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United Healthcare releases latest Premium Designation physician results

United Healthcare (UHC) recently released its latest Premium Designation assessment results to California physicians on July 20. The Premium Program Version 11 results, based on claims data from January 1, 2015, through February 28, 2018, will be released publicly via the payor's online physician directory beginning September 2018. Physicians within 16 specialty categories, encompassing 47 subspecialties including pediatric internal medicine (new for 2018), will again be ranked by UHC on both national and specialty-specific measures for quality and various cost-efficiency benchmarks. Physicians meeting or exceeding these benchmarks will receive a ...

New Medicare ID card mailing completed in California

The Centers for Medicare and Medicaid Services (CMS) recently completed mailing new Medicare ID cards to California beneficiaries. 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 has prepared a “Still Waiting for Your New Card?” handout (in English or Spanish) to provide to patients who did not receive a new Medicare ID card. Patients may be directed to the MyMedicare.gov website or to ...

United Healthcare Smart Edits go live August 16

UnitedHealthcare (UHC) will implement its Smart Edits program for professional claims for all of its commercial, Medicare Advantage and Community Plans effective August 16, 2018. UHC notified physicians in its 2018 United Healthcare network bulletin that it would implement Smart Edits, a new functionality introduced into the electronic data interchange (EDI) workflow allowing the payor to autodetect claims with potential errors in the claims pre-adjudication phase. Once a potential error has been identified, UHC will notify the physician (via the 277CA report) within 24 hours, returning the claim to ...

Best practices: Review your monthly capitation reports

Participation in capitated reimbursement contracts (financial arrangements where physicians are paid a fixed amount for each patient assigned to them) can offer physicians a routine and sustained source of monthly income for their practice. Capitation, however, can be a complicated process. It is essential that physicians monitor their monthly capitation reports to ensure they are being paid per the terms of their agreements. Under many capitation arrangements, physicians are typically paid a fixed amount per member/per month for each patient assigned to them, regardless of whether the patient receives care ...

Choice Medical Group looking for a Primary Care Physician

Choice Medical Group is a group of primary care and specialty physicians dedicated to serving the High Desert area, serving our members for over 25 years in Apple Valley, Adelanto, Barstow, Big Bear, Hesperia and Victorville, California. We are looking for a Primary Care Physician to join our team to deliver superior care to the High Desert Community. Competitive Salary Comprehensive Benefit Package Malpractice Insurance Coverage Excellent Retirement Plans This is just a quick overview but hopefully we ...

CMA joins California Department of Insurance in opposing CVS/Aetna Merger

Today, the California Medical Association (CMA) applauded the finding of the California Department of Insurance that the proposed merger between CVS Health and Aetna, Inc. would significantly reduce competition in California’s health insurance market and calls on the U.S. Department of Justice to block the merger from proceeding. In a letter submitted to the U.S. Attorney General and Assistant Attorney General for the Antitrust Division, Insurance Commissioner Dave Jones concluded that the proposed merger would create anti-competitive conditions in the Medicare Part D market, the Pharmacy Benefit Manager services market ...

Medical Board of California iOS app now available for iPhone and iPad

Access to information on your doctor at your fingertips, 24/7. Developed by the Medical Board of California as part of its ongoing commitment to protecting California's health care consumers. Making informed health care decisions has never been easier. Receive notifications when a doctor's name, address, practice status, license expiration, or survey data changes, and when administrative actions and enforcement documents are added to a doctor's profile. The information includes notification when a doctor's license is suspended, revoked, or placed on probation.  News Release July 26, 2018

Blue Shield CEO addresses California physicians on digital health efforts

Paul Markovich, president and CEO of Blue Shield California, on Friday addressed the California Medical Association’s (CMA) Board of Trustees, to discuss the payor’s initiatives to develop new health care technologies including sharable digital patient records and electronic claims among other initiatives. Markovich told the CMA trustees that Blue Shield was seeking to reduce administrative costs significantly over the next three years to help support investment in numerous digital efforts. Blue Shield and CMA announced in June a new, multi-year collaboration to develop and support a new health care model that ...

Proposed policy, payment, and quality provisions changes to the Medicare Physician Fee Schedule

On July 12, 2018, the Centers for Medicare & Medicaid Services (CMS) released the 2019 Medicare Physician Fee Schedule and Quality Payment Program proposed rule with comment period.  This is the first year the two rules have been combined.  CMS also issued QPP and PFS fact sheets on the proposed rule.  CMS is accepting comments on the proposed rule through September 10, 2018. The final rule is expected to be released in early November.    American Medical Association staff is continuing to conduct a detailed review of the proposed rule and ...

Health Net Federal Services experiences significant challenges with TRICARE transition

On January 1, 2018, Health Net Federal Services (HNFS) became the new Defense Heath Agency (DHA) managed care contractor for the TRICARE West Region, serving approximately 2.9 million beneficiaries in 21 western states, including California. HNFS took over the contract previously held by UnitedHealthcare Military and Veterans’ Services (UMVS). The California Medical Association (CMA) has learned that HNFS has experienced implementation issues related to provider contracting and credentialing, beneficiary reassignment to new primary care managers (PCM), and provider directory inaccuracies. The contracting and credentialing issues in California are reportedly related ...