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Hospital at center of "existential threat" to medical staff self-governance files for bankruptcy

The Tulare hospital embroiled in a bitter legal battle over the self-governance rights of its medical staff has filed for Chapter 9 bankruptcy. The filing came just two days before closing arguments were scheduled in the case, Tulare Regional Medical Center Medical Staff v. Tulare Regional Medical Center, et al. Although the hospital is in bankruptcy, the California Medical Association (CMA) will continue to seek a legal remedy in this matter. If the medical staff is unable to resolve the case out of court, the trial court could resume the ...

CMA publishes AB 72 payment monitoring workbook

The California Medical Association has published a workbook to help practices identify if payments they receive comply with AB 72's interim payment rules. AB 72—California’s new out-of-network billing and payment law—requires fully insured commercial plans and insurers to make “interim payments” to non-contracted physicians for covered, 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 is the greater of the average contracted rate (including only commercial contracts) or 125 ...

Help save lives: Co-prescribe naloxone to patients at risk of opioid overdose

For more than 40 years, the life-saving opioid overdose antidote naloxone has been used to reverse the effects of opioid overdose. Timely administration of naloxone has saved tens of thousands of lives. The American Medical Association Opioid Task Force, of which the California Medical Association (CMA) is a member, recently issued updated guidance encouraging physicians to consider co-prescribing naloxone when clinically appropriate for patients who are at risk for opioid overdose or might be in a position to help someone else at risk. The updated guidance includes several important questions that ...

Saturday, Oct. 28, is National Prescription Drug Take Back Day

Saturday, October 28, 2017, is National Prescription Drug Take Back Day. On this day, hundreds of locations throughout California will be accepting and properly disposing of unused prescription drugs, including controlled substances. Proper disposal of unused prescription drugs helps prevent diversion and misuse associated with these medications. This one-day event will provide patients with free, anonymous collection of unwanted and expired medicines. The last National Take Back event collected 450 tons of unwanted prescription drugs at almost 9,700 collection sites nationwide. In addition to providing a safe, convenient and responsible means ...

California physicians oppose elimination of ACA cost-sharing subsidies

President Donald Trump announced yesterday that his administration will cease making critical cost-sharing reduction (CSR) payments to health insurers that help low-income Americans afford health care. This announcement also followed yesterday’s executive order seeking to loosen the Affordable Care Act’s (ACA) health insurance regulations. “Rather than taking action to make health care more affordable and accessible, the President’s actions threaten to destabilize the insurance market, increase health care costs and reduce patient access to care,” said California Medical Association (CMA) President Ruth Haskins, M.D. “We urge our leaders in Washington ...

FSMB releases free online education modules for medical students and residents

The Federation of State Medical Boards (FSMB) has released a free online education module for medical students and residents who are interested in learning about the medical licensing process. The new module, "Understanding and Navigating the Medical Licensing Process," is designed to help medical students and residents familiarize themselves with the licensing process before they apply with their state medical board. This is the second module in a series of online educational offerings developed by the FSMB Workgroup on Education for Medical Regulation. The workgroup is currently working on future ...

Free webinar Nov. 2: POLST eRegistry pilot project

The Coalition for Compassionate Care of California (CCCC) is hosting a webinar for health care providers and medical professionals, “POLST eRegistry Pilot Project: 2017 Overview and Update." The free webinar takes place on Thursday, November 2, 2017, from 12-1:30 p.m. This webinar will provide an overview of the California POLST (Physician Orders for Life-Sustaining Treatment) eRegistry pilot project. This project, funded by the California Health Care Foundation, is designed to test implementation, use and sustainability of an electronic POLST registry in two California communities, with electronic POLST forms securely submitted ...

New claim format for Child Health and Disability Prevention Program providers

Historically, fee-for-service Child Health and Disability Prevention (CHDP) program health assessments and immunizations were billed by providers using the proprietary PM 160 claim form or its electronic equivalent.  However, because this claim form applied local codes for the purpose of billing, it did not conform to federal HIPAA laws. In order to comply with HIPAA requirements, the California Department of Health Care Services (DHCS) stopped accepting PM 160 claim forms on July 1, 2017, except for claims with dates of service prior to July 1, 2017. Fee-for-service CHDP claims are ...

CMS unveils new Medicare Beneficiary Identification cards

The Centers for Medicare and Medicaid Services (CMS) recently unveiled the newly designed Medicare card, which will contain the unique, randomly assigned Medicare Beneficiary Identification (MBI) number replacing the current Social Security-based number.  CMS will begin mailing the new cards to people with Medicare benefits in April 2018, with the deadline for replacing all existing Medicare cards by April 2019 as required under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). CMS will allow a 21-month transition period beginning no sooner than April 2018, where health care providers ...

UnitedHealthcare delays consultation services payment policy change

UnitedHealthcare (UHC) announced in its October 2017 Network Bulletin that it will indefinitely delay changes to its consultation services payment policy, which would have discontinued reimbursement for CPT codes 99241-99245 and 99251-99255.  Citing alignment with a policy implemented by the Centers for Medicare and Medicaid Services, and in response to misuse of consultation service codes, UHC had previously announced that it would no longer reimburse consultation services for commercial product lines effective October 1, 2017. In lieu of a consultation service code, physicians would have been required to bill utilizing ...