Anthem software upgrade caused widespread claims payment errors in March Anthem Blue Cross recently announced that a software upgrade the weekend of March 19 resulted in a zero allowance for some provider claims. According to Anthem, approximately 130,000 claims were affected. The error was resolved on Thursday, March 24. The California Medical Association (CMA) was made aware of this problem by calls from members to our reimbursement help line. Anthem advised CMA that all impacted claims will automatically be reprocessed within 90-120 days and physicians do not need to resubmit claims or file appeals. Interest and penalties will automatically be ... April 18, 2016 Managed Care Commercial Insurance, Anthem Blue Cross 0 0 Comment Read More »
April is National Donate Life Month; physicians encouraged to talk to patients about the importance of organ donation In honor of Donate Life Month, the California Medical Association (CMA) and the CMA Foundation are encouraging physicians to talk to their patients about the importance of organ and tissue donation, particularly in underserved ethnic communities. There are almost 124,000 men, women, and children who are currently waiting for an organ transplant in the United States. Each day, an average of 79 people receive organ transplants. However, an average of 22 people die each day waiting for life-saving transplants due to the shortage of donated organs. According to Donate Life America, ... April 18, 2016 General Organ Donation, Public Health, CMA Foundation (CMAF) 0 0 Comment Read More »
Call for nominations: CMA Quality and Cost Technical Advisory Committee The California Medical Association (CMA) is currently seeking physician members to serve on the newly formed Quality and Cost Technical Advisory Committee (QTAC). CMA's committees and councils provide key input to the Board of Trustees to guide the association as it sets new policies. The deadline to submit an application or nomination for the QTAC is Friday, April 29, 2016. The purpose of this committee is to provide input in the development of a cohesive and consistent approach to quality and cost rating programs and value-based payment initiatives. Committee members will ... April 18, 2016 General CMA Nominations, Quality Reporting, CMA Committees 0 0 Comment Read More »
Reminder: Deadline to register for CURES is July 1, 2016 Under California law, all individuals practicing in California who possess both a state regulatory board license authorized to prescribe, dispense, furnish or order controlled substances and a Drug Enforcement Administration Controlled Substance Registration Certificate (DEA Certificate) must register to use the Controlled Substance Utilization Review and Evaluation System (CURES) by July 1, 2016. The California Medical Association (CMA) has compiled a list of educational materials to familiarize physicians with the registration process and key features of the newly upgraded system, CURES 2.0. These resources are available at www.cmanet.org/cures. Physicians who experience ... April 18, 2016 General Webinars, CURES, Drug Prescribing 0 0 Comment Read More »
CMS announces new primary-care payment and health care delivery model The Centers for Medicare and Medicaid Services (CMS) this week announced a new payment model aimed at transforming and improving how primary care is delivered and paid for in America. The Comprehensive Primary Care Plus (CPC+) model will be implemented in up to 20 regions and can accommodate up to 5,000 practices, which would encompass more than 20,000 doctors and clinicians and the 25 million people they serve. The initiative is designed to provide doctors the freedom to care for their patients the way they think will deliver the ... April 18, 2016 Medi-Cal, Medicare Medicare, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
Will your practice be ready to comply with the requirements under new provider directory accuracy law? On July 1, 2016, a new law will take effect that requires plans to ensure that physician directories are accurate and up-to-date. The law (SB 137) includes multiple components aimed at providing patients with more accurate and complete information to identify which providers are in their payors' networks. Plans and insurers will be required to have certain data fields in the directory including, but not limited to, provider name, specialty, board certification (if any), practice address, city, zip, license number, NPI, whether the provider is accepting new patients, the product ... April 14, 2016 General Payor Contracting, Provider Directories, Provider Networks, Network Adequacy 0 0 Comment Read More »
State pharmacy board issues proposed rules for drug take-back programs The California State Board of Pharmacy recently released draft rules for prescription drug take-back programs. The proposed regulations are part of statewide efforts to combat prescription drug misuse by making it easier for patients to safely dispose of old and unwanted drugs. The California Medical Association (CMA) submitted comments on the proposed rules and congratulated the board for providing needed clarity and guidance to pharmacies that elect to participate in drug take-back programs. A significant component of the prescription drug abuse and diversion problem stems from misuse of unused drugs. According ... April 14, 2016 General Pharmacists, Prescription Drugs 0 0 Comment Read More »
Song-Brown residency program grant cycle begins April 26 The Office of Statewide Health Planning and Development (OSHPD) will soon be accepting the next round of applications from California residency programs seeking grant funding for new or existing resident positions. The 2015-2016 California State Budget allocated $6 million to expand OSHPD's Song-Brown Program to create more residency slots in the state and to open the program to all primary care specialties (family medicine, internal medicine, obstetrics-gynecology and pediatrics). The next application cycle will open on April 26, 2016. All accredited residency programs interested in applying for primary care residency funding, ... April 12, 2016 General Residents and Fellows, Physician Workforce 0 0 Comment Read More »
CMA Capitol Insight: April 11, 2016 CMA Capitol Insight is a biweekly column by veteran journalist Anthony York, reporting on the inner workings of the state Legislature. ___________________________________________________________________________________________________________ A Higher Wage (and Higher Tobacco Tax?) Gov. Jerry Brown continued to make history when he signed a $15/hour minimum wage into law. The governor, whose administration had publicly opposed calls for a higher wage, couched the increase in moral terms at a Los Angeles signing ceremony. What’s notable is that the higher wage will take effect statewide. Others had thought that more economically depressed areas of the state ... April 12, 2016 General CMA Capitol Insight, State Legislative Advocacy, Anthony York 0 0 Comment Read More »
Reminder: Practices should be wary of virtual credit card fees Is your practice accepting virtual credit card (VCC) payments from payors? If so, you risk losing a significant amount of your contractual reimbursement to high interchange fees. When paying claims, some payors have shifted from paper checks to electronic payment methods, including payor-issued VCCs. With this method, when issuing payment a payor sends credit card payment information and instructions to physicians, who process the payments using standard credit card technology. This method is beneficial to payors, but costly for physicians. Health plans often receive cash-back incentives from credit card companies for ... April 12, 2016 General Practice Resources, Payment 0 0 Comment Read More »
