Did you know you can request reconsideration if you're getting dinged with a 2% Medicare eRx penalty? Physicians and group practices who were not successful electronic prescribers under the 2012 or 2013 Medicare eRx Incentive Program will be subject to a negative payment adjustment of 2 percent in 2014 on all Medicare Part B claims paid under the physician fee schedule. The Centers for Medicare and Medicaid Services (CMS) has notified physicians and group practices that did not meet the requirements and will be subject to the 2014 payment adjustment. Some practices have reported that their meaningful use attestation was not taken into consideration as an exemption. ... February 5, 2014 General Health Information Technology, Insurance/Reimbursement, E-Prescribing, Medicare 0 0 Comment Read More »
Anthem Blue Cross to move eligibility, benefits and claim status inquiry functions to Availity Web Portal in March Anthem Blue Cross has advised that effective March 14, 2014, patient eligibility, benefits and claim status inquiry functions will transition from its ProviderAccess portal to the Availity web portal. As of that date, practices will only be able to access this information via the Availity web portal. While BlueCard eligibility, benefits and claim status functions will also transition to Availity, the BlueCard Advisor function that allows practices to determine which Blues plan to send the claim to will continue to be available on the ProviderAccess portal. In order to access information ... February 5, 2014 General BlueCard, Managed Care, Anthem Blue Cross, Insurance/Reimbursement 0 0 Comment Read More »
CMA develops simple tool to identify physician participation status in exchange plans On January 1, 2014, Covered California began providing health coverage to more 500,000 patients statewide. With that figure expected to grow by the end of the 2014 open enrollment period, it is critical that physicians and their staff have a clear understanding of their exchange plan participation status so they can communicate this information to patients before scheduling. It’s equally as important that practices understand the reimbursement rates and other terms associated with the plans with which they are contracted. Even if you did not intentionally contract with any exchange ... January 27, 2014 General Covered California, Health Benefit Exchange, Insurance/Reimbursement, Health Care Reform 0 0 Comment Read More »
CMS to conduct ICD-10 testing in March On October 1, 2014, the ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets. To help physicians prepare for this transition, the Centers for Medicare & Medicaid Services (CMS) has announced a limited national testing week for current direct submitters (providers and clearinghouses) from March 3 - 7, 2014. This testing week will give trading partners access to the Medicare Administrative Contractors (MACs) and Common Electronic Data Interchange (CEDI) for testing with real-time help desk support. While participants will not be able ... January 27, 2014 General CMS, ICD-10, Insurance/Reimbursement 0 0 Comment Read More »
Making sense of Medicare payment changes With the new 2014 fee schedule, the temporary halt to the sustainable growth rate (SGR) cut and an interim .5 percent payment increase, Medicare physicians are understandably confused about what impact these changes will have on their practices. Below is a quick summary of the various Medicare payment changes facing physicians in 2014: 2014 Fee Schedule: While the 2014 Medicare fee schedule contains a 3.7 percent conversion factor increase, the overall fee schedule is budget neutral due to myriad relative value unit (RVU) changes. These changes will impact providers differently ... January 14, 2014 Medicare Medicare, Insurance/Reimbursement 0 0 Comment Read More »
Gov. Brown's proposed budget eliminates retroactive Medi-Cal cuts Governor Jerry Brown this morning announced that the State of California would not be moving forward with retroactive collection of a 10 percent cut to the Medi-Cal program, a win for physicians and patients in California. The announcement came as part of the governor's 2014-2015 fiscal year budget proposal. "The Governor’s budget demonstrates a clear understanding of the importance that California’s Medicaid (Medi-Cal) program has for the state’s poorest and most vulnerable patients," says Richard Thorp, M.D., president of the California Medical Association (CMA). “After voicing a commitment to expand ... January 14, 2014 Medi-Cal Medi-Cal, Insurance/Reimbursement 0 0 Comment Read More »
Duals demonstration project delayed in three counties The California Department of Health Care Services (DHCS) has delayed passive enrollment for three of the eight counties affected by the state's "pilot project" to redesign care for Medicare/Medi-Cal dual eligibles. The project in these three counties—Alameda, Santa Clara and Los Angeles—will begin instead with a voluntary period, during which patients can choose early enrollment with a Medi-Cal managed care plan, or wait until the automatic passive enrollment period, which will begin no earlier than July 1, 2014. The project—known as Cal MediConnect—was authorized by the state in July 2012 ... December 16, 2013 Managed Care Dual Eligible, Insurance/Reimbursement, Medicare, Medi-Cal 0 0 Comment Read More »
Updates to Covered California, the state's health benefit exchange CMA has updated our exchange toolkit, “CMA’s Got You Covered: A physician’s guide to Covered California, the state’s health benefit exchange.” There are significant updates since we last made updates in September that reflect key developments within the exchange including: • Updates on the grace period • Which plans have exited the exchange • How plans are building their networks • Information on how physicians can check their participation status on the Covered California website • Phone numbers of all of the plans in the event physicians have questions about their participation status December 10, 2013 General Health Care Reform, Health Insurance Exchange, Covered California, Insurance/Reimbursement 0 0 Comment Read More »
2014 Medicare fee schedule confirms 24 percent cut Demonstrating yet again how broken the Medicare sustainable growth rate (SGR) formula is, physicians will face a 24 percent Medicare payment cut next year if Congress does not seize the opportunity to put a stop to the formula's annual threat of drastic payment cuts. This figure was confirmed by the Centers for Medicare and Medicaid Services (CMS) last week, when the agency released its final physician fee schedule for 2014. The California Medical Association (CMA) is currently reviewing the final rule, which was released much later than usual because of ... December 3, 2013 Medicare Medicare, SGR, Sustainable Growth Rate, Advocacy, Insurance/Reimbursement 0 0 Comment Read More »
CMA Medi-Cal Survival Guide helps physicians understand numerous program changes Over the past year, there have been a number of changes for Medi-Cal patients and for the physicians who treat them. There will be more changes in 2014 as well. To help physicians understand the impact these changes will have on their practices, the California Medical Association (CMA) has published a Medi-Cal Survival Toolkit. The toolkit contains a summary on many of the changes, important dates, options for physicians and links to important resources. The toolkit is available to free to members in CMA's online resource library. Contact: CMA's reimbursement helpline, (888) ... November 6, 2013 Medi-Cal Healthy Families, Medi-Cal, Insurance/Reimbursement 0 0 Comment Read More »
