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 »
Survey: ER visits continue to climb under Affordable Care Act A recent survey conducted by the American College of Emergency Physicians (ACEP) shows that emergency room (ER) visits are continuing to climb since the implementation of the Affordable Care Act (ACA), despite predictions that the law would result in less crowding. According to a news release, about three-quarters of the 2,098 ER physicians surveyed said that visits have risen since January 2014 — a significant increase from a year earlier, when less than half said they saw an upturn. More than one-quarter reported “significant increases in all emergency patients” since ... May 15, 2015 General, Managed Care Affordable Care Act, Emergency Rooms, Health Care Reform, ACA 0 0 Comment Read More »
Covered California board proposes to cut budget because of slower enrollment Due to tepid enrollment numbers, Covered California’s board of directors has proposed to spend $58 million less in 2016, slashing its marketing and outreach program by 33 percent. Open enrollment in Covered California fell short of its goal of 1.7 million this year, ending with the number of enrollees at 1.4 million. Additionally, the exchange must pay its own way in the future after receiving $1 billion in federal money. And while it still has some $290 million in reserve for 2016, the exchange projects that fewer than 1.5 million ... May 15, 2015 General, Managed Care Covered California, Health Insurance Exchange, Affordable Care Act 0 0 Comment Read More »
Learn more: Medicare SGR replacement payment system details On April 16, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) legislation, which negates the Medicare sustainable growth rate (SGR) formula, replaces it with new payment options and extends the Children’s Health Insurance Program (CHIP). The bill was passed in a monumental bipartisan action taken by Congress, after a decade of fighting for change by the California Medical Association, the American Medical Association (AMA) and a host of other medical associations. In summary, MACRA permanently repeals the SGR formula and stabilizes Medicare payments ... May 15, 2015 Medicare Medicare, SGR, Sustainable Growth Rate, Federal Legislative Advocacy 0 0 Comment Read More »
Changes to Anthem Blue Cross reimbursement policies and claims software Anthem Blue Cross recently notified physicians of upcoming changes to the insurer’s reimbursement policies and claims editing software, called ClaimsXten. The changes will go into effect on July 1, 2015. 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 the new, revised and existing reimbursement policies and claims editing rules as well as copies of Anthem’s reimbursement policies. The changes include additions to the types of service Anthem will consider bundled ... May 15, 2015 Managed Care Billing/Coding, Insurance, Managed Care, Anthem Blue Cross 0 0 Comment Read More »
Open Payments database now available for physician review The Centers for Medicare and Medicaid Services (CMS) Open Payments database, based on 2013 data, is available to physicians for their review of payments made to them by drug and medical device companies. The review period opened on April 6, 2015, and will be open until at least May 21. The Open Payments database is a part of the Physician Payments Sunshine Act, a provision of the Affordable Care Act. The California Medical Association (CMA) recommends that physicians review their data for accuracy as it will be published on ... April 29, 2015 Medicare CMS, Physician Payments Sunshine Act, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
Senate Bill 277 clears Senate Judiciary Committee Sacramento – Senate Bill 277 (Pan/Allen) passed overwhelmingly out of the Senate Judiciary Committee today. The California Medical Association (CMA), American Academy of Pediatrics, California (AAPCA), California Immunization Coalition (CIC), Vaccinate California and Health Officers Association of California (HOAC) recently launched the I Heart Immunity Campaign supporting the bill. “Our thanks to the Senate Judiciary Committee along with Senators Pan and Allen for their commitment to this very important issue,” said Luther F. Cobb, M.D., CMA president. “Vaccines are a proven way to keep children healthy and communities safe ... April 29, 2015 General Senate Bill 277, Immunizations, Vaccinations 0 0 Comment Read More »
