Verifying your patients' eligibility and benefits in 2015 may save your practice thousands of dollars With the new year soon upon us, physicians are urged to be diligent in verifying patients' eligibility and benefits to ensure that you will be paid for services rendered. The beginning of a new year means calendar year deductibles and visit frequency limitations start over. With open enrollment there may also be changes to patients’ benefit plans, or they may even be insured through a new payor. The new year also brings a host of other challenges that could affect your ability to be paid: Medicare patients ... January 6, 2015 General Practice Management, Insurance/Reimbursement 0 0 Comment Read More »
United Healthcare to host webinars about its Premium Designation Program for contracted physicians At the request of the California Medical Association, United Healthcare (UHC) is inviting physicians and practice administrators to attend a special webinar presentation about its Premium Designation program in California. The webinars will be offered in mid-November and will provide an overview on the background and methodologies of the Premium Designation program and allow physicians an opportunity to ask specific questions they may have. The webinars will take place on the following dates and times. Participants will need to register with UHC prior to attending. Click the registration links below ... November 10, 2014 Managed Care Insurance/Reimbursement, Managed Care, Webinars, United Healthcare 0 0 Comment Read More »
State issues report cards for HMOs, PPOs and large medical groups The California Office of the Patient Advocate yesterday released its 14th annual “California Health Care Quality Report Cards” that rate the state's health plans and medical groups on a four-star scale. Available in English, Spanish and Chinese, the report cards allow consumers to compare the quality of care that more than 16 million commercially insured consumers receive from the state’s 10 largest HMOs, six largest PPOs and more than 200 medical groups. The data for the report cards is drawn from claims data and patient surveys for 2013. Users can drill-down ... October 17, 2014 General Insurance/Reimbursement, Insurance 0 0 Comment Read More »
How much revenue is your practice losing by not working denials? It’s no secret that claim rejections and denials can result in a significant amount of lost revenue. Consider this – a practice submitting 80 claims a day at an average reimbursement rate of $100 per claim should expect to receive $8,000 in daily revenue. If 10 percent of those claims were rejected or denied (eight claims per day at $100 per claim equals $800 per day), and the practice only appealed one out of every 10 rejections or denials ($720 per day loss), the practice could expect to lose ... October 10, 2014 General Denials, Insurance/Reimbursement, Practice Resources, Billing/Coding 0 0 Comment Read More »
Updated payor profiles now available The California Medical Association’s (CMA) Center for Economic Services has published updated profiles on each of the major payors in California including Aetna, Anthem Blue Cross, Blue Shield of California, CIGNA, Health Net, United Healthcare, Medicare/Noridian and Medi-Cal. Each profile includes key information on health plan market penetration, a description of the plan’s dispute resolution process and the name and contact numbers for medical directors, provider relations and other key contacts. Don’t waste your time searching the internet for this information – members can download CMA’s Payor Profiles free ... October 6, 2014 General Payor Profiles, Insurance/Reimbursement, Practice Management 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 »
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 »
State audit finds DHCS may have paid $93.7 million for fraudulent Medi-Cal drug treatment A California State Auditor’s report issued today found the Department of Health Care Services (DHCS) failed to properly administer the Medi-Cal Drug Treatment Program and may have paid at least $93.7 million for fraudulent drug treatment. The program provides substance abuse services to Medi-Cal beneficiaries when physicians determine they are medically necessary. The focus of the report was on outpatient drug-free services. The audit was requested by Assemblyman Ted Lieu after stories appeared in the media revealing that substance abuse clinics were fraudulently billing for patients who did not use ... August 21, 2014 Medi-Cal DHCS, Drug Abuse, Medi-Cal, Insurance/Reimbursement 0 0 Comment Read More »
CMS must provide better oversight to prevent duplicate audits says GAO study A newly released study by the federal General Accounting Office (GAO) found that the Centers for Medicare and Medicaid Services (CMS) needs to provide better oversight and guidance for provider payment auditors to prevent duplicative post-payment claims review audits. Several types of Medicare contractors conduct postpayment claims reviews to help reduce improper payments: Medicare Administrative Contractors, which process and pay claims; Zone Program Integrity Contractors, which investigate potential fraud; Recovery Auditor Contractors, tasked with identifying on a postpayment basis improper payments not previously reviewed by other contractors; and the Comprehensive ... August 21, 2014 General CMS, Insurance/Reimbursement, Medicare, Audits 0 0 Comment Read More »
CMA urges United to make meaningful changes to Premium Designation program Citing physician confusion and complaints as well as additional concerns with the rollout of the United Healthcare (UHC) Premium Designation program, the California Medical Association (CMA) has, again, urged the insurer to make meaningful and necessary changes to the program prior to the next assessment this fall. "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 in making important health care decisions,” wrote CMA President Richard Thorp, M.D., in an August 13, 2014, ... August 21, 2014 Managed Care Managed Care, United Healthcare, Insurance/Reimbursement 0 0 Comment Read More »
