MACRA final rule exempts one-third of Medicare physicians from MIPS Nearly a third of Medicare physicians could be exempt from Medicare's new merit-based incentive payment system (MIPS) under the final rule implementing the Medicare Access and CHIP Reauthorization Act (MACRA). The rule was released today by the Centers for Medicare and Medicaid Services (CMS). In the final rule, CMS raised the low-volume threshold, so that providers with less than $30,000 in Medicare payments or fewer than 100 Medicare patients are exempt from the MIPS reporting requirements. The earlier proposed rule would only have exempted physicians with less than $10,000 ... November 1, 2016 Managed Care, Medicare Centers for Medicare and Medicaid Services, MACRA, Medicare 0 0 Comment Read More »
California Medical Association responds to final MACRA implementation rule The Centers for Medicare and Medicaid Services (CMS) today released the final implementation rule for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which aims to reform the Medicare physician payment system. The California Medical Association (CMA), American Medical Association (AMA) and nearly every other physician organization supported the bipartisan legislation because it was intended to provide stable payment updates, significantly reduce the quality reporting program burdens, reinstate bonus payments and allow innovative, physician-led alternative payment models. “Physicians, particularly small and rural practices, need a modernized, flexible and ... October 27, 2016 Medicare MACRA, Medicare, Regulatory Advocacy 0 0 Comment Read More »
AMA introduces new MACRA payment model evaluator The American Medical Association (AMA) has introduced a new online tool to help physicians evaluate the various new Medicare payment models and improve their opportunities for success under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which will go into effect in 2017. The AMA Payment Model Evaluator is a free interactive tool offering initial assessments to help physicians determine how their practices will be impacted by MACRA. Once physicians or medical practice administrators fill out the online questionnaire, they will receive guidance on participating in the MACRA ... October 14, 2016 Medicare American Medical Association, AMA, MACRA, Medicare 0 0 Comment Read More »
Podcast series: Inside Medicare's new payment system Changes to the Medicare payment system are on the horizon, and physicians around the country are wondering how the new Medicare Access and CHIP Reauthorization Act (MACRA) will impact their practices. The American Medical Association (AMA) and ReachMD have produced a podcast series to provide physicians with an inside look at what’s to come and what they can do now to prepare for the transition to MACRA. Hear from industry experts and physician leaders about their experiences with new payment models, quality reporting and more. Available episodes include: ... October 13, 2016 Medicare MACRA, Medicare, Podcast 0 0 Comment Read More »
Physicians encouraged to verify CHPI data by November 11 Earlier this month, approximately 13,000 physicians in California received their individual quality measurement scores for the second cycle of the California Healthcare Performance Initiative System (CHPI) quality rating program. Physicians can review and verify the accuracy of the data used to calculate their scores through the CHPI online portal through November 11, 2016. The program rates physicians using claims data from Medicare fee-for-service, Anthem Blue Cross, Blue Shield of California and United Healthcare. This claims data includes both commercial and self-funded health plan data from HMO, PPO, POS and Medicare ... September 22, 2016 Managed Care, Medicare Medicare, Quality of Care, United Healthcare, Anthem Blue Cross, Blue Shield, CHPI 0 0 Comment Read More »
CMA urges CMS to recalculate practice expense data to reflect California's higher practice costs As required by law, at least every three years the Centers for Medicare and Medicaid Services (CMS) adjusts payments under the Medicare physician fee schedule to reflect local differences in practice costs. In the proposed 2017 Medicare physician fee schedule, CMS made nationwide updates to the geographic practice cost indices (GPCI) based on new wage, rent and malpractice expense data. Unfortunately, according to CMS, the malpractice and practice expense GPCIs went down in nearly every region of California, which would result in a 0.48 percent GPCI payment reduction in all ... September 22, 2016 Managed Care, Medicare Fee Schedule, Geographic Practice Cost Index, GPCI, Medicare, Regulatory Advocacy, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
New CMA resource clarifies prohibitions on balance billing Medi-Medi patients The California Medical Association (CMA) often receives questions from physician members regarding the ability to collect the 20 percent that Medicare does not cover when the physician is not a Medi-Cal provider, but provides services to Medi-Medi (Medicare/Medi-Cal) patients. Both state and federal laws provide broad protections to such individuals and prohibit billing a Medi-Cal patient in most circumstances. Running afoul of these laws can put you at risk of a CMS audit and sanctions. CMA has created a new resource on this topic, “Ask the Expert: Billing Medi-Medi Patients,” ... September 13, 2016 Medi-Cal, Medicare Balance Billing, Medi-Cal, Medicare 0 0 Comment Read More »
United Healthcare fails to provide proper notification on rollout of clinical data submission protocol The California Medical Association (CMA) is concerned that United Healthcare (UHC) failed to properly notify physicians before implementation of its Clinical Data Submission Protocol. Although California law (California Insurance Code §10133.65 and Health & Safety Code §1375.7) requires payors to provide contracted physicians with the 45 business days’ advance notice of any material contracting changes, UHC's only notification to physicians about this new protocol was in its Network Bulletin. First introduced in 2015, the program originally targeted only Medicare benefit plans and required physicians to submit all laboratory test ... September 13, 2016 Managed Care, Medicare United Healthcare, Medicare 0 0 Comment Read More »
Last chance for some providers to prevent deactivation by Medicare Noridian, Medicare’s administrative contractor for California, will soon begin deactivating billing privileges for physicians who received revalidation notices from Noridian but have not submitted completed applications to the Centers for Medicare and Medicaid Services (CMS). Last month, Noridian reported that only 19 percent of providers had responded to the most recent Medicare Part B revalidation notices. Since the passage of the Affordable Care Act (ACA), all Medicare providers and suppliers have been required to revalidate their Medicare enrollment information under new enrollment screening criteria in an effort to prevent ... August 8, 2016 Medicare Noridian, Medicare 0 0 Comment Read More »
CMA publishes MACRA preparation checklist On April 16, 2015, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), changing the health care financing system in the most significant and far-reaching way since the program's inception in 1965. To help physicians understand MACRA payment reforms, and what they can do now to start preparing for the transition, the California Medical Association (CMA) has published an important checklist titled, “MACRA: What Should I Do Now to Prepare?” The checklist is available in CMA's MACRA resource center at www.cmanet.org/macra. There you will ... August 8, 2016 CMA, Medicare Practice Resources, Running a Practice, MACRA, Medicare 0 0 Comment Read More »
