Family Medicine & Internal Medicine Job Opportunity in Barstow, CA Barstow Healthcare Management MSO is seeking a Family Medicine or Internal Medicine physician for a full-time employment opportunity within a start-up practice. The clinic's, Barstow Health Partners, website is http://barstowhealthpartners.com/. This opportunity offers a competitive and comprehensive recruitment package that is hard to walk away from. Internal Medicine Listing: http://www.practicelink.com/jobs/377976/physician/internal-medicine/california/barstow-healthcare-management-mso/ Family Practice Listing: http://www.practicelink.com/jobs/377858/physician/family-medicine/california/barstow-healthcare-management-mso/ For more information regarding either position, please contact Rhonda Lynch at (760) 957-3224. August 27, 2014 General Barstow Health Partners, Employment , Barstow Healthcare Management 0 0 Comment Read More »
Anthem and Blue Shield to partner in the creation of California's largest health information exchange Two of California's largest health insurers – Anthem Blue Cross and Blue Shield of California are investing a total of $80 million to develop a not-for-profit health information exchange database called Cal INDEX, which is expected to go live in November. It is expected to house the medical records of 9 million patients, about a quarter of California’s population. The initial $80 million stake will get the exchange through the first three years, the insurers said. After that, they expect funding will come from participating health plans and providers who will be charged a subscription fee. Thirty large medical groups are expected to help build the database. It will house such information as patient diagnoses, lab tests, physician and hospital visits and procedures. In a press release, the plans said they hope the exchange will improve quality of care by providing physicians with a unified and integrated source of patient information; and that the portability of patients' information will be seamless between health plans and across various health care professionals and hospitals. Although consumers will not initially be able to access their own data, Anthem and Blue Shield say that functionality will be added at a later date. While the plans say the exchange will comply with all federal and state privacy laws for medical records, consumer groups have raised concerns about patient privacy. According to the plans, patients will be notified that their information will be placed in the information exchange database and they will be given the opportunity to opt out. August 25, 2014 General Blue Shield, Health Information technology, HIT, Anthem Blue Cross 0 0 Comment Read More »
Huge chunk of data excluded from Open Payments website because of inaccuracies According to several news sources, the Centers for Medicare & Medicaid Services (CMS) has rejected about one-third of the "Open Payment" records submitted by manufacturers and group purchasing organizations (GPOs) because of "intermingled data." When the data goes public next month, those records will not be included. CMS says it will not publish the withheld data until June 2015, when it expects that manufacturers will have had time to correct the inaccuracies. Physician Payments Sunshine Act is a provision of the Patient Protection and Affordable Care Act. Drug and medical device manufacturers and GPOs are required to report their financial interactions with licensed physicians – including consulting fees, travel reimbursements, research grants and other gifts. Any payments, ownership interests and other “transfers of value” will be reported to CMS for publication in an online database. This data will be made public via the "Open Payments" website beginning on September 30. The Open Payments system was taken offline a few weeks ago because of errors reported by physicians. Some of the physician website data was found to be “intermingled” between physicians with the same last names by manufacturers. After removing the offending records, CMS re-opened the website for physician review on August 15. To account for system down time, CMS is extending the time for physicians and teaching hospitals to review, and if necessary dispute, their records to September 8, 2014. The public website will be available on September 30, 2014. Physicians and authorized representatives can submit questions to the CMS Help Desk at openpayments@cms.hhs.gov. Live Help Desk support is also available by calling (855) 326-8366, Monday through Friday, from 7:30 a.m. to 6:30 p.m. Central time, excluding Federal holidays. More information on the Sunshine Act is available in the American Medical Association's online “Physician Sunshine Act Tool Kit,” which provides a variety of resources to help physicians navigate the Sunshine Act changes, including a free webinar, a list of important dates, answers to frequently asked questions, information about how to challenge incorrect reports and ways to be more transparent with patients about the physician's interactions with the pharmaceutical and medical device industries. August 21, 2014 Medi-Cal, Medicare CMS, Physician Payment Sunshine Act, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
State audit finds DHCS may have paid $93.7 million for fraudulent Medi-Cal drug treatment A California State Auditor’s report issued today found the Department of Health Care Services (DHCS) failed to properly administer the Medi-Cal Drug Treatment Program and may have paid at least $93.7 million for fraudulent drug treatment. The program provides substance abuse services to Medi-Cal beneficiaries when physicians determine they are medically necessary. The focus of the report was on outpatient drug-free services. The audit was requested by Assemblyman Ted Lieu after stories appeared in the media revealing that substance abuse clinics were fraudulently billing for patients who did not use the clinics, including some who were deceased or incarcerated. The report concluded that failure to properly administer the program created opportunities for fraud. “Using five high-risk indicators that we believe are symptomatic of fraud, our analysis of four years of statewide program claims billing data identified....more than 2.6 million outpatient drug-free services that are potentially indicative of fraudulent activity,” the report said. The state audit looked at claims from outpatient drug‑free services provider submitted from July 1, 2008, to December 31, 2013, for Los Angeles, Fresno and Sacramento counties, and found that the DHCS approved nearly $1 million to potentially ineligible providers. They also found 323 instances amounting to more than $10,000 that the state reimbursed for services to beneficiaries that were deceased. The audit found that DHCS could have accessed the data necessary to prevent fraudulent payments. “They failed to use information that was available in a timely manner,” the report states. The state auditor recommended that DHCS coordinate with counties to recover unauthorized payments, develop new administrative practices to identifying fraudulent payments and to take disciplinary action against providers who commit fraud and to better coordinate with counties to monitor for fraudulent activities. To read the report, click here. August 21, 2014 Medi-Cal DHCS, Drug Abuse, Medi-Cal, Insurance/Reimbursement 0 0 Comment Read More »
CMS must provide better oversight to prevent duplicate audits says GAO study A newly released study by the federal General Accounting Office (GAO) found that the Centers for Medicare and Medicaid Services (CMS) needs to provide better oversight and guidance for provider payment auditors to prevent duplicative post-payment claims review audits. Several types of Medicare contractors conduct postpayment claims reviews to help reduce improper payments: Medicare Administrative Contractors, which process and pay claims; Zone Program Integrity Contractors, which investigate potential fraud; Recovery Auditor Contractors, tasked with identifying on a postpayment basis improper payments not previously reviewed by other contractors; and the Comprehensive Error Rate Testing contractor, which reviews claims used to annually estimate Medicare's improper payment rate. The report notes that although CMS implemented a database to track audit activities, designed in part to prevent duplicative audits by multiple contractors, it must do more to ensure that auditors are not completing duplicative reviews. The report notes that the database was not designed to provide information on all possible duplication, and found that it's data is not reliable because other postpayment contractors do not consistently enter information about their reviews. The report concludes that CMS has not provided sufficient oversight of this data or issued complete guidance to contractors on avoiding duplicative claims reviews. GAO recommends that CMS take actions to improve the efficiency and effectiveness of contractors' post-payment review efforts, which include providing additional oversight and guidance regarding data, duplicative reviews and contractor correspondence. In its comments, the U.S. Department of Health and Human Services concurred with the recommendations and noted plans to improve CMS oversight and guidance. Click here to read the full report. August 21, 2014 General CMS, Insurance/Reimbursement, Medicare, Audits 0 0 Comment Read More »
CMA urges United to make meaningful changes to Premium Designation program Citing physician confusion and complaints as well as additional concerns with the rollout of the United Healthcare (UHC) Premium Designation program, the California Medical Association (CMA) has, again, urged the insurer to make meaningful and necessary changes to the program prior to the next assessment this fall. "In its current form, the program will not only confuse patients but will also fail to provide them with meaningful information that could actually assist them in making important health care decisions,” wrote CMA President Richard Thorp, M.D., in an August 13, 2014, letter to the insurer. The program uses clinical information from health care claims to evaluate physicians against various quality and cost-efficiency benchmarks. CMA believes that the program as currently planned will only lead to confusion among patients and physicians and fails achieve a central goal of the program – which is to modify physician practice patterns to improve both quality and cost-effectiveness. Since the June rollout of the Premium Designation physician assessment reports, doctors have reported numerous problems including the inability to decipher and obtain clarification of the complex assessment reports, insufficient time to thoroughly review and appeal the results of the physician reports, the misattribution of costs related to facilities or other physicians to the assessed physician, and the inability to speak with a UHC representative who could provide feedback on ways to improve performance and meet the program benchmarks for future assessments. CMA in its letter also reiterated its concerns with the ineffective appeal process for physicians who identify errors in the data or who have a high rate of patient non-compliance. CMA believes the appeal process should afford physicians the ability to discuss their concerns with a UHC medical director of the same or similar specialty and that physicians wishing to dispute their status should have a minimum of 60 days to appeal, rather than the 30 days currently allowed. "With the many flaws in the Premium Designation Program that have been identified, CMA is concerned that UHC will needlessly harm physicians and inappropriately steer patients away from quality physicians," Dr. Thorp wrote. Given the significant impact this program could have on a physician practice, CMA also recommended that UHC provide an interactive educational program for physicians and their staff on the background and specifics of the program. While CMA had previously voiced concerns with the rollout of the Premium Designation program in California, United Healthcare sidestepped the issues raised, saying it planned to proceed with the rollout of its physician performance program in California as planned. The first UHC Premium Designation letters and results were mailed in early June to over 25,000 physicians with the results publicly displayed in the insurer's network directory on August 6, 2014. A second round of assessments will be distributed in fall 2014, with publication set for early January 2015. CMA had previously urged UHC to delay implementation of the program for a minimum of six months to allow time for the insurer to address deficiencies with the program and to allow physicians the opportunity to familiarize themselves with the initiative. United Healthcare responded citing the longstanding history of the Premium Designation program (established in 2005) and previous incorporation in 41 other states across the country as a basis for moving forward with implementation as planned in California. Physicians who encounter problems with their physician assessment reports or that have concerns regarding their Premium Designation can contact United Healthcare at (866) 270-5588. Practices that are unable to obtain answers to their questions or resolve the issue with United Healthcare directly should contact CMA at the number below. For more information on the Premium Designation program, visit the United Healthcare website at www.unitedhealthcareonline.com. Contact : CMA's reimbursement helpline, (888) 401-5911 or mlane@cmanet.org. August 21, 2014 Managed Care Managed Care, United Healthcare, Insurance/Reimbursement 0 0 Comment Read More »
Cyclosporiasis and Ebola Virus - Dept. of Public Health The California Department of Public Health (CDPH) urges medical providers to specifically request Cyclospora testing. Cryptosporidiosis is an intestinal illness caused by the microscopic parasite Cyclospora cayetanensis. In the United States, foodborne outbreaks of cyclosporiasis have been linked to various types of imported fresh produce. Click here for more information and recommendations to medical providers.. The risk of the spread of Ebola virus disease (Ebola) in California is low. While the risk is low, state and local public health officials in California are monitoring the situation closely and taking steps to keep Californians safe. Click here for more information on important facts about Ebola based on current science. August 13, 2014 General Ebola Virus, Public Health, Cyclospora 0 0 Comment Read More »
CME certification now available online Users of the CME certification service offered by the California Medical Association's (CMA) Institute for Medical Quality (IMQ) are now able to check the status of CME credits, keep track of their progress and print their transcripts at their convenience from IMQ's online CME certification user portal. Physicians are required to complete 50 CME hours during every two-year licensure period, with reporting deadlines based on the physician's personal license renewal date (the last day of the month of the physician's birthday). IMQ's CME Certification Program documents and verifies physicians' CME activities. When certified by IMQ, physicians' CME credits will automatically be accepted by the California Medical Board, saving you time and hassle. (IMQ also provides documentation of physicians' CME in the event of a medical board audit.) IMQ's CME certification is $30 for CMA members, $55 for nonmembers. Physicians also can request that their CME certification information be sent to hospitals, health plans, specialty societies, and others for credentialing or membership renewal purposes at no additional charge. For more information, visit the IMQ website. Contact: Erin Lovell, (415) 882-3387 or elovell@imq.org. August 13, 2014 General Continuing Medical Education, IMQ, Institute for Medical Quality, CME 0 0 Comment Read More »
Noridian incorrectly denies 300,000 claims for E&M services Last fall, the Centers for Medicare and Medicaid Services (CMS) experienced some editing issues with new patient E&M codes that resulted in incorrect claim denials. These problems started in October 2013, and was thought to have been corrected in late January 2014. The California Medical Association recently learned, however, that some claims continued to be paid incorrectly through July 15, 2014. Noridian, California's Medicare contractor, in January began making mass adjustments and correcting claims subjected to overpayment recovery. Unfortunately, while implementing the corrections, Noridian inadvertently subjected established patient E&M codes to incorrect editing, resulting in incorrect denial of codes 99211-99215. Noridian has corrected the editing for both the new patient codes and the established patient codes, and claims received by Noridian on and after July 16, 2014, should be processing correctly. Noridian is now beginning the process of mass adjustments to the incorrectly denied claims. Due to the number of claims involved (~300,000 claims back to October of 2013), this process could take a month or so to complete. Physicians do not need to do anything to have their claims adjusted and they should NOT resubmit the claims. The claims will be automatically adjusted. For more information, see Noridian's notice on this issue. Contact: Michele Kelly, (213) 226-0338 or mkelly@cmanet.org. August 13, 2014 Medicare Medicare, Noridian, Billing/Coding 0 0 Comment Read More »
CMS temporarily takes Sunshine Act system offline The Centers for Medicare and Medicaid (CMS) announced yesterday that the verification system for financial interactions tracked under the Physician Payments Sunshine Act system has been taken offline temporarily because of physician complaints of inaccuracies. Under the Sunshine Act, drug and medical device manufacturers are required to report their financial interactions with licensed physicians – including consulting fees, travel reimbursements, research grants and other gifts. Any payments, ownership interests and other “transfers of value” will be reported to CMS for publication in an online database. CMS had opened the system for physicians to review and, if necessary, dispute the data reported by drug and device manufacturers on July 14, 2014, and the six week dispute period was supposed to remain open until August 27, 2014. According to CMS, for each day the Open Payments system is offline, CMS will extend the review and dispute deadline and the subsequent 15-day corrections period deadline accordingly. The California Medical Association will keep members up-to-date when the deadline dates are announced. CMS said physicians can still register with the CMS Enterprise Portal (the first step in signing up to review your data), despite the shutdown. They will not, however, be able to register for the Open Payments system (step two) until the system is brought back online. Physicians and authorized representatives can submit questions to the CMS Help Desk at openpayments@cms.hhs.gov. Live Help Desk support is also available by calling (855) 326-8366, Monday through Friday, from 7:30 a.m. to 6:30 p.m. Central time, excluding Federal holidays. More information on the Sunshine Act is available in the American Medical Association's online “Physician Sunshine Act Tool Kit,” which provides a variety of resources to help physicians navigate the Sunshine Act changes, including a free webinar, a list of important dates, answers to frequently asked questions, information about how to challenge incorrect reports and ways to be more transparent with patients about the physician's interactions with the pharmaceutical and medical device industries. August 8, 2014 Medi-Cal, Medicare CMS, Physician Payment Sunshine Act, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
