious, and sometimes deadly, preventable diseases. According to the Centers for Disease Control and Prevention (CDC), immunizations are one of the top 10 public health accomplishments of the 20th century. Among children born between1994-2013, vaccination will prevent an estimated 322 million illnesses, 21 million hospitalizations and 732,000 deaths over the course of their lifetimes. As part of this important effort, the California Medical Association (CMA) and its county medical societies are ... August 8, 2017 General I Heart Immunity, Immunization, Public Health, Vaccination 0 0 Comment Read More »
