DHCS reopens window for NICU/PICU claims submission under ACA PCP rate increase On May 18, the California Department of Health Care Services (DHCS) released additional information about Medi-Cal payment increases for primary care physicians under the Affordable Care Act (ACA) who file claims for patients treated in neonatal intensive care units (NICU) or pediatric intensive care units (PICU). In the past, NICU/PICU claims were billed to Medi-Cal using a local code. In order to be eligible for the ACA enhanced payments, physicians were required to submit claims with ACA modifiers beginning April 11, 2014, that linked the local code to an eligible ... May 26, 2015 Medi-Cal Affordable Care Act, Medi-Cal, Pediatrics, ACA 0 0 Comment Read More »
California seniors' state of health ranks 29th in national health study According to a study released June 20 from America’s Health Rankings, California’s seniors have decreased exercising in the past two years, have begun drinking more alcohol and are experiencing more mental health issues. Over the past two years, California’s senior population decreased exercising and dropped stopped from a national ranking of 18th in the nation to 29th -- this according to a study conducted by the United Health Foundation, a nonprofit arm of the United Health Group, which also owns the insurer United Healthcare. The study tracked 35 measures for senior ... May 26, 2015 Medicare Seniors and Persons with Disabilities, Medicare 0 0 Comment Read More »
Ask the Expert: If Medicare pays for a procedure, does a Medicare Advantage plan also have to pay? The California Medical Association (CMA) has received this question from physician practices many times over the past few years. The answer is – it depends. Title XVIII of the Social Security Act established regulations for the Medicare program, which includes provisions affecting Medicare Advantage (MA) plans. The Centers for Medicare and Medicaid Services (CMS) has interpreted these provisions through the Medicare Managed Care Manual (Chapter 4 – Benefits and Beneficiary Protections). The Manual provides guidance for MA plans under Internet-only manual (IOM) 100-16. These guidelines reflect CMS’ current interpretation ... May 21, 2015 Medicare Medicare Advantage, Medicare 0 0 Comment Read More »
United Healthcare to deactivate inactive physician TINs as part of provider directory cleanup Beginning August 1, 2015, United Healthcare (UHC) will initiate a cleanup of its participating provider database and directory. Participating physicians who have not submitted a claim to UHC for a period of one year will be deemed to have voluntarily ceased participation in the UHC physician network; United will initiate a termination of the physician agreement. UHC will contact impacted providers to advise of the termination and to clarify any concerns from the physician. The California Medical Association has inquired about when and how physicians will be notified. Additionally, ... May 21, 2015 General, Managed Care United Healthcare 0 0 Comment Read More »
California Medical Association removes opposition to physician aid in dying bill Sacramento – Today, the California Medical Association (CMA) announced that it has become the first state medical association in the nation to change its position on the long-debated issue of physician aid in dying. By removing decades-old organizational policy, CMA has eliminated its historic opposition and is now officially neutral on Senate Bill 128 (Monning/Wolk), the End of Life Option Act. “As physicians, we want to provide the best care possible for our patients. However, despite the remarkable medical breakthroughs we’ve made and the world-class hospice or palliative care ... May 21, 2015 General State Legislation, Physician Aid in Dying 0 0 Comment Read More »
Survey: Is your practice ready for ICD-10? With less than five months left until the October 1, 2015, implementation date of ICD-10, physician practices should be well into the preparation and planning process for the ICD-10 transition. Congress has reaffirmed that it intends on moving forward with no delays in the implementation date. In an effort to gauge members’ preparedness, the California Medical Association (CMA) is surveying physicians on their readiness for ICD-10 implementation. The survey will take less than five minutes, and your participation will help in directing our advocacy efforts around additional ICD-10 training and ... May 19, 2015 General ICD-10 0 0 Comment Read More »
United Healthcare to alter Premium Designation criteria The California Medical Association (CMA) has learned that United Healthcare (UHC) has altered the criteria for meeting the physician cost efficiency component of its Premium Designation program. UHC will now designate a physician as “Cost Efficient” when he or she has met the episodic cost benchmark, even if the physician did not achieve the population cost benchmark. The change only impacts those physician specialties that are evaluated on both population cost and episode cost, which include: Family medicine, Internal medicine ... May 18, 2015 General, Managed Care United Healthcare 0 0 Comment Read More »
Save Lives California files two ballot initiatives to raise California's tobacco tax An initiative filed with the Attorney General’s Office on May 4 may give California voters the final say on a proposal that would raise the state’s tobacco tax by $2 per pack. The Save Lives California Coalition filed two ballot initiatives with the Attorney General. Both would direct revenue from a new tobacco tax into smoking prevention, cures for tobacco-related diseases and reinforcing the state’s health care system. The only difference between them is that one includes a tax hike on e-cigarettes in addition to combustible cigarettes. The filing is the ... May 18, 2015 General Save Lives California, Tobacco Tax, Public Health, Tobacco 0 0 Comment Read More »
Governor's revised budget contains no significant increases for Medi-Cal On May 14, Governor Jerry Brown released his revised budget for fiscal year 2015-16, which includes an increase in overall expenditures from the General Fund to $115.3 billion, but does not include any significant increases to Medi-Cal provider reimbursement rates. Overall, the revised plan contains $169 billion in total state spending, up from $164.7 billion in January. The total includes $46.9 billion in special funds and $6.8 billion in bond funds. The California Medical Association and other stakeholders continue to point out that beneficiaries of the Medi-Cal program are having ... May 18, 2015 Medi-Cal State Budget, California State Budget, Medi-Cal 0 0 Comment Read More »
Institute for Medical Quality offers grants for opioid training In continuing efforts to address the serious issues related to the misuse of prescription opioids, the California Medical Association’s Institute for Medical Quality (IMQ) is participating in a second round of funding to make available grants to continuing medical education (CME) providers who conduct Food and Drug Administration (FDA)-approved opioid training for physicians, pharmacists and other health care providers. On July 9, 2012, the FDA launched a risk evaluation and mitigation strategy (REMS) for extended-release and long-acting opioid medications. IMQ participates in REMS as part of the Collaborative on REMS ... May 18, 2015 General IMQ, Institute for Medical Quality, Prescription Drugs, Drug Prescribing 0 0 Comment Read More »
