Survey finds nation's physicians not ready to fulfill MACRA reporting requirements Fewer than one in four physicians feel ready to meet the Centers for Medicare and Medicaid Services (CMS) Quality Payment Program (QPP) reporting requirements, according to a survey of 1,000 physicians conducted by the American Medical Association (AMA). QPP is the new physician payment system created by the Medicare Access and CHIP Reauthorization Act (MACRA). It replaces the fee-for-service reimbursement model with two paths to choose from: the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APM). Over half of those surveyed (56 percent) plan to participate in MIPS in ... July 24, 2017 Medicare MACRA, Medicare, Merit-Based Incentive Payment System, Alternative Payment Models (APM) 0 0 Comment Read More »
Free CME: Child abuse prevention, recognition and reporting The Institute for Medical Quality (IMQ) is offering a free online course on child abuse prevention, recognition and reporting. This 75-minute course, created by the Child Abuse Prevention Center in Sacramento, is designed for physicians, nurses and other health care professionals who are mandated by law to report suspected child abuse and neglect, but who may not be familiar with the signs and symptoms. This course will also explain what, when and to whom to properly report findings. Upon completion of the course, attendees will receive 1.25 continuing education credits ... July 24, 2017 General CME, Continuing Medical Education, IMQ, Institute for Medical Quality, Child Abuse 0 0 Comment Read More »
CMA joins coalition to oppose Senate health care bill The California Medical Association (CMA) and a coalition of 9 other state medical associations have joined together to oppose the Republican Senate health care reform bill, the Better Care Reconciliation Act of 2017 (BCRA). CMA and the other associations are concerned that the Medicaid funding cap and inflation index would not keep pace with rising costs beyond physicians’ control. The California Department of Health Care Services estimates that the Senate bill would cut California’s Medi-Cal program by $114 billion. "The proposal places an untenable burden on state budgets and an ... July 24, 2017 Medi-Cal Advocacy, Health Care Reform, Better Care Reconciliation Act (BCRA), Federal Legislation, Medicaid, Medi-Cal 0 0 Comment Read More »
New video shows physicians how to avoid Medicare payment penalties The American Medical Association (AMA) has published a short instructional video to help physicians avoid being penalized under the new Medicare Quality Payment Program (QPP). QPP is the new physician payment system created by the Medicare Access and CHIP Reauthorization Act (MACRA) and is administered by the Centers for Medicare and Medicaid Services (CMS). Because QPP is new this year, AMA and the California Medical Association (CMA) want to make sure physicians know what they have to do to participate in QPP’s “pick your pace” options for reporting. This is ... July 21, 2017 Medicare MACRA, Medicare 0 0 Comment Read More »
Noridian to issue electronic Level 1 Medicare Redetermination Notices via web portal Effective June 16, 2017, providers who submit their redetermination and/or reopening requests through the Noridian Medicare Portal (NMP) will now receive their Level 1 Medicare Redetermination Notices (MRNs) via NMP. If a redetermination or reopening outcome results in a fully favorable (payable) determination, the remittance advice will provide details. For all other decisions in which providers receive an MRN, the determination letters will now be available through the Appeal Status Inquiry feature in NMP only. Practices that submit electronic reopening and redetermination requests should ensure that any assigned staff member is ... July 21, 2017 Medicare Medicare, Noridian 0 0 Comment Read More »
UnitedHealthcare to issue new Premium Designation physician results In its June Network Bulletin, UnitedHealthcare (UHC) announced that the next iteration of its Premium Designation assessment results will be sent to physicians in early July. These results will be released publicly via the payor's online physician directory beginning September 6, 2017. Physicians within 16 specialties (allergy, cardiology, ENT, endocrinology, family medicine, gastroenterology, general surgery, internal medicine, nephrology, neurology, neurosurgery, OB/GYN, pediatrics, pulmonology, rheumatology and urology) and their 46 credentialed sub-specialties will again be ranked by UHC on both national and specialty-specific measures for quality and various cost-efficiency benchmarks. UHC says ... July 21, 2017 Managed Care United Healthcare 0 0 Comment Read More »
Blue Cross adds 3D mammography to preventative care coverage Anthem Blue Cross recently updated its preventive coverage policy on screening digital breast tomosynthesis (DBT or 3D mammography). Beginning with June 6, 2017, dates of service for individual, small group and large group health plans, 3D mammography for screening purposes will be covered at 100 percent, with no member cost share (copayments, deductibles or coinsurance). Anthem National Account plans will be updated to reflect this update beginning August 1, 2017. This follows a February 2017 change Anthem made to archive its prior policy on 3D mammography, which deemed the procedure ... July 21, 2017 Managed Care Anthem Blue Cross 0 0 Comment Read More »
UnitedHealthcare to implement new drug testing reimbursement policy UnitedHealthcare has advised that it will implement a new drug testing reimbursement policy for commercial members effective for dates of service on or after September 1, 2017. The new policy will only allow one Presumptive Drug Class procedure per drug class (codes 80305, 80306 and 80307) per member, per date of service, whether submitted by the same or different provider. The policy will also only allow one Definitive Drug Class procedure per drug class (codes G0480, G0481, G0482, G0483 and G0659) per member, per date of service, whether submitted ... July 21, 2017 Managed Care Drug Testing, UnitedHealthcare 0 0 Comment Read More »
Have you received a termination notice from Blue Cross recently? The California Medical Association (CMA) has heard from several physicians who have received unexpected termination notices from Anthem Blue Cross. The notices, which specify no cause for termination, appear directed only to physicians who refer to out-of-network ambulatory surgical centers. If you have recently received a similar termination notice from Anthem Blue Cross, CMA wants to hear from you. Please contact CMA's Reimbursement Helpline at (888) 401-5911 or economicservices@cmanet.org. July 21, 2017 Managed Care Anthem Blue Cross 0 0 Comment Read More »
CMA urges strong regulatory system for medical cannabis In 2015, the legislature passed and the governor signed into law a series of bills to create a licensing and regulatory framework for medical cannabis. The Bureau of Medical Cannabis Regulation and California Department of Public Health (CDPH) have issued proposed regulations as they begin to construct the medical cannabis regulatory system. The California Medical Association (CMA) submitted written comments on the proposed medical cannabis regulations, which will affect medical cannabis dispensaries, manufacturers, distributors and transporters. While California became the first state to decriminalize the cultivation and use of medical cannabis ... July 21, 2017 General Medical Marijuana, Regulatory Advocacy, Adult Use of Maijuana 0 0 Comment Read More »
