President's Message from Michael Sequeira, M.D. - October 2016 Dear Friends and Colleagues, Every few years, the opportunity comes along to make a powerful and positive change in the lives, work and futures of California physicians and families. Proposition 56 is one of those transformational measures, and it will appear on this November’s ballot. Most of us recall – vividly – the battle in 2014 over Proposition 46, passage of which would have overturned the MICRA protections. Not only would this have quadrupled the cap on non-economic damages in malpractice suits, but also it would have resulted in physicians having ... October 14, 2016 General, President's Message Physician Advocacy, Proposition 56m, Save Lives Coalition 0 0 Comment Read More »
California Medical Association endorses soda tax ballot measures The California Medical Association (CMA) today announced endorsements for three Bay Area ballot propositions aimed at reducing sugar intake to prevent diabetes and obesity: Measure V in San Francisco (Tax on Distributing Sugar-Sweetened Beverages) proposes a 1-cent per ounce tax that is estimated to generate $14.4 million/year. Measure HH in Oakland (Sugar-Sweetened Beverage Tax) proposes a 1-cent per ounce tax that is estimated to generate $6-8 million/year. Measure 01 in Albany (Sugar-Sweetened Beverage General Tax) proposes a 1-cent per ounce ... October 14, 2016 General Ballot Measures, Election, Political Advocacy, Public Health 0 0 Comment Read More »
FDA adds boxed warning to hepatitis C drugs The U.S. Food and Drug Administration (FDA) is warning of serious, potentially life-threatening risks for patients infected with hepatitis B virus who are being treated with certain direct-acting antiviral medicines for hepatitis C virus (HCV). According to the FDA, direct-acting antiviral medicines for hepatitis C virus can reactivate hepatitis B virus. In a few cases, hepatitis B reactivation in patients treated with direct-acting antivirals resulted in serious liver problems or death. As a result, FDA is requiring a boxed warning about the risk of hepatitis B reactivation to be ... October 14, 2016 General Food and Drug Administration, Public Health 0 0 Comment Read More »
CMA publishes FAQ on controversial new law to end "surprise billing" In September 2016, Governor Jerry Brown signed into law a controversial bill (AB 72) that will change the billing practices of non-participating physicians providing non-emergency care at in-network hospitals, ambulatory surgery centers and laboratories. While the enactment of AB 72 can never be described as favorable, the end result is a law that puts to rest the issue of so-called “surprise billing” in a way that preserves the ability of physicians to continue collecting their usual rate (as long as they obtain the consent of the patient), implements a statutory ... October 14, 2016 General, Managed Care Network Adequacy, Out of Network Care, Provider Networks 0 0 Comment Read More »
Are you in compliance with federal nondiscrimination rule? The California Medical Association has published answers to the most frequently asked questions regarding the new nondiscrimination rules recently published by the U.S. Department of Health and Human Services Office for Civil Rights. The final rule, which implements the nondiscrimination provision of the Affordable Care Act, Section 1557, requires covered physician practices to post nondiscrimination notices and inform patients with disabilities and limited English proficiency (LEP) about the right to receive communication assistance, including the availability of language assistance services. These requirements aim to provide important protections for individuals with disabilities ... October 14, 2016 General Affordable Care Act, Discrimination 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 »
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 »
