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CMA physicians travel to D.C. to advocate on critical health care issues

A California Medical Association (CMA) contingent of two dozen physician and medical student leaders recently traveled to Washington, D.C., to participate in the American Medical Association’s (AMA) National Advocacy Week. They met with 24 members of the California Congressional Delegation and top leadership of the Centers for Medicare and Medicaid Services (CMS) to advocate for many health care issues critically important to California physicians.  While in Washington, California physicians focused on promoting the bipartisan Affordable Care Act (ACA) market stabilization bill that would reinstate the cost-sharing reduction payments and ...

$1.3 trillion federal appropriations bill loaded with new health care spending

Last Friday, President Trump signed a massive $1.3 trillion federal spending bill—the Omnibus Consolidated Appropriations Act of 2018. It is loaded with new spending for health care programs that were supported by the California Medical Association (CMA). Unfortunately, it did not include two bills that CMA was strongly promoting – the Affordable Care Act (ACA) market stabilization bill and a permanent solution for the nearly 700,000 Deferred Action for Childhood Arrivals program recipients. A brief summary of the federal spending bill is below.  Bipartisan ACA Market Stabilization: CMA, the American Medical ...

Medical board looking for expert reviewers

The Medical Board of California is looking for physicians interested in becoming expert reviewers. Experts assist the board by providing reviews and opinions in medical board investigations, conducting professional competency examinations, and performing medical and psychiatric evaluations. The medical board is currently looking for experts in the following specialties: addiction medicine with added certification in family medicine or internal medicine or psychiatry; colon/rectal surgery; dermatology; family medicine; gastroenterology; neurological surgery; neurology; OB/GYN; pathology (anatomic/clinical); forensic pathology; pain medicine; pediatric gastroenterology; pediatric surgery; pediatric cardiac surgery; pediatric pulmonology; plastic surgery (hair ...

Health Net announces significant policy changes to Medicare Advantage and Medi-Cal managed care product lines

Health Net recently announced several new payment policies for its Medicare and Medi-Cal lines of business, effective May 16, 2018. The California Medical Association (CMA) is very concerned with the adverse impact these policies would have on physician practices. The new policies would: Reduce reimbursement of evaluation and management (E&M) services when billed with modifier 25 under the following circumstances: When a minor surgical procedure code is reported on the same day as an E/M code by the same physician, payment for the E/M ...

Patient outcomes shortchanged by prior authorization

More than nine in 10 physicians (92 percent) say that prior authorizations programs have a negative impact on patient clinical outcomes, according to a new physician survey by the American Medical Association (AMA). The survey results further bolster a growing recognition across the entire health sector that prior authorization programs must be reformed. According to the AMA survey, which examined the experiences of 1,000 patient care physicians, nearly two-thirds (64 percent) report waiting at least one business day for prior authorization decisions from insurers—and nearly a third (30 percent) said ...

Tip: Get ready for the new Medicare beneficiary cards and ID numbers

The Centers for Medicare and Medicaid Services (CMS) will begin mailing new identification cards to California Medicare beneficiaries between April and June 2018, as required under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The new cards will contain a unique, randomly assigned Medicare Beneficiary Identification (MBI) number replacing the current Social Security-based number.   CMS will allow a 21-month transition period beginning April 2018, where health care providers will be able to use either the patient’s current Medicare number or the patient’s new Medicare number. CMS has developed ...

CMA advocacy results in DHCS revaluing two CPT codes

The California Medical Association (CMA) received a call from a physician member with concerns that the California Department of Health Care Services (DHCS) had priced a CPT code for destruction of up to 14 benign skin lesions (CPT 17110) at a higher level than it priced a more complex procedure for the destruction of 15 or more lesions (CPT 17111). CMA escalated the issue to DHCS so it could investigate. Upon further inspection and months of discussions, DHCS announced in October that it was increasing reimbursement on both codes, resulting ...

Physicians encouraged to warn patients of new Medicare scam

Seniors in California are being targeted by a new Medicare card phone scam. Medicare beneficiaries are getting calls from scammers telling them their new Medicare card will arrive between April and June 2018, which is true.   However, they go on to state beneficiaries must first buy a temporary card for $5.00 to $50.00 and provide personal information before they receive their new Medicare card. THIS IS NOT TRUE. It is true that Medicare is issuing a newly designed Medicare card, which will contain the unique, randomly assigned Medicare Beneficiary Identification (MBI) ...

Slate of SBCMS Leadership 2018-2019

The Nominating Committee held a conference call on January 22, 2018 at 6:00 p.m. Members in attendance were Michael Sequeira, MD (Chair); Eric Hansen, DO; Mark Bai, MD; Christopher Tsai, MD; Marti Baum, MD; SBCMS Staff Alison Elsner, Linda Sue Myers, Jenise Solorio, and Soteria Cobb.  The final vote to approve this slate will take place at the SBCMS board of directors' meeting on March 26, 2018. Click here for the slate of nominees. OFFICERS: Damodara Rajasekhar, M.D. as President – Pediatrician, Apple Valley Mark Bai, M.D. as President-Elect:- Family Medicine, So. Cal Permanente Christopher ...

10 Things to Do and Know About MIPS Reporting Deadlines

Deadlines are fast approaching if you plan to submit data for the 2017 Merit-based Incentive Payment System (MIPS) performance period. Don’t wait until the last minute to submit your data.  Submit early and often. The two key dates are: March 16 at 8 pm Eastern time for group reporting via the CMS web interface March 31 for all other MIPS reporting, including via qpp.cms.gov Now is the time to act. Here are the top 10 things you need to do and know ...