Next phase of Healthy Families to Medi-Cal transition scheduled for August 1 Phase 3 of the Healthy Families transition from fee-for-service to Medi-Cal managed care is scheduled for August 1, 2013. This phase will impact approximately 107,000 children who have a Healthy Families plan that does not offer Medi-Cal managed care or subcontract with a Medi-Cal managed care plan, thus requiring them to transition to a new plan. This is the first phase of the Healthy Families transition where patients may be required to change physicians. Enrollment will include consideration of the child’s primary care providers. Affected counties are: ... July 9, 2013 Managed Care, Medi-Cal Managed Care, Medi-Cal, Healthy Families 0 0 Comment Read More »
Update your NPI information before the Medicare transition to Noridian According to a new report by the U.S. Department of Health & Human Services Office of the Inspector General, 58 percent of the databases used to determine provider identities and help to prevent the occurrence of fraud are inaccurate or incomplete. The National Plan and Provider Enumeration System (NPPES), which houses National Provider Identifier (NPI) numbers, is not always consistent with information in the Provider Enrollment, Chain and Ownership System (PECOS). The national revalidation effort by the Centers for Medicare & Medicaid Services (CMS) is a big step in improving ... July 9, 2013 Medicare Medicare, NPI, Noridian 0 0 Comment Read More »
AMA's new "administrative burden index" ranks cost of doing business with commercial insurers The American Medical Association (AMA) recently unveiled its new Administrative Burden Index (ABI), which ranks commercial health insurers according to the level of unnecessary cost they contribute to the billing and payment of medical claims. The ABI reflects the overhead cost needed to bill and collect payment from each major payer and was introduced as part of AMA's annual National Health Insurer Report Card. AMA found that administrative tasks associated with avoidable errors, inefficiency and waste in the medical claims process resulted in an average ABI cost per claim of ... July 8, 2013 General Billing and Coding, AMA, Insurance/Reimbursement, Practice Management 0 0 Comment Read More »
Budget deal jump starts special session bills Almost six months have passed since Gov. Jerry Brown opened a special session on health care reform in California, and members of the state Legislature are now beginning to tie up the final loose ends. Of the three sets of bills put forward under the special session’s parameters, all but one appeared to be stalled indefinitely until members of the Legislature reached a budget deal. These bills, which outlined California’s plans to expand the Medi-Cal program and establish a so-called "bridge plan" between Medi-Cal and exchange plans, were sprung from ... July 8, 2013 Medi-Cal Health Insurance Exchange, Affordable Care Act, Health Care Reform, Medi-Cal 0 0 Comment Read More »
Physicians are encouraged to check Covered California's provider database in July As previously reported, there remain some uncertainties around the process of physician contracting with exchange plans. Beginning sometime in July, the exchange should alleviate much of the uncertainty as to who is and is not considered to be an exchange provider. This is because Covered California will be unveiling a centralized online provider database for the first time in July. Using this database, exchange patients will be able to see which providers are included in the respective exchange plans’ networks. This centralized database will also be utilized by the exchange’s eligibility ... July 8, 2013 Managed Care Health Care Reform, Health Insurance Exchange, Affordable Care Act, Covered California 0 0 Comment Read More »
Highlights from AMA's 2013 House of Delegates The California delegation to the American Medical Association’s (AMA) House of Delegates presented a number of important resolutions at the AMA annual meeting in Chicago. The following are summaries of some of the California resolutions that the AMA House of Delegates adopted as policy. 1. Health Risks of Sitting (Res. 413): The delegates adopted a resolution that asks AMA to recognize that there are potential risks of prolonged sitting and encourage efforts by employers, employees and others to make available alternatives such as standing work stations and isometric balls, and ... June 27, 2013 General AMA, American Medical Association, House of Delegates 0 0 Comment Read More »
Scope of practice bills to be heard on July 2, urge your legislator to OPPOSE these bills The California Medical Association (CMA) is urging physicians to contact legislators and ask for NO votes on SB 491, SB 492 and SB 493. These three bills will expand scope of practice of nonphysician practitioners and remove necessary physician supervision, ultimate harming patients and decreasing quality of care. These bills may be heard in the Assembly Business, Professions and Consumer Protection Committee as early as July 2. Senate Bill 491 (Hernandez) would allow nurse practitioners to open practices without any oversight from a trained medical doctor and prescribe dangerous, addictive ... June 27, 2013 General Advocacy, Scope of Practice 0 0 Comment Read More »
CMS conducts meaningful use audits in California The Centers for Medicare & Medicaid Services (CMS) has begun auditing California physicians who received payments through the federal electronic health record (EHR) incentive programs. Physicians selected for the audit have received letters from CMS contractor Figliozzi and Co., with requests for documentation to support their stage 1 meaningful use attestation. Figliozzi is an accounting firm that specializes in auditing health care facilities for Medicare cost compliance. Under the 2009 federal economic stimulus package, health care providers can qualify for Medicaid and Medicare incentive payments by demonstrating meaningful use of ... June 27, 2013 EHR EHR, Incentive Payments, Meaningful Use, CalHIPSO, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
CMA amicus brief argues exorbitant 'nominal' damage puts patient care at risk In June, the California Medical Association (CMA) filed an amicus curiae letter with the Court of Appeals in the case Regents of the University of California v. The Superior Court of Los Angeles County (Platter). This case arises from the theft of a computer hard drive containing private, confidential information on approximately 16,000 patients. The plaintiffs filed a class action lawsuit alleging that the UC Regents failed to have proper safeguards in place to prevent the theft in violation of the Confidentiality of Medical Information Act (CMIA). The plaintiffs seek $1,000 ... June 27, 2013 General Legal Advocacy, Amicus Briefs 0 0 Comment Read More »
Medical board decides it does have authority to discipline utilization review physicians The Medical Board of California recently considered the issue of whether workers' compensation utilization review can be considered the "practice of medicine" and, if so, does the medical board have the authority to discipline physicians who do not practice within the standard of care when performing utilization review on behalf of payors and other entities? After testimony by the California Medical Association (CMA) and the California Society of Physical Medicine and Rehabilitation (CSPMR), the board agreed that physicians conducting worker's compensation utilization review were indeed engaged in the practice of ... June 27, 2013 General Medical Board of California, Professional Liability, Workers Comp, Disciplinary Actions 0 0 Comment Read More »
