AMA urges quick action to stabilize individual insurance market With the window quickly closing to properly price individual insurance products for 2018, the American Medical Association (AMA) is urging President Trump and Congressional leaders to commit to continued funding for the cost-sharing reductions that are critical to stabilizing the individual market. AMA, along with other groups representing insurers, hospitals, health plan purchasers and physicians, sent a letter urging quick action to deliver short-term stability and affordable coverage while broader marketplace stabilization efforts are developed. Nearly 60 percent of all individuals who purchase coverage via the exchange receive financial assistance to ... April 19, 2017 General, Managed Care ACA, Affordable Care Act, AMA, American Medical Association, Health Insurance Exchange, Insurance 0 0 Comment Read More »
Open Payments review and dispute period open Drug and medical device manufacturers have completed their submission of data to the Open Payments system on payments or transfers of value made to physicians during 2016. Physicians now have 45 days to review and dispute records attributed to them. The review and dispute period is open until May 15, 2017. The review and dispute process is voluntary, but encouraged. The Centers for Medicare and Medicaid Services (CMS) will publish the 2016 payment data, along with updates to the 2013 and 2014 data, on June 30, 2017. Disputes that are ... April 19, 2017 General, Managed Care, Medicare Centers for Medicare and Medicaid Services, CMS, Medical Devices, Physician Payments Sunshine Act, Prescription Drugs 0 0 Comment Read More »
CMS delays reporting deadline for physician labs The Centers for Medicare and Medicaid Services (CMS) has announced that it will delay the deadline for physician office-based laboratories to meet new reporting requirements. Qualified laboratories now have until May 30, 2017, to complete reporting of private payor payment data for clinical testing services, as required by the Protecting Access to Medicare Act (PAMA). Under PAMA, laboratories that meet revenue thresholds are required to report private payor payment rates and associated volumes for tests they perform that are paid on the Clinical Laboratory Fee Schedule (CLFS). CMS said it ... April 19, 2017 General Centers for Medicare and Medicaid Services, Clinical Laboratories, CMS, Medicare, Regulatory Advocacy 0 0 Comment Read More »
Ask the expert: Making a business case to join a payor network When physicians identify a payor network they wish to join, typically their first step is to submit a letter of interest or intent signaling their desire to join. However, physicians often fail to adequately present a “business case” as to why the payor would want to add the practice into their network. Failure to present a business case often results in a quick reply from the payor indicating that they have no interest or need to add providers to their network at this time. To prevent the “auto-reply,” the ... April 19, 2017 General, Managed Care Economic Advocacy, Insurance/Reimbursement, Payor Contracting 0 0 Comment Read More »
CHPI publishes physicians' quality ratings for cycle 2 On March 22, 2017, the California Healthcare Performance Initiative System (CHPI) released its second cycle of physician quality ratings to the public. The ratings can be accessed at CHPI’s newly launched website, CAqualityratings.org, which allows consumers to search ratings on approximately 10,000 California physicians. As previously reported in September 2016, approximately 13,000 physicians in California received their individual quality measurement scores for the second cycle of the CHPI quality rating program. The program rates physicians using claims data from Medicare fee-for-service, Anthem Blue Cross, Blue Shield of California and UnitedHealthcare. ... April 19, 2017 Managed Care, Medicare Managed Care, Medicare, CHPI, Quality of Care 0 0 Comment Read More »
CMA updates MACRA preparation checklist The California Medical Association’s (CMA) Center for Economic Services has published an update to its Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) preparation checklist. The checklist, “MACRA: What Should I Do Now to Prepare?”, is available in CMA's MACRA resource center at www.cmanet.org/macra. CMA published this important checklist to help physicians understand MACRA payment reforms and what they can do now to start preparing for the transition. Also available in the MACRA resource center is an overview of MACRA, and a comprehensive list of tools, resources and information ... April 19, 2017 Managed Care, Medicare Practice Management, Insurance/Reimbursement, Medicare 0 0 Comment Read More »
CMS to remove SSNs from all Medicare cards by April 2019 The Centers for Medicare & Medicaid Services (CMS) will remove social security numbers (SSNs) from all Medicare cards by April 2019, as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). As part of the Social Security Number Removal Initiative, a new Medicare Beneficiary Identifier (MBI) will replace the SSN-based Health Insurance Claim Number (HICN) for all Medicare transactions. The MBI is confidential like the SSN, and should be protected as personally identifiable information. By replacing the SSN-based HICN on all Medicare cards, private health care and ... April 19, 2017 Medicare Insurance/Reimbursement, MACRA, Medicare 0 0 Comment Read More »
$14 million reasons to be a CMA member The California Medical Association (CMA) Center for Economic Services (CES) has recouped $14 million from payors on behalf of CMA member physicians over the past eight years. These monies 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. With more than 125 years of combined medical practice operations experience, CES staff helps members with issues ranging from underpayment or denials by payors to assisting with contract ... April 18, 2017 General CES, Center for Econimic Services, Reimbursement 0 0 Comment Read More »
UnitedHealthcare requiring stricter notification requirements for out-of-network ASC referral UnitedHealthcare (UHC) recently issued a notification to approximately 80 California physicians reminding them that their participation agreement requires them to refer to in-network ambulatory surgical centers (ASC) for elective services. This notice comes on the heels of an August 2016 announcement that UHC will begin enforcing stricter notification requirements related to out-of-network ASC referrals. According to the UHC letter, physicians wishing to perform services at an out-of-network ASC will be required to notify UHC at least five days in advance of the procedure. Additionally, physicians will be expected to ... April 18, 2017 Managed Care Ambulatory Surgical Centers, ASC, UnitedHealthcare 0 0 Comment Read More »
Health Net Federal Services begins TRICARE contracting initiative As previously reported, the Department of Defense awarded the $17.7 billion TRICARE West Region contract to Health Net Federal Services (HNFS). As the recipient of the contract, HNFS will provide managed care services to 2.9 million TRICARE beneficiaries in 19 western states, including California, beginning October 1, 2017. In preparation for the transition, Health Net has sent recruitment notices to physicians soliciting interest in participation in the new Health Net Federal Services (HNFS) West Region network. Included in the recruitment packet is a “Join our Network” form. Physicians interested in ... April 18, 2017 Managed Care Health Net Federal Services, HNFS, Managed Care, TRICARE 0 0 Comment Read More »
