Anthem Blue Cross announces further changes to reimbursement policies and claims software Anthem Blue Cross recently notified physicians of additional upcoming changes to its reimbursement policies and claims editing software, ClaimsXten. The additional changes, scheduled to go into effect on September 14, 2015, come less than 90 days after Anthem’s most recent set of changes were implemented in July, and less than a month prior to the implementation of ICD-10. Anthem states that the additional changes are necessary to bring its claims editing system in line with correct coding guidelines. Anthem did not provide a detailed listing of all the incorporated changes; ... July 6, 2015 General, Managed Care Anthem Blue Cross, Insurance/Reimbursement 0 0 Comment Read More »
Aetna issues physician terminations over frequency of E/M visits The California Medical Association (CMA) has received several reports from physicians in the San Francisco Bay Area that they’ve received contract termination notices from Aetna due to their above-average use of high-level Evaluation and Management (E/M) codes. The termination letters, issued by Aetna in mid-January, advised physicians that upon review of claims for a one year period, their usage of high level E/M codes was “significantly outside the norm” of comparative physicians within their market. CMA has learned that approximately 40 physicians within the Northern California Aetna PPO network were ... July 6, 2015 General Billing/Coding, Coding and Documentation, Practice Resources, Aetna 0 0 Comment Read More »
CMA works to address problems posed by CURES 2.0 launch on July 1 The Department of Justice (DOJ) announced last week that an update to the Controlled Substance Utilization Review and Evaluation System (CURES) database would go live July 1, but with browser requirements that could potentially cut off access for thousands of prescribers and dispensers. According to the DOJ, CURES 2.0 would require users to have Internet Explorer version 11, Safari, Firefox or Chrome Internet browsers installed on their systems in order to access the database. In response to member concerns, the California Medical Association (CMA) met with DOJ to discuss the browser ... July 6, 2015 General Drug Prescribing, EHR, Prescription Drugs, CURES 0 0 Comment Read More »
CalHIPSPO receives Medi-Cal EHR incentive program award The California Department of Health Care Services has awarded the California Health Information Partnership & Services Organization (CalHIPSO), founded by the California Medical Association (CMA), the California Primary Care Association and the California Association of Public Health Hospitals and Health Systems, a Medi-Cal electronic health record (EHR) incentive program technical assistance contract for $15 million. Other organizations also given EHR technical assistance awards include the Health Information Technology Regional Extension Center, the CalOptima Regional Extension Center and Object Health. Over the next three years, these organizations will assist more than ... July 6, 2015 Medi-Cal Electronic Health Record, CalHIPSO, EHR 0 0 Comment Read More »
California Medical Association responds to vote on Senate Bill 323 Sacramento – After today’s Assembly Business and Professions Committee vote, California Medical Association President Luther F. Cobb, M.D., responded with the following statement regarding Senate Bill 323: "Today was a good day for the health of Californians. We commend the Assembly for rejecting SB 323, which would have significantly compromised patient safety. SB 323 would have done nothing to address access to care, and absent a bar on the corporate practice of medicine, adequate physician and medical board oversight, and the extensive training necessary, this legislation would have only put ... July 6, 2015 General SB 323 0 0 Comment Read More »
CMA asks Congress and CMS for two-year grace period for ICD-10 conversion With the implementation of ICD-10 only 90 days away (October 1, 2015), the window for the transition from ICD-9 is rapidly closing for many physician practices. The California Medical Association (CMA), in collaboration with the American Medical Association and other medical associations, sent a letter to the Centers for Medicare and Medicaid Services (CMS) and Congressional leadership urging them to help mitigate the impact of the transition by supporting a two-year grace period whereby physicians would use ICD-10 but not have claims delayed, denied or subject to audits because ... July 6, 2015 General ICD-10, Regulatory Advocacy, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
Coalition partners stand together to thank Legislature, Governor Brown for passing and signing Senate Bill 277 Representing tens of thousands of advocates across the state, doctors, parents, school representatives join in Sacramento for one final rally on SB 277. Sacramento – Despite three-digit temperatures, dozens of coalition partners came together to rally one last time for Senate Bill 277 (Pan/Allen). The bill passed out of the State Assembly on Thursday and cleared the final hurdle in the State Senate Monday. Governor Brown signed the bill today. “This is a monumental day for Californians. Senate Bill 277 will help keep kids and communities safe and I thank ... July 6, 2015 General Immunizations, Public Health, I Heart Immunity, Vaccinations 0 0 Comment Read More »
Educate office staff to avoid fraud and abuse In February 2015, the California Medical Association (CMA) issued a fraud alert to warn its members about clinical laboratory payments to referring physicians that may trigger fraud and abuse concerns. Some clinical labs have been offering physicians cash and gift incentives for blood draws of Medicare patients. CMA has continued to receive reports about these anti-kickback violations, which have led to several recent physician arrests in New Jersey, Virginia and other states. Furthermore, physicians' employees have also been implicated in these alleged bribes, including clerical staff and physician assistants. ... July 6, 2015 General Fraud and Abuse 0 0 Comment Read More »
Anthem Blue Cross begins medical chart reviews in July In July, Anthem Blue Cross will begin chart reviews on enrollees who purchased Affordable Care Act (ACA)-compliant plans in either the individual and small group insurance markets (both on and off the exchange, known as “Covered California”). The records requests are a result of the commercial risk adjustment program created by ACA Section 1343. The primary goal of the risk adjustment program is to spread the financial risk borne by payors more evenly in order to stabilize premiums and provide issuers the ability to offer a variety of plans to ... July 6, 2015 General, Managed Care Affordable Care Act, Anthem Blue Cross, Covered California, ACA, Health Insurance Exchange 0 0 Comment Read More »
Vaccine bill passes through state Assembly and Senate; heads to Gov. Brown for signature A widely supported vaccination bill cleared its second house in the California legislature on Thursday, and passed through the Senate again today. Senate Bill 277, which passed through the Assembly Health Committee on June 9, was approved on the Assembly floor with a 46-30 vote. Today the bill was approved on the Senate floor with a 24-14 vote. The bill’s next stop is the desk of Governor Jerry Brown. “Overwhelmingly, doctors will tell us that vaccines are one of the greatest health achievements in all of mankind,” Assemblywoman Lorena Gonzalez ... July 6, 2015 General Advocacy, Immunization, Public Health, State Legislation, Vaccination, I Heart Immunity 0 0 Comment Read More »
