Payors report system changes to comply with AB 72 When California’s new out-of-network billing and payment law (AB 72) took effect on July 1, 2017, the California Medical Association (CMA) began receiving calls from physician offices concerned that Anthem Blue Cross and Blue Shield of California were not correctly paying claims. In both cases the incorrect payments were linked to manual processing of AB 72 claims. CMA worked with Blue Shield to ensure affected claims through October of 2017 were automatically reprocessed. Blue Shield also committed to conducting weekly audits to catch any additional claims that were processed erroneously. ... April 5, 2018 General, Managed Care Anthem Blue Cross, Blue Shield, Economic Advocacy, AB 72, Out of Network Care 0 0 Comment Read More »
New Anthem anesthesia policy can have blinding consequences A policy change made by health insurer Anthem, Inc. could result in increased risk for many patients – up to and including blindness – if not immediately rescinded, according to physicians’ groups. The California Academy of Eye Physicians and Surgeons (CAEPS) and the California Society of Anesthesiologists (CSA) have sent letters to Anthem Inc. requesting that they immediately rescind a new policy that deems Monitored Anesthesia Care (MAC) “not medically necessary” during “routine” cataract surgery – a move seen as endangering patients. These were followed up with complaints to the ... February 5, 2018 General, Managed Care Advocacy, Anesthesiology, Anthem Blue Cross, California Academy of Eye Physicians and Surgeons, California Society of Anesthesiologists, Ophthalmology 0 0 Comment Read More »
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 »
Anthem still not complying with AB 72 interim payment rules, physicians report The California Medical Association (CMA) has continued to receive reports from physician offices that Anthem Blue Cross is not paying the “interim payment” as required under California’s new law (AB 72) limiting out-of-network billing for covered, non-emergent services performed at in-network facilities. CMA has also received reports that Anthem representatives have advised some physicians that its Covered California EPO products are not subject to AB 72, which is incorrect. The new law requires fully insured commercial plans and insurers to make “interim payments” to non-contracted physicians for non-emergent services performed ... December 28, 2017 Managed Care Anthem Blue Cross, AB 72, Economic Advocacy, Out of Network Care 0 0 Comment Read More »
Anthem Blue Cross to implement restrictive outpatient advanced radiology policy Effective December 1, 2017, Anthem Blue Cross will implement a new policy restricting outpatient advanced radiologic imaging procedures in the hospital setting. The updated policy, originally scheduled to become effective October 1 but recently delayed, indicates that advanced radiologic imaging procedures in the hospital outpatient department are only considered medically necessary under the follow circumstances: If services are only available in the hospital setting; or The patient requires obstetrical observation; or The patient is receiving perinatology services; or ... October 19, 2017 General, Managed Care Anthem Blue Cross, Radiology 0 0 Comment Read More »
Anthem Blue Cross offering fall seminars on 2017 operational updates Throughout October, the Anthem Blue Cross Provider Network Education Team will offer live seminars to discuss 2017 operational updates. Topics will include participation in the California health care marketplace, Blue Cross and Blue Shield alpha prefix change, and details on the new website for radiology services. Each seminar runs from 8:30 a.m. to 12 p.m. The first session is slated for October 3 in San Mateo, and the series will conclude on October 26 in Fresno. Practices interested in attending should register on the Anthem website. Click here for the ... September 25, 2017 Managed Care Anthem Blue Cross, Seminars 0 0 Comment Read More »
Physicians report Anthem not complying with AB 72 interim payment rules The California Medical Association (CMA) has received reports from physician offices that Anthem Blue Cross is not paying the “interim payment” as required under the recently effective law (AB 72) limiting out-of-network billing for covered, non-emergent services performed at an in-network facility. The new law requires fully insured commercial plans and insurers to make “interim payments” to non-contracted physicians for non-emergent services performed at in-network health facilities, and places limitations on the ability of physicians in such circumstances to collect their full billed charges. The interim rate defined in AB 72 ... September 25, 2017 General, Managed Care AB 72, Anthem Blue Cross, Out of Network Care 0 0 Comment Read More »
Anthem Blue Cross rescinds termination of Medicare Advantage agreement with Brown and Toland Anthem Blue Cross has reached an agreement to extend its Medicare Advantage contract with Brown & Toland Physicians. Although Anthem Blue Cross previously announced the contract would be terminated effective October 1, 2017, the parties have since signed a contract extension through December 2018. The termination would have affected approximately 1,900 Medicare Advantage enrollees in San Francisco. Click here to see the letter sent from Brown & Toland. Physicians with questions can contact Brown & Toland Physician Services at physicianservices@btmg.com. August 17, 2017 Managed Care, Medicare Anthem Blue Cross, Medicare Advantage, San Francisco Medical Society 0 0 Comment Read More »
Anthem Blue Cross terminates Medicare Advantage agreement with Brown and Toland Effective October 1, 2017, Anthem Blue Cross will terminate its contract with Brown & Toland Physicians for its Medicare Advantage product. The termination will affect approximately 1,900 Medicare Advantage enrollees in San Francisco. Affected patients will be reassigned to Asian American Medical Group, Jade Health Care Medical Group or Imperial Health Holdings Medical Group. The termination was reportedly due to a failure to reach a contractual agreement with Brown & Toland. Physicians with questions can contact Brown & Toland representative Stephanie Mamane at (415) 972-4282 or smamane@btmg.com. August 9, 2017 Managed Care, Medicare Anthem Blue Cross, Medicare Advantage, San Francisco Medical Society 0 0 Comment Read More »
