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Coding Corner: NCCI Policy Manual updates: Part 2

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. Each year, the Centers for Medicare and Medicaid Services (CMS) releases an updated version of the National Correct Coding Initiative (NCCI) Policy Manual. The annual updates reflect changes to the CPT® and HCPCS code sets, as well as new and revised coding guidelines. This month, we’ll discuss the most significant, ...

Noridian to present in-person Medicare seminars in Irvine and Sacramento

Noridian, the Medicare administrative contractor for California, has announced several in-person seminars around the state in September. The all-day presentations will be divided into morning and afternoon sessions, including information on the following: Morning Session: 8:30 a.m. to 12 p.m. What's New Preventive Services Telehealth Incident to Services Top A/B Errors Afternoon Session: 1-4:30 p.m. NCDs/LCDs Review Entities Documentation/Signature Requirements Education Corner The seminars are ...

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 ...