Both houses of Congress working together in an unprecedented collaboration to repeal SGR http:///On Thursday, the Senate Finance Committee and the House Ways and Means Committee released an unprecedented bipartisan and bicameral “discussion draft” proposal that would fully repeal the flawed Medicare Sustainable Growth Rate (SGR) formula. The draft legislation would not provide automatic payment increases for 10 years. However, starting in 2016 physicians can choose to participate in new payment models (such as medical homes) and qualify for 5 percent annual bonuses. In 2017 and beyond, physicians remaining in the fee-for-service program can participate in a new “value-based performance payment program,” which ... November 5, 2013 Medicare Insurance/Reimbursement, Medicare, SGR, Sustainable Growth Rate, Advocacy 0 0 Comment Read More »
CMA part of national effort to urge House leadership to act on Medicare SGR payment overhaul before the year ends The California Medical Association (CMA) is part of a national multi-state, multi-specialty effort headed by the American Medical Association to keep bipartisan momentum going to address Medicare fee-for-service sustainable growth rate (SGR) reform. CMA has asked the California congressional delegation to sign a letter to House Speaker John Boehner and House Minority Leader Nancy Pelosi urging them to make it a priority to reform the Medicare physician payment system before the end of the year. The joint letter is being circulated in Congress by Rep. Bill Flores (R-TX) and ... October 28, 2013 Medicare Insurance/Reimbursement, Medicare, SGR, Sustainable Growth Rate, Advocacy 0 0 Comment Read More »
House of Delegates Highlights House of Delegates acts on hospital care The California Medical Association (CMA) House of Delegates has voted to take action on the Centers for Medicare and Medicaid Services' (CMS) "outpatient patient observation" status, finding it to be a practice that places undue financial burden on patients, complicates the practice of medicine and often results in physicians receiving reduced payments for services provided. ​Resolution 211-13, which received strong support on the floor of the House, was submitted as an emergency resolution and asked that CMA request that CMS eliminate its "outpatient patient ... October 14, 2013 General Advocacy, California Political Action Committee, CALPAC, Electronic Health Record, Health Information Technology, MICRA, Professional Liability, EHR, House of Delegates, Insurance/Reimbursement 0 0 Comment Read More »
Government shutdown to have minimal impact on Medicare and TRICARE programs With the October 1 shutdown of the federal government, the California Medical Association (CMA) has received calls from physicians with questions about how federally funded programs like Medicare and TRICARE will be affected. TRICARE On October 1, 2013, the Defense Health Agency issued a statement regarding TRICARE programs, indicating that there will be minimal impact to TRICARE beneficiaries utilizing private sector physicians. CMA has also confirmed with United Healthcare Military & Veterans Services, the managed care support contractor for the TRICARE West Region, that there should be no interruption in operations ... October 4, 2013 General Medicare, TRICARE, Insurance/Reimbursement 0 0 Comment Read More »
Blue Shield announces fee schedule changes effective December 1 Blue Shield announced changes to its physician fee schedule that will take effect December 1, 2013. In a September 23 notice to physicians, the insurer said that it would be increasing payment for evaluation and management services for preventive care. Additionally, Blue Shield notes payment increases for the more commonly billed office visit codes 99204, 99205, 99213 and 99214. The new rates will be available on the Blue Shield website (under Helpful Resources) beginning October 1. Physicians can also request a copy of the new fees by completing the allowance ... October 2, 2013 Managed Care Blue Shield, Managed Care, Payor Contracting, Insurance/Reimbursement 0 0 Comment Read More »
Medicare and Medi-Cal continue to operate despite government shutdown; FDA, CDC, and NIH are impacted A stalemate in Congress over a spending plan for the 2013-2014 fiscal year and a delay in the Affordable Care Act (ACA), has forced a federal shutdown at midnight last night, closing many federal agencies, including a number of departments under the U.S. Department of Health and Human Services (HHS). The new fiscal year began today, October 1. The House Republicans are proposing to continue spending at current levels with a one year delay in the implementation of the ACA. While the Senate Democrats have also agreed to continue ... October 2, 2013 General Medi-Cal, Medicare, Government, Insurance/Reimbursement 0 0 Comment Read More »
Don't miss out on increased Medi-Cal payments The California Department of Health Care Services (DHCS) will soon be implementing rate increases for primary care physicians who treat Medicaid patients, as authorized under the Affordable Care Act. The increase also applies to services provided by physicians to Medi-Cal managed care patients. In order to see the bump in pay, providers must first attest to their eligibility. According to DHCS, less than half of eligible providers have completed the brief self-attestation process as of September 24. For purposes of this regulation, primary care is defined as family medicine, general ... September 30, 2013 General Health Care Reform, Insurance/Reimbursement, Medi-Cal, Affordable Care Act, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
Medicare transition update September 16, 2013, marked the transition to the new Medicare Administrative Contractor, Noridian. In the first few days, the California Medical Association (CMA) heard about only minor problems with technology, including phone systems that went up and went down, a few issues with the online provider service tool and problems with printing of -PDF files from the Noridian website. Most issues have been resolved. Traffic on the Noridian Provider Contact Center phone line is high, as expected. Wait times are sometimes four to five minutes, but practices report satisfaction with ... September 25, 2013 Medicare Medicare, Noridian, Insurance/Reimbursement 0 0 Comment Read More »
Study finds that ACA Medi-Cal expansion could fuel ER use A retrospective study conducted by researchers at the University of California, San Francisco (UCSF) found that the number of visits to California emergency rooms (ERs) rose by 13.2 percent between 2005 and 2010, from 5.4 million to 6.1 million annually, with a significant 35 percent increase in the number of ER patients insured through Medi-Cal. The authors suggest that the Medi-Cal expansion under the Affordable Care Act (ACA) could further increase these numbers, as millions of additional patients become eligible for Medi-Cal in 2014. Researchers also found that Medi-Cal patients ... September 20, 2013 Medi-Cal Emergency Physicians, Emergency Rooms, Insurance/Reimbursement, Medi-Cal, Medi-Cal Cuts, Access to Care 0 0 Comment Read More »
Reminder: Changes to Anthem Blue Cross reimbursement policies and claims software become effective November 1 In late July, Anthem Blue Cross sent physicians a notice advising of upcoming changes to the insurer’s reimbursement policies and claims editing software called ClaimsXten. The changes will go into effect on November 1, 2013. Because of these changes, physicians may notice a difference in how certain codes and code pairs are adjudicated. Along with the notice, Anthem provided a comprehensive grid outlining all new, revised and existing reimbursement policies and claims editing rules as well as copies of Anthem’s reimbursement policies. Changes include: denial of 3D rendering CPT codes 76376 ... September 20, 2013 General Anthem Blue Cross, Managed Care, Insurance/Reimbursement 0 0 Comment Read More »
