Don't miss out on increased Medi-Cal payments - deadline to attest is December 31 The Department of Health Care Services (DHCS) reports that eligible physicians who have already attested have received over $283 million for services provided to fee-for-service Medi-Cal enrollees under the Affordable Care Act (ACA) primary care rate increase. Don't miss out! Remember, to qualify for enhanced payments for fee-for-service Medi-Cal and Medi-Cal managed care plans, you must first self-attest to your eligibility. The deadline to attest, if you haven't already done so, is December 31, 2014. Practices that have attested but have not yet received any additional funds are encouraged to ... November 6, 2014 Managed Care, Medi-Cal Attestation, DHCS, Medi-Cal, Department of Health Care Services 0 0 Comment Read More »
Are you interested in joining Anthem's Medi-Cal managed care network? In an effort to expand its Medi-Cal managed care provider network across the state, Anthem Blue Cross is reaching out to California Medical Association (CMA) member physicians who are interested in joining the insurer's network. "Anthem welcomes CMA member physicians into its growing network during this time of exciting and unprecedented Medi-Cal member growth," says Steve Melody, president of Anthem's Medicaid Health Plan for California. Physicians who would like to learn more about this opportunity are asked to provide CMA with some basic information by filling out this brief form. Anthem ... November 5, 2014 Medi-Cal Medi-Cal, Provider Networks, Anthem Blue Cross 0 0 Comment Read More »
CMA publishes duals project FAQ The 2012 California state budget authorized a three-year demonstration project that transitions dual eligibles into managed care and allows them to receive medical, behavioral, long-term supports and services and home-and-community-based services coordinated through a single health plan. The Cal MediConnect project was approved in 8 counties: Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara. No more than 456,000 individuals will be allowed to enroll into Cal MediConnect. Los Angeles’ enrollment will be capped at 200,000. To help physicians and their patients better understand the program, ... October 21, 2014 Medi-Cal, Medicare Dual Eligible, Medi-Cal, Medicare, Cal MediConnect 0 0 Comment Read More »
CMS reopening meaningful use hardship exception deadline The Centers for Medicare and Medicaid Services (CMS) announced that it is reopening the submission period for meaningful use hardship exception applications so that physicians can avoid the 2015 payment penalty. The new deadline will be November 30, 2014. As part of the American Recovery and Reinvestment Act of 2009, Congress mandated payment adjustments under Medicare for eligible professionals that are not meaningful users of Certified Electronic Health Record Technology (CEHRT). The Act allows the Secretary to consider, on a case-by-case basis, hardship exceptions for eligible professionals to avoid the ... October 10, 2014 Medi-Cal, Medicare EHR, Electronic Health Record, Medicare, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
DHCS releases duals project toolkit The California Department of Health Care Services (DHCS) has published a physician toolkit to help providers and their patients understand the Cal MediConnect duals demonstration project. The toolkit has been developed in conjunction with Harbage Consulting and various stakeholder groups, including the California Medical Association. The toolkit contains several documents, including an overview and several fact sheets that include information on the following: How to submit crossover claims to Medi-Cal plans Contracting with Cal MediConnect plans How crossover claims ... October 6, 2014 Medi-Cal, Medicare Dual Eligible, Medi-Cal, Medicare, Cal MediConnect 0 0 Comment Read More »
PQRS GPRO registration extended until October 3 The Centers for Medicare and Medicaid services has extended the Physician Quality Reporting System Group Purchasing Reporting Option (GPRO) registration deadline until October 3, 2014, 11:59 PM EDT because of a glitch in the registration system. The deadline was originally supposed to be today, September 30, 2014. The PQRS registration system can be accessed a https://portal.cms.gov/. Group practices can register to participate in the PQRS Group Practice Reporting Option in 2014 via Qualified PQRS Registry, EHR or web interface (for groups with 25 or more eligible professionals only). In order to ... October 1, 2014 Medi-Cal, Medicare PQRS, Quality Reporting, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
DHCS announces additional delays for some ACA Medi-Cal primary care rate increases The California Department of Health Care Services (DHCS) has released additional information about the timing of the outstanding Affordable Care Act (ACA) Medi-Cal primary care rate increase for certain claim types. Specifically, DHCS had previously announced delays in payment of three types of claims, including certain NICU/PICU services, Child Health and Disability Prevention Program (CHDP) services and crossover claims (also referred to as Medi/Medi claims). Retroactive NICU/PICU claims – At the request of CMA and other stakeholders DHCS will allow claims data to be submitted via ... September 19, 2014 Medi-Cal Child Health and Disability Prevention Program, DHCS, Medi-Cal, CHDP 0 0 Comment Read More »
DHCS announces new continuity of care rules for duals demonstration project The California Department of Health Care Services (DHCS) recently announced new continuity of care rules for the Cal MediConnect duals demonstration project. The project – an effort to save money and better coordinate care for the state’s low-income seniors and persons with disabilities – transitions a large portion of the state's dual eligible beneficiaries to managed care plans. Although the program already had continuity of care provisions, the new rules make it easier for a patient to continue receiving needed care from out-of-network physicians without interruption. The new continuity of care ... September 19, 2014 Medi-Cal, Medicare DHCS, Medi-Cal, Medicare, Cal MedConnect, Dual Eligible 0 0 Comment Read More »
Medi-Cal audits began in September The California Department of Health Care Services (DHCS) has begun post-payment claims review of Medi-Cal claims in California. The purpose of this audit is to identify and correct improper Medicaid payments through the collection of overpayments and reimbursement of underpayments made on claims for health care services provided to Medicaid beneficiaries. The program will enable the Centers for Medicare and Medicaid Services (CMS) to implement actions that will prevent future improper payments in all 50 states. DHCS has contracted with Health Management Systems, Inc. (HMS) to act as the Recovery ... September 18, 2014 Medi-Cal Department of Health Care Services, DHCS, Medi-Cal, Audits 0 0 Comment Read More »
DHCS releases Medi-Cal concept paper that proposes risk-based health home models and malpractice subsidies The California Department of Health Care Services (DHCS) has released a proposal in the form of a concept paper for the state’s next 1115 Section Medicaid Waiver for public for comment. California is currently in the fourth year of its current Section 1115 waiver that was approved by the federal government so California could expand Medi-Cal coverage in accordance with the Affordable Care Act in 2010 and implement a variety of delivery reform projects like the duals demonstration project. The concept paper outlines new ideas to modify provider payments and save ... September 4, 2014 Medi-Cal DHCS, Medi-Cal, Affordable Care Act 0 0 Comment Read More »
