Know Your Rights: Managed care contractual protections CMA’s “Know Your Rights” series summarizes vital protections under state and federal law that physicians should be aware of in their dealings with payors. Thanks to legislation sponsored by the California Medical Association (CMA), all health plan contracts with physicians are required to be fair, reasonable and consistent with California law and regulations. Contractual clauses that are specifically prohibited cover the following: Claims filing deadlines that are inconsistent with the law (see "Unfair Payment Practice: Timely Filing Denials") Financial incentives to deny, reduce, limit ... October 13, 2016 Managed Care Know Your Rights, Managed Care, Payor Contracting 0 0 Comment Read More »
CMA to host webinar on AB 72 out-of-network billing In September 2016, Governor Jerry Brown signed a controversial bill, Assembly Bill 72, into law. This bill will change the billing practices of non-participating physicians providing non-emergent care at in-network hospitals, ambulatory surgery centers and laboratories. The October 19 webinar will present an overview of the new law, and will help physicians understand the circumstances under which the bill applies, how physicians can continue to charge their usual and customary rates, and how the bill provides an opportunity to improve network adequacy standards. Presented by Janus Norman, California Medical Association (CMA) ... October 13, 2016 CMA, General Webinars, Out of Network Care 0 0 Comment Read More »
CMA publishes 2016 Legislative Wrap-Up The delivery of health care, and its costs, remains at the forefront of California politics. Dramatic changes, such as the Affordable Care Act, escalating health care premiums, consolidation of health plans, rising drug costs and the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), continue to create uncertainty in the marketplace, causing a relatively new state legislature to question nearly every aspect of health care delivery in California. The result during the 2016-2017 legislative session was a record number of significant legislative challenges to the ... October 13, 2016 General State Legislative Advocacy, State Legislature, State Legislation 0 0 Comment Read More »
Blue Shield to update fee schedule effective December 1 Blue Shield recently announced changes to its physician fee schedule that will take effect December 1, 2016. The new rates are now available on the Blue Shield website (under "Helpful Resources," click “Professional Fee Schedule” then click “Search the Claims Fee Schedule”). To view the new fees, change the default date of service on the “Search Fee Schedule” page to December 1, 2016, (effective date of the change) or later. Physicians can also request a copy of the new fees for up to 20 codes by completing the allowance review ... October 13, 2016 General, Managed Care Blue Shield 0 0 Comment Read More »
Hardware upgrades will impact Medi-Cal systems in October Required systems upgrades to the California Medicaid Management Information System (CA-MMIS) are scheduled to take place during two weekends in October. This is an upgrade of the hardware where many Medi-Cal services run. Upgrades will start during the regular daily maintenance period, which begins at midnight, and will continue through extended maintenance windows on October 9 and October 16. During these windows, providers will be unable to submit transactions. To reduce the impact on providers, upgrades are scheduled during a period when the systems are used less frequently. A System Status ... October 13, 2016 Medi-Cal Medi-Cal 0 0 Comment Read More »
Amador physician featured in Big Tobacco's latest misleading ad, CMA responds The latest misleading ad from the tobacco industry-funded No on Prop. 56 campaign prominently features a retired ob-gyn from Amador county, Arnold Zeiderman, M.D. In the ad he claims, “I do everything in my power to stop people from smoking, but that's not what Prop. 56 is really about." The Executive Committee of the California Medical Association and physician leaders across the state today issued an open letter to Dr. Zeiderman, urging him to reconsider his role as spokesperson for the tobacco industry and join with the rest of the ... October 13, 2016 CMA, General Obstetrics and Gynecology, Tobacco Tax, Ballot Measures, Pediatrics, Prop. 56 (tobacco tax), Tobacco 0 0 Comment Read More »
Did you know physician assistants can now certify state disability and family leave claims? In September 2014, Governor Jerry Brown signed a bill that authorizes physician assistants (PAs) to certify disability insurance (DI) and paid family leave (PFL) claims after a physical examination and under physician supervision. Individuals seeking DI or PFL benefits in California are required to file a claim that includes a certificate from a treating physician or practitioner. PAs in California were previously unable to certify these claims because they were not included in the definition of “practitioner.” For more information about the physician's role in certifying for benefits, view the Employment ... October 13, 2016 General State Disability Insurance (SDI), Paid Family Leave (PFL), Physician Assistants 0 0 Comment Read More »
When was your last HIPAA risk analysis? The U.S. Department of Health and Human Services (HHS) has updated the Security Risk Assessment (SRA) tool, which is designed to help health care providers in small to medium sized practices conduct information security risk analyses of their organizations, as required under the Health Insurance Portability and Accountability Act (HIPAA) Security Rule. New features of the tool include Windows 10 compatibility and improved reporting features. The tool, available at www.HealthIT.gov, is the result of a collaborative effort by the HHS Office of the National Coordinator for Health Information Technology (ONC) ... October 13, 2016 General Protected Health Information, HIPAA Security Rule 0 0 Comment Read More »
$1.1 billion in Zika funding approved by Congress Funding for public health efforts against the Zika virus was finally approved by Congress with the passage of a stopgap measure to avoid a federal government shutdown. The spending measure includes $1.1 billion to fight the virus, capping a fierce months-long debate over the money that dismayed public health experts. The White House first requested $1.9 billion in funds to fight Zika in the spring. But Republicans initially resisted the request, before finally putting forward their own $1.1 billion Zika funding bill in July. The Republicans' bill failed to pass ... October 13, 2016 General Public Health, U.S. Congress, Zika Virus, Department of Public Health 0 0 Comment Read More »
Life-saving tobacco tax measure holds narrow lead in Field poll A new Field poll shows that California voters narrowly favor Proposition 56, but also reflects the effect of Big Tobacco's mammoth spending and deceptive messaging. The Field poll found that Prop. 56 is ahead by 53 percent to 40 percent, with six weeks before Election Day. “This is not a surprise. Tobacco companies have spent $200 million over the last 10 years in campaign contributions to defeat tobacco taxes,” said Yes on 56 Campaign Manager Jim DeBoo. “They know the tax itself will help prevent passing this deadly, costly habit ... October 13, 2016 General Election, Political Advocacy, Prop. 56 (tobacco tax), Ballot Measures, Public Health 0 0 Comment Read More »
