CMA opposes proposed changes to duals demonstration The Department of Health Care Services (DHCS) recently released a series of proposals that would change the Coordinated Care Initiative (CCI) enrollment process to 1) passively enroll beneficiaries into Cal MediConnect; and to 2) streamline enrollment by allowing plans to eliminate or dramatically reduce the role of the enrollment broker. The California Medical Association (CMA), in partnership with Justice in Aging and other patient advocacy groups, signed a joint letter strongly opposing the proposals. The Coordinated Care Initiative was authorized by the state in July 2012 in an effort to save ... April 28, 2016 General, Medi-Cal, Medicare Dual Eligible, Medi-Cal, Medicare, DHCS, Regulatory Advocacy 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 »
CMS announces second cycle of Medicare revalidation 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 fraud within the Medicare system. Once a Medicare enrollment application is validated, the clock starts ticking on a five-year revalidation cycle. Now that five years have passed since the ACA's revalidation requirement took effect, the Centers for Medicare and Medicaid Services (CMS) is initiating a second cycle of revalidation requests. According to CMS, Medicare Administrative Contractors (MAC) ... March 31, 2016 Medicare Affordable Care Act, Medicare, ACA 0 0 Comment Read More »
Deadline to file for meaningful use hardship exemption is March 15 In mid-December, Congress adopted a last-minute bill that gives CMS the authority to grant a blanket exemption for all eligible physicians who apply for the exemption from the 2015 meaningful use penalties. This action prevents the Centers for Medicare and Medicaid Services (CMS) from implementing Medicare payment penalties for physicians who fail to demonstrate meaningful use of a certified electronic health record (EHR) system in 2015. New rules released last year state that eligible professionals must attest that they met the requirements for stage 2 meaningful use for a period ... February 9, 2016 Medicare Electronic Health Record, Meaningful Use, Medicare, EHR 0 0 Comment Read More »
CMS to hold webinars for providers on updates to the Physician Compare website The Centers for Medicare and Medicaid Services (CMS) will host a series of one-hour webinars about recent updates to the Physician Compare website and future plans for public reporting, including benchmark and star ratings. The Affordable Care Act required CMS to create a website that would allow consumers to search for and compare physicians and other health care professionals who provide Medicare services. That site—the "Physician Compare" website, initially launched in 2010—provides contact information, specialties and clinical training, hospital affiliations, and group practice information. In 2014, the website also began phasing ... February 1, 2016 Medicare CMS, Medicare, Webinars, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
Noridian posts updated Medicare Physician Fee Schedule California's Medicare contractor, Noridian, has posted an updated 2016 Medicare Physician Fee Schedule on its website. Last week, Noridian had removed the fee schedule because it contained several technical errors that needed to be fixed. This update is not expected to cause any delays in reimbursement for physicians, because under current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt. The updated fees are valid for dates of service from January 1 through December 31, 2016. To see the ... January 25, 2016 Medicare Medicare, Noridian, Fee Schedule 0 0 Comment Read More »
AMA publishes guide to physician-focused alternative payment models The legislation that repealed the Medicare sustainable growth rate—the Medicare Access and CHIP Reauthorization Act (MACRA)—created major new opportunities to advance alternative payment models (APM). Starting in 2019, MACRA will provide a 5 percent annual bonus payment to physicians who participate in APMs and it exempts them from participating in the fee-for-service meaningful use and quality reporting programs (MACRA's Merit-Based Incentive Payment System). In addition to accountable care organizations, medical homes and bundled payments for hospital-based episodes, MACRA also provides for the development of “physician-focused” APMs. The American Medical Association ... January 15, 2016 Medicare AMA, American Medical Association, Medicare, Alternative Payment Models (APM) 0 0 Comment Read More »
Physicians urged to preemptively file for meaningful use hardship exemptions Because of a delay in the publication of regulations governing the Medicare meaningful use program, physicians are being urged to preemptively file for a 2015 hardship exemption to avoid penalties in 2016. Physicians should apply for an exemption under the “extreme and uncontrollable circumstances” category, even if they are uncertain whether they will meet the program requirements this year. Doing so will not preclude physicians from receiving an incentive if they do meet meaningful use requirements, but applying can serve as a safety net in staving off a penalty. In order ... December 7, 2015 Medicare EHR, Meaningful Use, Medicare, CMS, Electronic Health Record 0 0 Comment Read More »
CMA urgers CMS to implement less burdensome, physician-led MACRA payment models The California Medical Association (CMA) is urging the Centers for Medicare and Medicaid Services to adopt principles that will assure access to high-quality care for all Medicare patients during the transition to the alternative payment models included in the Medicare payment reform legislation. In April, President Obama signed into law the Medicare Access and CHIP Reauthorization Act (MACRA), which repeals the badly broken Medicare sustainable growth rate formula and replaces it with new payment systems. After more than a decade of fighting for change by CMA and others in organized ... December 7, 2015 Medicare MACRA, Medicare, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
CMS changes enrollment requirements for Part D prescribers Beginning on June 1, 2016, all physicians and other providers who prescribe Medicare Part D drugs must be enrolled in Medicare or have a valid record of opting out. Failure to do so will result in a denial of the pharmacy claim or the beneficiary’s request for reimbursement. The Centers for Medicare and Medicaid Services (CMS) had originally intended to begin enforcing this regulation last June, but the agency delayed implementation to allow sufficient time for beneficiaries and Medicare Part D plans to prepare. All physicians and other prescribers who are ... November 19, 2015 Medicare Medicare, Medicare Part D, Prescription Drugs, Drug Prescribing 0 0 Comment Read More »
