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 »
President's Message from Michael A. Sequeira, M.D., F.A.C.E.P. April 2017 Dear Friends and Colleagues, One of my top priorities when I became President of SBCMS in 2016 was to move forward with development of an updated Strategic Plan. I'm excited to let you know that our medical society has completed this process, and we're delighted to unveil the final result! Our planning process took 15 months from start to finish, with the expert guidance of facilitator Ronald Stewart, Ph.D. and a committee of 22 physicians. With generous support to underwrite the process from IEHP, we held a series of meetings ... April 12, 2017 General, President's Message President's Message, Strategic Plan 0 0 Comment Read More »
Children and Families in Crisis - An Annual Educational Conference Join fellow health professionals, caregivers, educators and students for this 4th annual Unforgettables Foundation conference entitled "Trapped by Addiction: Finding the Way Out." Outstanding speakers will focus on the devastating effects of drug and alcohol addictions, child abuse and bullying, and PTSD on families and their children. April 12, 2017 General Addiction 0 0 Comment Read More »
Californians with Medi-Cal Face Hurdles Seeing Specialists California’s communities face a severe shortage of physicians, which is expected to get exponentially worse as the population continues to grow and our aging physician workforce moves toward retirement. Medi-Cal enrollment has surged since 2014, but the percentage of California physicians serving Medi-Cal patients has dropped, a trend that is hampering access to care for enrollees. One in every three Californians (14 million) is dependent on Medi-Cal for health care, so this disparity also negatively impacts a patient’s ability to access needed treatment, according to a recent study by the ... April 12, 2017 Medi-Cal Medi-Cal, physician shortage 0 0 Comment Read More »
SBC Dept. of Public Health Update on Oak Glen Outbreak On Saturday, March 25, several campers at Oak Glen Christian Camp became ill with symptoms that included nausea and vomiting. Forty-one people were reported ill and 14 people were transported to local hospitals. The camp has been temporarily closed and is being inspected by the Division of Environmental Health Services. DEHS is working closely with the Public Health Communicable Disease Section in this investigation. The cause of the illnesses has not yet been determined. Any updates regarding this incident will be announced in future news releases and social media postings. Please refer ... March 28, 2017 General Public Health 0 0 Comment Read More »
CDPH publishes new Zika resources for physicians The California Department of Public Health (CDPH) has published new and revised Zika virus resources for physicians on its website. The evolving Zika virus outbreak and science have presented challenges for providers who are asked to educate, counsel, screen, monitor and manage patients with Zika virus exposure. “We hope these resources will aid health care providers in meeting the needs of California’s families,” the agency said. These materials can be accessed through the CDPH Zika webpage. The new resources include: 1) CDPH Zika Screening Algorithm; 2) CDPH Zika Virus Information for Healthcare ... March 3, 2017 General Public Health, Zika Virus, Department of Public Health 0 0 Comment Read More »
CMS awards $100 million to help small practices succeed The Centers for Medicare & Medicaid Services (CMS) has awarded $20 million to 11 organizations for the first year of a five-year project to provide on-the-ground training and education about the Quality Payment Program, established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), for clinicians in individual or small group practices. CMS intends to invest up to an additional $80 million over the remaining four years. Among the awardees are three California organizations: IPRO in San Francisco, Health Services Advisory Group in Glendale and Burlingame, and Qualis ... March 3, 2017 General, Medicare Medicare, CMS, MACRA, Quality Reporting 0 0 Comment Read More »
Physicians targeted by identity theft tax scam The California Medical Association (CMA) has received reports from physicians that fraudulent federal income tax returns have been filed using physician names, addresses and social security numbers. In many cases the fraudulent tax return includes the name of an unknown person listed as the physician's spouse. Sometimes, this other name is a prior patient of the physician. Affected physicians are likely to learn of the scam by receiving a 5071C letter from the IRS alerting them of possible fraud. Physicians may also have received a rejection notification when attempting to ... March 2, 2017 General Tax 0 0 Comment Read More »
California grapples with 'severe' doctor shortage, study shows California doesn't have enough doctors to handle its primary health care demands and the problem is getting worse. A new study by UCSF Healthforce Center finds that California doesn’t have enough primary care physicians in most regions of the state. According to the study, the shortage is becoming more acute because of an aging physician workforce, a growing patient population and expanded coverage through the Affordable Care Act. According to the study, only two regions of California (the Greater Bay Area and Sacramento) have ratios of primary care physicians per ... March 2, 2017 General California State Budget, Graduate Medical Education, Physician Workforce, Primary Care, State Legislative Advocacy, Underserved Communities 0 0 Comment Read More »
