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Coding Corner: Physician/patient meet-and-greet

CPR’s “Coding Corner” focuses on coding, compliance, and documentation issues relating specifically to physician billing. This month’s tip comes from G. John Verhovshek, the managing editor for AAPC, a training and credentialing association for the business side of health care. Potential patients sometimes ask to meet with a provider prior to needing health care to be sure that the patient/provider relationship will be a good fit. For example, it’s common for expectant parents to “interview” obstetricians and pediatricians. The reality is, time equals money, and physicians’ time is in demand. As ...

Anthem issues new ID number for some patients

Anthem Blue Cross has issued new identification numbers and cards for a number of its members. New ID cards containing the new ID number were mailed to all affected members in late December. Providers are encouraged to make copies of each patient’s insurance card at the time of visit to verify the member’s identification number. Anthem advises that claims submitted with an incorrect ID number will be returned to the provider for correction and resubmission with the correct ID. Providers will need to contact their patients to obtain their updated ...

Call to Action: Act now to ensure patients can get needed prescriptions

Flawed implementation of a new state law that requires all security prescription forms to have a uniquely serialized number law has left pharmacies unable to fill prescriptions and patients being refused necessary medications. The California Medical Association (CMA) is currently working on a legislative fix to address this issue immediately to ensure no patient goes without the essential medicine and care they need. Last week, AB 149 (Assemblymembers Cooper, Arambula and Low) was introduced to correct the flawed implementation the new law, which was intended to improve the security of ...

Bill introduced to fix security prescription law

Flawed implementation of a new state law that requires all security prescription forms to have a uniquely serialized number law has left pharmacies unable to fill prescriptions and patients being refused necessary medications. The California Medical Association (CMA) is currently working on a legislative fix to address this issue immediately to ensure no patient goes without the essential medicine and care they need. This week, AB 149 (Assemblymembers Cooper, Arambula and Low) was introduced to correct the flawed implementation the new law, which was intended to improve the security of ...

DHCS loads 2019 CPT Codes and Pricing by January 1

The California Department of Health Care Services (DHCS) has confirmed that the 2019 CPT/HCPCS updates have been loaded to the Medi-Cal system and were effective January 1, 2019.  Every year, the Centers for Medicare and Medicaid Services (CMS) issues new, updated and terminated CPT and HCPCS codes. However, in past years it has taken DHCS up to 10 months to update its system with the new or updated codes and pricing. This has caused unnecessary delays and denials in payment not only on Medi-Cal fee-for-service claims, but also for many ...

Medi-Cal provider enrollment moving exclusively to PAVE starting March 5

The Medi-Cal Provider Enrollment Division (PED) recently announced that it will no longer accept paper enrollment forms, effective March 5, 2019. Medi-Cal enrollment applications and forms will move entirely to the e-form application process through the California Department of Health Care Services’ (DHCS) Provider Application and Validation for Enrollment (PAVE) portal.  While PAVE was anticipated to eventually replace the paper application process, DHCS moved swiftly to eliminate the paper option for providers after the September PAVE update (3.0). Prior to the announcement, PED did seek feedback from stakeholders including the ...

Golden Shore Medical Group to shut down following Molina contract termination

The California Medical Association (CMA) has learned that Molina Healthcare has terminated its contract with Golden Shore Medical Group. The plan filed requests in late 2018 with the California Department of Managed Health Care (DMHC) to transfer its enrollees to other delegated groups and the request was approved by the Department on January 11, 2019. According to Molina’s block transfer filing with DMHC, the termination was the result of the parties’ inability to agree on contractual terms. As a result of the termination, Golden Shore has announced to its network ...

CMA working to fix security prescription legislation

The California Medical Association (CMA) has heard from dozens of physicians and patients across the state about prescriptions not being filled because the pads the prescriptions were written on were not compliant with a new state law. On January 1, 2019, a new California law took effect that requires all security prescription forms to have a uniquely serialized number. The legislation did not include any transition or grandfathering period to allow for continued use of old controlled substance security prescription forms on or after January 1. Unfortunately, with less than two ...

CMA membership reaches all time high of 44k

The collective voice of physicians just got a little louder. The California Medical Association (CMA) now has over 44,000 members, after a year of record-setting growth. In 2018, CMA’s active, dues paying membership grew by 6.3 percent, with a 92.2 percent retention rate. According to CMA Vice President of Membership and Marketing Mike Steenburgh, membership growth has been driven by the association’s group recruitment strategy, with several medium-sized groups signing membership agreements throughout the state this year.  “We say it all the time –Together we are stronger. When we speak with ...

Federal court halts expanded religious exemption from ACA contraceptive mandate

On January 7, 2019, the California Medical Association (CMA), along with other health care provider organizations, filed an amicus brief in support of the State of California in its challenge to federal rules that would expand a group health plan or health insurer's ability to claim a religious or moral objection to opt out of the Affordable Care Act’s (ACA) contraceptive coverage mandate. On January 13, 2019, one day before the effective date, the federal court granted the state’s motion for a preliminary injunction, blocking the rules from going ...