Ask the expert: Making a business case to join a payor network When physicians identify a payor network they wish to join, typically their first step is to submit a letter of interest or intent signaling their desire to join. However, physicians often fail to adequately present a “business case” as to why the payor would want to add the practice into their network. Failure to present a business case often results in a quick reply from the payor indicating that they have no interest or need to add providers to their network at this time. To prevent the “auto-reply,” the ... April 19, 2017 General, Managed Care Economic Advocacy, Insurance/Reimbursement, Payor Contracting 0 0 Comment Read More »
CMA updates MACRA preparation checklist The California Medical Association’s (CMA) Center for Economic Services has published an update to its Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) preparation checklist. The checklist, “MACRA: What Should I Do Now to Prepare?”, is available in CMA's MACRA resource center at www.cmanet.org/macra. CMA published this important checklist to help physicians understand MACRA payment reforms and what they can do now to start preparing for the transition. Also available in the MACRA resource center is an overview of MACRA, and a comprehensive list of tools, resources and information ... April 19, 2017 Managed Care, Medicare Practice Management, Insurance/Reimbursement, Medicare 0 0 Comment Read More »
CMS to remove SSNs from all Medicare cards by April 2019 The Centers for Medicare & Medicaid Services (CMS) will remove social security numbers (SSNs) from all Medicare cards by April 2019, as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). As part of the Social Security Number Removal Initiative, a new Medicare Beneficiary Identifier (MBI) will replace the SSN-based Health Insurance Claim Number (HICN) for all Medicare transactions. The MBI is confidential like the SSN, and should be protected as personally identifiable information. By replacing the SSN-based HICN on all Medicare cards, private health care and ... April 19, 2017 Medicare Insurance/Reimbursement, MACRA, Medicare 0 0 Comment Read More »
Anthem Blue Cross announces further changes to reimbursement policies and claims software Anthem Blue Cross recently notified physicians of additional upcoming changes to its reimbursement policies and claims editing software, ClaimsXten. The additional changes, scheduled to go into effect on September 14, 2015, come less than 90 days after Anthem’s most recent set of changes were implemented in July, and less than a month prior to the implementation of ICD-10. Anthem states that the additional changes are necessary to bring its claims editing system in line with correct coding guidelines. Anthem did not provide a detailed listing of all the incorporated changes; ... July 6, 2015 General, Managed Care Anthem Blue Cross, Insurance/Reimbursement 0 0 Comment Read More »
New fee reduction for Workers' Compensation Independent Medical Review and Independent Bill Review submissions The California Department of Industrial Relations (DIR) announced that fees for submission of an Independent Medical Review (IMR) or Independent Bill Review (IBR) for workers’ compensation were reduced effective January 1, 2015. The following table summarizes the reduction in fees. Fee prior to December 31, 2014 ... March 17, 2015 General Insurance/Reimbursement, Department of Industrial Relations, Workers' Compensation 0 0 Comment Read More »
Anthem system error results in missing remittances In early February, the California Medical Association (CMA) began receiving reports from practices of missing Anthem Blue Cross remittances. CMA escalated the issue to the payor and has since learned that a system issue is to blame for the missing electronic remittance advices (ERA). Anthem reports that the problem began in mid-December and affected ERAs for exchange/mirror and Federal Employee Program (FEP) claims. Somehow, the ERA function was turned off in the Anthem system for these product types. So, while practices received the money for the affected claims through ... March 17, 2015 Managed Care Anthem Blue Cross, Insurance/Reimbursement, Managed Care 0 0 Comment Read More »
United Healthcare to pursue EFT and ERA for all contracted physicians in 2015 United Healthcare (UHC) plans to move all contracted providers from paper checks and remittances to electronic funds transfer (EFT) and electronic remittance advices (ERA) in 2015 through Optum’s Electronic Payments and Statement (EPS) system. United Healthcare stated that moving to an electronic process for checks and explanation of benefits will reduce administrative costs. UHC advised the California Medical Association that they plan to send notice of the change to contracted providers sometime in April. Physicians will be required to select to receive payment either by Automated Clearinghouse (ACH) direct ... February 5, 2015 Managed Care Payment, United Healthcare, Insurance/Reimbursement 0 0 Comment Read More »
ICD-10 transition guide now available; new resource webpage available With eight months until the transition to ICD-10, will your practice be ready be October 1, 2015? To help physicians prepare for the transition, the California Medical Association (CMA) has published a new resource, “ICD-10 Transition Guide – What physicians need to know,” which includes an ICD-10 transition preparation checklist. CMA has also created an ICD-10 transition webpage, www.cmanet.org/icd10, that includes important news articles and other ICD-10 transition information. CMA will also be hosting a number of live training events to assist physicians with the transition, with details announced soon. February 5, 2015 General Insurance/Reimbursement, Practice Resources, ICD-10 0 0 Comment Read More »
CMA survey finds workers' comp reform has brought new challenges for physicians California’s workers’ compensation system is arguably undergoing its biggest period of transformation since its enactment in 1914. Senate Bill 863, signed into law on September 19, 2012, initiated changes to the utilization review process, implementation of an independent medical review and independent bill review process, and a migration to a resource-based relative value scale payment system, among other changes. In late 2014, after hearing complaints from physicians that these changes have resulted in patient care roadblocks, the California Medical Association (CMA) initiated a survey to solicit physician feedback on ... February 5, 2015 General Insurance/Reimbursement, Workers' Compensation 0 0 Comment Read More »
Ensure your practice information is up-to-date with contracted payors Every practice understands the importance of collecting up-to-date demographic information from patients, including changes to a patient’s address, phone number, insurance, and eligibility and benefits. Ensuring that these items are up-to-date guarantees that the practice can quickly communicate with the patient about test results or other medical issues, as well as schedule and confirm appointments. Accurate patient insurance, eligibility and benefits information also helps to prevent unnecessary denials delays in payment, and goes a long way toward ultimately saving time and money for the practice. It is equally important ... February 4, 2015 General Insurance/Reimbursement, Payors 0 0 Comment Read More »
