CMA calls for investigation into Anthem policy restricting use of sedation during cataract surgery On December 27, 2017, Anthem Blue Cross implemented a clinical guideline that restricts the use of intravenous anesthesia to sedate patients during cataract surgery. The California Medical Association (CMA) believes this drastic change in policy will cause significant patient safety concerns and put patients at risk of serious complications, including blindness. The new policy, “Anesthesia for Cataract Surgery,” deems intravenous anesthesia (including moderate sedation, monitored anesthesia care or general anesthesia) not medically necessary, except in very narrow circumstances. Anthem patients wishing to have any form of intravenous anesthesia during the ... February 5, 2018 General, Managed Care Anthem Blue Cross, Anesthesiology, Contract Amendment, Medical Necessity, Opthalmology 0 0 Comment Read More »
Anthem dials back modifier 25 payment reduction policy; delays implementation This past fall, Anthem Blue Cross notified physicians in several states that effective January 1, 2018, it would reduce reimbursement of evaluation and management (E&M) services billed with modifier 25 by 50 percent. The California Medical Association (CMA) quickly jumped into action and coordinated with the American Medical Association (AMA) and the American Association of Dermatologists, along with many other state and specialty organizations, to push back on the proposed change. Due to the overwhelming opposition from organized medicine, Anthem recently announced it would reduce the magnitude of its modifier ... January 29, 2018 General, Managed Care Contract Amendment, Economic Advocacy, Payor Contracting, Anthem Blue Cross 0 0 Comment Read More »
United Healthcare introduces Group Medicare Advantage PPO product Effective June 1, 2015, United Healthcare (UHC) will be introducing its Group Medicare Advantage PPO product in several southern California counties. The California Medical Association (CMA) has learned that contract amendments were mailed on February 24 to over 10,000 currently contracted UHC physician practices in Imperial, Orange, Los Angeles, Riverside, San Bernardino and San Diego counties that the payor intends on including in its provider network for this new product. The insurer states that the new product, offered exclusively to employer/union group retirees, will offer greater access to a national ... March 17, 2015 Medicare Contract Amendment, Payor Contracting, United Healthcare 0 0 Comment Read More »
