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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 ...

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's online health law library is free to members

The California Medical Association (CMA) online health law library contains nearly 5,000 pages of up-to-date legal information on a variety of subjects of everyday importance to practicing physicians. One of CMA's most valuable member benefits, the searchable online library contains all the information available in the California Physician's Legal Handbook (CPLH), an annual publication from CMA's Center for Legal Affairs. CMA members can access the library documents free at cmadocs.org/health-law-library. Nonmembers can purchase documents for $2 per page. CPLH, the complete health law library, is also available for purchase in a ...

CMS completes issuance of new Medicare ID cards

The Centers for Medicare and Medicaid Services (CMS) has now completed the process of mailing new Medicare cards to beneficiaries across all states and territories. The new Medicare ID cards, required under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), contain a unique, randomly assigned Medicare Beneficiary Identification (MBI) number, which replaces the previous Social Security-based number. CMS also reports that for the week ending January 11, 2019, fee-for-service health care providers submitted 58 percent of claims with the new MBIs.  CMS is allowing a 21-month transition period (which ...

UnitedHealthcare delays outpatient advanced radiology policy until February 1

Citing the need for additional time for communication and optimal rollout, UnitedHealthcare (UHC) has delayed implementation of its outpatient advanced radiology policy until February 1, 2019.  The new UHC policy—originally scheduled for implementation on Jan. 1—requires prior authorization for advanced imaging procedures, including certain magnetic resonance imaging, magnetic resonance angiography and computed tomography imaging procedures, when performed in the outpatient hospital setting.  Under UHC’s Outpatient Radiology Notification/Prior Authorization Protocol, a site of care review will be required for these advanced imaging services when performed in the outpatient hospital. Site of care ...

CMA and AMA urge exemptions from Open Payments reporting

The American Medical Association, the California Medical Association (CMA) and more than 80 other health care organizations recently submitted a joint letter in response to a request from the Centers for Medicare and Medicaid Services (CMS) for feedback on the Open Payments Program reporting requirements. Under the Open Payments program, 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. The joint letter urges CMS to exempt journal reprints and medical textbooks from “Open Payments” ...

CMA recoups $29 million on behalf of physician members

California physicians have a powerful ally when it comes to dealing with problematic payors—the California Medical Association (CMA) Center for Economic Services (CES). Staffed by practice management experts with a combined experience of more than 125 years in medical practice operations, the CES team has recovered $29 million from payors on behalf of its physician members over the past 10 years. In 2018, CES had a record year, recovering nearly $11 million from payors on behalf of physician members, up from $3 million in 2017. This is money that would ...