Educate office staff to avoid fraud and abuse In February 2015, the California Medical Association (CMA) issued a fraud alert to warn its members about clinical laboratory payments to referring physicians that may trigger fraud and abuse concerns. Some clinical labs have been offering physicians cash and gift incentives for blood draws of Medicare patients. CMA has continued to receive reports about these anti-kickback violations, which have led to several recent physician arrests in New Jersey, Virginia and other states. Furthermore, physicians' employees have also been implicated in these alleged bribes, including clerical staff and physician assistants. ... July 6, 2015 General Fraud and Abuse 0 0 Comment Read More »
Anthem Blue Cross begins medical chart reviews in July In July, Anthem Blue Cross will begin chart reviews on enrollees who purchased Affordable Care Act (ACA)-compliant plans in either the individual and small group insurance markets (both on and off the exchange, known as “Covered California”). The records requests are a result of the commercial risk adjustment program created by ACA Section 1343. The primary goal of the risk adjustment program is to spread the financial risk borne by payors more evenly in order to stabilize premiums and provide issuers the ability to offer a variety of plans to ... July 6, 2015 General, Managed Care Affordable Care Act, Anthem Blue Cross, Covered California, ACA, Health Insurance Exchange 0 0 Comment Read More »
Vaccine bill passes through state Assembly and Senate; heads to Gov. Brown for signature A widely supported vaccination bill cleared its second house in the California legislature on Thursday, and passed through the Senate again today. Senate Bill 277, which passed through the Assembly Health Committee on June 9, was approved on the Assembly floor with a 46-30 vote. Today the bill was approved on the Senate floor with a 24-14 vote. The bill’s next stop is the desk of Governor Jerry Brown. “Overwhelmingly, doctors will tell us that vaccines are one of the greatest health achievements in all of mankind,” Assemblywoman Lorena Gonzalez ... July 6, 2015 General Advocacy, Immunization, Public Health, State Legislation, Vaccination, I Heart Immunity 0 0 Comment Read More »
Supreme Court upholds ACA subsidies In a major victory for the Obama administration, the U.S. Supreme Court upheld a key provision of the Affordable Care Act (ACA), reaffirming that 6.4 million people in 34 states can continue to receive subsidies to purchase health care insurance. The question in the case, King v. Burwell, was what to make of a phrase in the law that seems to say the subsidies are available only to people buying insurance on “an exchange established by the state.” Chief Justice John Roberts and Justice Anthony Kennedy joined the court’s four Democratic ... June 26, 2015 General Affordable Care Act, United States Supreme Court, ACA 0 0 Comment Read More »
Registration now open for IMQ 2015 Medical Staff Conference The California Medical Association's Institute for Medical Quality (IMQ) has opened registration for its annual Medical Staff Conference, to be held October 29 at Embassy Suites Hotel near LAX. At the conference, attendees will discover solutions and best practices that physicians need to successfully lead their medical staffs. The conference will answer questions about tackling difficult decisions that face medical staffs, such as granting privileges for aging physicians and those reentering practice after an absence. Through examples and discussion, the faculty will demonstrate how, by maintaining a focus on quality and ... June 26, 2015 General Institute for Medical Quality Medical Staff, IMQ, Medical Staff 0 0 Comment Read More »
Governor calls for special Medi-Cal session after budget agreement struck with legislators Governor Jerry Brown has called for a special session of the Legislature to address “Health Care Financing” after he struck a deal with Democratic lawmakers last week. California legislators passed a $115.4 billion budget, part of a deal with Governor Brown to hold back on spending despite the state’s improving financial picture. Left out of the budget agreement were higher rates for Medi-Cal providers. In a typical year, the conclusion of budget negotiations would mean the end of the California Medical Association’s (CMA) hopes of improving access for the over ... June 26, 2015 Medi-Cal Medi-Cal, Medi-Cal Cuts, State Budget, California State Budget 0 0 Comment Read More »
Senate Bill 277 Clears Assembly Sacramento — Senate Bill 277 jumped its final hurdle in the state Assembly today, clearing the house with overwhelming 46-30 approval. The bill now heads back to the Senate, where legislators will consider amendments made in the Assembly. “The California Medical Association (CMA) would like to thank the Assemblymembers who supported this important piece of legislation that will improve public health and keep our communities safe,” CMA President Luther F. Cobb, M.D., said. “Diseases that were once declared eradicated have resurfaced in recent years and SB 277 will help to ... June 26, 2015 General Public Health, State Legislation, Vaccination, Advocacy, I Heart Immunity, Immunization 0 0 Comment Read More »
Court rules against constitutional attack on MICRA On June 9, the California Court of Appeal based in San Francisco issued its precedential opinion in Chan v. Curran, fully upholding various provisions of California's landmark Medical Injury Compensation Reform Act (MICRA) against constitutional attacks by California’s trial attorneys. The California Medical Association (CMA), together with a broad coalition of health care providers, including the American Medical Association, the California Hospital Association and the California Dental Association, had filed an amicus brief last year supporting the constitutionality of the non-economic damages cap of MICRA. This appeal was the latest in ... June 26, 2015 General Legal Advocacy, MICRA, Amicus Briefs 0 0 Comment Read More »
CMA works to address problems posed by CURES 2.0 launch on June 30 The Department of Justice (DOJ) recently announced that an update to the Controlled Substance Utilization Review and Evaluation System (CURES 2.0) database would go live June 30, but with browser requirements that could potentially cut off access for thousands of prescribers and dispensers. According to the DOJ, CURES 2.0 would require users to have Internet Explorer version 11, Firefox or Chrome Internet browsers installed on their systems in order to access the database. While it is possible for some users to simply update or switch to one of the supported ... June 26, 2015 General Drug Prescribing, EHR, Prescritpion Drugs, CURES 0 0 Comment Read More »
Physicians receiving notice from CHPI encouraged to verify data accuracy by July 31 On May 29, 2015, approximately 18,000 physicians in California were notified of a new quality rating program through the California Healthcare Performance Initiative System (CHPI). CHPI is managed by staff from the Pacific Business Group on Health (PBGH), but has its own board of directors. The letter states that 19 quality measures were constructed using claims data from Medicare fee-for-service, Anthem Blue Cross, Blue Shield of California and United Healthcare. This claims data includes both commercial and self-funded health plan data from HMO, PPO, POS and Medicare Advantage products. Along with ... June 26, 2015 General Quality Reporting 0 0 Comment Read More »
