Survey: ER visits continue to climb under Affordable Care Act A recent survey conducted by the American College of Emergency Physicians (ACEP) shows that emergency room (ER) visits are continuing to climb since the implementation of the Affordable Care Act (ACA), despite predictions that the law would result in less crowding. According to a news release, about three-quarters of the 2,098 ER physicians surveyed said that visits have risen since January 2014 — a significant increase from a year earlier, when less than half said they saw an upturn. More than one-quarter reported “significant increases in all emergency patients” since ... May 15, 2015 General, Managed Care Affordable Care Act, Emergency Rooms, Health Care Reform, ACA 0 0 Comment Read More »
CMA Capitol Insight: Jan. 5, 2015 CMA Capitol Insight is a biweekly column by veteran journalist Anthony York, reporting on the inner workings of the state Legislature .-------------------------------------------------------------------------------- Hot Button Health Care As lawmakers return to Sacramento this week, much is still to be decided about the future of health care reform. State legislators will deal with a number of hot-button issues in the first half of 2015, many of which will have dramatic impacts on California’s health care policy and potentially the future success of the Affordable Care Act. It all begins on Monday when Gov. Jerry Brown ... January 6, 2015 General CMA Capitol Insight, Health Care Reform, Advocacy, Anthony York 0 0 Comment Read More »
Anthem Blue Cross begins medical chart reviews for exchange patients In July, Anthem Blue Cross began chart reviews on enrollees who purchased an individual exchange or mirror product. Similar to the Medicare Risk Adjustment Audit process, and as required by the Affordable Care Act (ACA), the audit is designed to identify the health status and demographic characteristics of exchange/mirror product enrollees. Blue Cross will review diagnosis code data obtained from the medical records of exchange patients. This is not a typical audit on the physician practice; rather, Blue Cross is looking to identify conditions/illnesses that demonstrate patients who are at ... August 7, 2014 Managed Care Anthem Blue Cross, Covered California, Health Insurance Exchange, Health Care Reform 0 0 Comment Read More »
CMS proposes to end Sunshine Act CME exclusion The Centers for Medicare & Medicaid Services (CMS) has decided to eliminate the continuing medical education (CME) exclusion for the Physician Payments Sunshine Act. The news was included in the 2015 Medicare Physician Fee Schedule proposed rule. The Sunshine Act stems from a provision of the Patient Protection and Affordable Care Act. Under the Sunshine Act, drug and medical device manufacturers are required 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 ... July 15, 2014 General Health Care Reform, Physician Payment Sunshine Act, Affordable Care Act 0 0 Comment Read More »
CMA releases fact sheets regarding Covered California grace period, updates toolkit Recognizing the Affordable Care Act’s “grace period” provision to be one of the most confounding provisions of the law, the California Medical Association (CMA) has published an FAQ sheet dedicated entirely to helping physicians make sense of the issue. The fact sheet, “Covered California: Understanding the Grace Period for Subsidized Exchange Enrollees," is available through CMA’s exchange resource center. Federal law allows Covered California enrollees who receive financial subsidies to keep their health insurance for three months, even if they have stopped paying their premiums. This is known as the “grace ... February 7, 2014 General Grace Period, Health Care Reform, Health Insurance Exchange, Covered California 0 0 Comment Read More »
CMA develops simple tool to identify physician participation status in exchange plans On January 1, 2014, Covered California began providing health coverage to more 500,000 patients statewide. With that figure expected to grow by the end of the 2014 open enrollment period, it is critical that physicians and their staff have a clear understanding of their exchange plan participation status so they can communicate this information to patients before scheduling. It’s equally as important that practices understand the reimbursement rates and other terms associated with the plans with which they are contracted. Even if you did not intentionally contract with any exchange ... January 27, 2014 General Covered California, Health Benefit Exchange, Insurance/Reimbursement, Health Care Reform 0 0 Comment Read More »
Surviving the first month of Covered California On January 1, 2014, California's health benefit exchange, Covered California, began providing health coverage to more 400,000 patients statewide. With that figure expected to grow by the end of the 2014 open enrollment period, it is critical that physicians and their staff know what to expect. To that end, the California Medical Association (CMA) offers these tips to survive the first month of Covered California. This document is available to members only. Please join CMA or Login to access the document. January 9, 2014 Managed Care Health Insurance Exchange, Covered California, Health Benefit Exchange, Health Care Reform 0 0 Comment Read More »
Updates to Covered California, the state's health benefit exchange CMA has updated our exchange toolkit, “CMA’s Got You Covered: A physician’s guide to Covered California, the state’s health benefit exchange.” There are significant updates since we last made updates in September that reflect key developments within the exchange including: • Updates on the grace period • Which plans have exited the exchange • How plans are building their networks • Information on how physicians can check their participation status on the Covered California website • Phone numbers of all of the plans in the event physicians have questions about their participation status December 10, 2013 General Health Care Reform, Health Insurance Exchange, Covered California, Insurance/Reimbursement 0 0 Comment Read More »
NEPO launches regional Covered California health care provider outreach and education meetings The CMA Foundation's Network of Ethnic Physician Organizations (NEPO) is hosting its first Covered California provider outreach and education meeting December 7, 2013, at 9:30 a.m. at the Kaplan Medical offices in Pasadena. Physicians and other health care providers and their staff are invited to attend this 2.5 hour educational session. Participants will learn more about Covered California and how they can help patients get health insurance coverage. Registration is free, but space is limited, so secure your spot today. For more information or to register, visit http://www.eventbrite.com/event/9019901769. This is first ... November 6, 2013 General Covered California, Health Benefit Exchange, Network of Ethnic Physician Organizations, Health Care Reform, Health Insurance Exchange, NEPO 0 0 Comment Read More »
Provider search function operational on Covered California website In what has been one of the most fluid deadlines put forth by the state’s health benefit exchange, Covered California launched the online provider search function on Monday, October 7. The search will allow patients to determine if a particular physician is contracted with any of the participating health plans. Though aimed at patients, physicians can also use the search to determine which plans list them on their exchange provider directories. The California Medical Association (CMA) recommends physicians review their status with plans offered in their area to determine whether ... October 8, 2013 General Covered California, Health Benefit Exchange, Health Insurance Exchange, Health Care Reform 0 0 Comment Read More »
