New version of POLST form effective October 1 Physicians across California are successfully using Physician Orders for Life-Sustaining Treatment (POLST) to improve patient care at the end of life. Effective October 1, 2014, a new version of POLST makes this tool even more effective. POLST is a physician order, signed by both doctor and patient, that specifies the types of medical treatment a patient wishes to receive toward the end of life. POLST is a tool that encourages conversation between physicians and patients about medically appropriate end-of-life treatment options. It also helps patients make more informed decisions and ... September 18, 2014 General POLST, Physician Orders for Life Sustaining Treatment 0 0 Comment Read More »
DEA announces new rules to expand opportunities for consumers to return unused controlled substances to pharmacies The U.S. Drug Enforcement Administration (DEA) announced Monday that it would allow consumers to return unused controlled substances to approved facilities, including hospitals with onsite pharmacies and retail pharmacies. Under the new rules, consumers and their families will also be allowed to mail unused prescription drugs to authorized collection agencies using packages that are expected to be available at pharmacies, libraries and senior centers. These new regulations will go into effect October 9. Up to now, controlled substances could not legally be returned to pharmacies. Instead, the Controlled Substances Act ... September 11, 2014 General Public Health, Prescription Drugs 0 0 Comment Read More »
DHCS revises Cal MediConnect 'Choice Forms' After advocacy from the California Medical Association (CMA) in conjunction with patient advocacy groups, the California Department of Health Care Services (DHCS) has revised its “Choice Forms” that allow dual eligibles to opt-out of the Cal MediConnect duals demonstration project and remain in traditional Medicare fee for service. The project was authorized by the state in July 2012 in an effort to save money and better coordinate care for the state’s low-income seniors and persons with disabilities. The program begins with a three-year demonstration project that transitions a large portion ... September 11, 2014 Medicare Department of Health Care Services, DHCS, Dual Eligible, Medicare, Cal MediConnect 0 0 Comment Read More »
System error causing some Anthem Blue Cross claims to be underpaid The California Medical Association (CMA) has received physician complaints that Anthem Blue Cross is applying a sequestration cut to their payments, causing some claims to be underpaid. The issue appears to affect claims in which Medicare is the patient’s primary plan and Anthem Blue Cross CalPERS is the supplemental plan. After Medicare processes the claim and forwards on, Anthem’s system appears to be applying a 2 percent sequestration cut to the amount they would normally pay as a supplemental plan in error. While the individual amounts are small, they can ... September 9, 2014 Managed Care Insurance/Reimbursement, Anthem Blue Cross 0 0 Comment Read More »
New CMS rule changes meaningful use timeline The Centers for Medicare and Medicaid Services (CMS) published a new final rule on September 4, 2014, that would provide eligible professionals participating in the Medicare and Medi-Cal electronic health record (EHR) incentive program an additional year to upgrade their certified electronic health record technology (CEHRT). The rule also revises the meaningful use timeline. Under the new rule, eligible professionals can use 2011 Edition CEHRT or a combination of 2011 and 2014 Edition CEHRT for the 2014 EHR reporting period to demonstrate meaningful use. Eligible professionals who were scheduled to ... September 5, 2014 General Certified EHRs, Electronic Health Record, Meaningful Use, CMS 0 0 Comment Read More »
September 10 is last day to dispute Sunshine Act data Wednesday, September 10 is the last day that physicians can review and if necessary dispute their financial interactions as reported under the Physician Payments Sunshine Act. The Sunshine Act is a provision of the Patient Protection and Affordable Care Act that requires drug and medical device manufacturers and group purchasing organizations (GPOs) to report their financial interactions with licensed physicians – including consulting fees, travel reimbursements, research grants and other gifts. Any payments, ownership interests and other “transfers of value” will be reported to CMS for publication in an online ... September 5, 2014 General Physician Payment Sunshine Act, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
'Patient choice' bill goes down to defeat in the Assembly The California Medical Association (CMA) has defeated a bill that would have imposed unfair contracting conditions on physicians and exacerbated the state's current network adequacy concerns. The bill (AB 2533) would have required health insurers to arrange for, or assist in arranging for, out-of-network care for enrollees who are unable to obtain medically necessary care or services from a network provider, at no additional cost to the patient. Unfortunately, vague language in the bill could have been interpreted to require out-of-network providers to accept the contract reimbursement rates of ... September 5, 2014 General Advocacy, Payor Contracting, Network Adequacy 0 0 Comment Read More »
Encourage your patients to participate in 'National Prescription Drug Take Back Day' Sept. 27 Abuse of prescription drugs, including pain relievers, continues to be a significant problem in United States. In California, 4.7 percent of persons aged 12 or older nationwide reported having used pain relievers nonmedically in the past year according to the Substance Abuse and Mental Health Services Administration (SAMHSA) National Survey on Drug Use and Health. SAMHSA data also reveals that 69 percent of people abusing prescription pain relievers got them through friends or relatives, a statistic that includes raiding the family medicine cabinet. Proper disposal of unused prescription drugs helps ... September 5, 2014 General Public Health, Prescription Drugs 0 0 Comment Read More »
Legislature passes bill that would require annual reports from insurers on provider network adequacy The legislature has passed a bill that would require Medi-Cal managed plans and insurers offering individual plans through Covered California to provide annual reports to the California Department of Managed Health Care (DMHC) about the adequacy of their provider networks. The bill also requires DMHC to post annual reviews regarding plan compliance on its website. This California Medical Association (CMA) supported the bill, SB 964 (Hernandez), which passed late last week and is now on the governor's desk awaiting his signature. With roughly 1.4 million Californians newly enrolled in ... September 4, 2014 Managed Care Network Adequacy, Advocacy, Covered CA, Health Insurance Exchange 0 0 Comment Read More »
United to make some changes to Premium Designation program, but serious concerns remain United Healthcare (UHC) has agreed, at the urging of the California Medical Association (CMA), to make some changes to its Premium Designation program. However, UHC refused to address many critical problems that CMA had identified, and CMA still believes the program continues to have serious shortcomings. CMA continues to urge UHC to make additional, more meaningful changes with its physician rating and tiering program. "In its current form, the program will not only confuse patients but will also fail to provide them with meaningful information that could actually assist them ... September 4, 2014 Managed Care Managed Care, Insurance/Reimbursement, United Healthcare 0 0 Comment Read More »
