Noridian announces improvements to Medicare portal Noridian, the Medicare Administrative Contractor for California, recently announced improvements to the Noridian Medicare Portal (NMP) that will make it easier for providers to identify reasons behind eligibility-related claim denials. When a claim is denied for eligibility-related reasons, providers can select the link under Claim Status in the “Related Inquiries” portion of the page to access details to assist with determining their next steps. Effective July 27, 2018, all NMP users can also send secure online messages to Noridian regarding medical reviews or to voice concerns to be addressed by ... October 16, 2018 Medicare Practice Management, Public Payors 0 0 Comment Read More »
Annual Medicare preventative exams now include review of opioid use On August 28, the Centers for Medicare and Medicaid Services (CMS) published an update to the Initial Preventive Physician Examination and Annual Wellness Visit benefits, highlighting that a review of patient opioid use is now a component of medical and social history assessments. Per CMS, the review of opioid use during these annual preventative exams will help physicians identify patients using opioids, discuss alternative for non-opioid pain therapies, and assist in diagnosing and treatment for patients experiencing or at risk for opioid-use disorders. Additional CMS Resources Reducing opioid misuse The ABCs ... October 16, 2018 General Drug Prescribing/Dispensing, Public Payors 0 0 Comment Read More »
L.A. Care issues recoupment letters for services dating back to 2012 The California Medical Association (CMA) has learned that L.A. Care Health Plan, the publicly operated Medi-Cal health plan serving more than 2 million Los Angeles County residents, issued letters to physicians in late July requesting the refund of claim overpayments dating back to 2012. The letters, dated July 28 and received by practices through mid-August, cited that the overpayments were a result of processing errors, including the following: L.A. Care incorrectly processed Medi-Medi claims as the primary payor instead of secondary to Medicare. ... September 12, 2018 Medi-Cal Payor Issues and Reimbursement, Practice Management, Public Payors 0 0 Comment Read More »
CMA and AMA oppose CMS proposal to collapse E/M codes More than 150 health care organizations, including the California Medical Association (CMA) and the American Medical Association (AMA), sent a joint letter to the Centers for Medicare and Medicaid Services (CMS), opposing the agency’s proposal to collapse evaluation and management (E/M) code and payment levels. The proposal was included in the draft 2019 Medicare Physician Fee Schedule and MACRA Quality Payment Program rule released earlier this summer. CMA and AMA appreciate CMS’s genuine desire to reduce documentation burdens on physicians to allow them to focus on patients over paperwork. Several ... September 12, 2018 General, Medicare Advocacy, Payor Issues and Reimbursement, Public Payors 0 0 Comment Read More »
New Medi-Cal provider enrollment system to go live Sept. 4 The California Department of Health Care Services (DHCS) is releasing an update to its Medi-Cal provider enrollment system—called the Provider Application and Validation for Enrollment (PAVE)—on Tuesday, September 4, 2018. The current iteration (2.0) of the PAVE system, launched on November 18, 2016, transformed DHCS’ provider enrollment from a manual paper-based process to a web-based portal that providers could use to complete and submit their applications, verifications and to report changes. Version 2.0 included most physicians and allied provider types. The new 3.0 update will include even more eligible provider ... August 29, 2018 Medi-Cal Payor Contracting, Public Payors 0 0 Comment Read More »
UnitedHealthcare Community Plan preps for entry into additional Medi-Cal and Medicare Advantage markets Looking to potentially enhance its footprint in the Medi-Cal and Medicare Advantage marketplace by 2021, UnitedHealthcare (UHC) Community Plan of California has issued unilateral contract amendments to contracted physicians in seven California counties. Additionally, UHC providers in the seven counties who are not currently contracted for the Medicare Advantage product will receive a combined contract amendment for participation in both UHC Community Plan of California (Medi-Cal) and UHC Medicare Advantage products. As a condition of participation in the Medi-Cal Managed Care request for proposal process in late 2019 or early 2020, ... August 23, 2018 Managed Care, Medi-Cal, Medicare Commercial Payors, Payor Contracting, Public Payors 0 0 Comment Read More »
Medi-Cal to unveil updated provider enrollment system this summer The California Department of Health Care Services (DHCS) will soon be releasing an update to its Medi-Cal provider enrollment system, called the Provider Application and Validation for Enrollment (PAVE). The current iteration (2.0) of the PAVE system, originally launched on November 18, 2016, transformed DHCS’ provider enrollment from a manual paper-based process to a web-based portal that providers could use to complete and submit their applications, verifications and to report changes. The original launch included most physicians and allied provider types. The new update (3.0) will include even more eligible ... August 15, 2018 Medi-Cal Medi-Cal, Practice Management, Public Payors 0 0 Comment Read More »
CMA/AMA responding to proposed Medicare payment rule On July 12, 2018, the Centers for Medicare and Medicaid Services (CMS) released the proposed 2019 Medicare Physician Fee Schedule and MACRA Quality Payment Program (QPP) rule. This is the first year that CMS is combining the Medicare fee schedule and QPP rules. There are a number of positive elements in the proposed rule. These include: New payments for physician services that are not part of a face to face office visit (virtual check-ins, remote consults of patient videos and photographs, and online consultations with other physicians) ... August 7, 2018 CMA, Medicare Advocacy, MACRA, Public Payors 0 0 Comment Read More »
Noridian to present in-person Medicare seminars in Irvine and Sacramento Noridian, the Medicare administrative contractor for California, has announced several in-person seminars around the state in September. The all-day presentations will be divided into morning and afternoon sessions, including information on the following: Morning Session: 8:30 a.m. to 12 p.m. What's New Preventive Services Telehealth Incident to Services Top A/B Errors Afternoon Session: 1-4:30 p.m. NCDs/LCDs Review Entities Documentation/Signature Requirements Education Corner The seminars are ... August 3, 2018 Medicare Public Payors, Practice Management, Professional Development & Education 0 0 Comment Read More »
New Medicare ID card mailing completed in California The Centers for Medicare and Medicaid Services (CMS) recently completed mailing new Medicare ID cards to California beneficiaries. The new Medicare ID cards, required under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), contain a unique, randomly assigned Medicare Beneficiary Identification (MBI) number, which replaces the previous Social Security-based number. CMS has prepared a “Still Waiting for Your New Card?” handout (in English or Spanish) to provide to patients who did not receive a new Medicare ID card. Patients may be directed to the MyMedicare.gov website or to ... August 3, 2018 Medicare Medicare, Patient Privacy, Public Payors 0 0 Comment Read More »
