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policy developments, and events

SBCMS News/Media


Anthem dials back modifier 25 payment reduction policy; delays implementation

This past fall, Anthem Blue Cross notified physicians in several states that effective January 1, 2018, it would reduce reimbursement of evaluation and management (E&M) services billed with modifier 25 by 50 percent. The California Medical Association (CMA) quickly jumped into action and coordinated with the American Medical Association (AMA) and the American Association of Dermatologists, along with many other state and specialty organizations, to push back on the proposed change. Due to the overwhelming opposition from organized medicine, Anthem recently announced it would reduce the magnitude of its modifier ...

Are you being paid correctly under California's new out-of-network billing and payment law?

Effective July 1, 2017, California’s new out-of-network billing and payment law (AB 72) requires fully insured commercial plans and insurers to make “interim payments” to non-contracted physicians for covered, non-emergent services performed at in-network health facilities, and places limitations on the ability of physicians in such circumstances to collect their full billed charges. The interim rate is the greater of the payor’s average contracted rate or 125 percent of the amount that Medicare reimburses on a fee-for-service basis for the same or similar services in that geographic region. This law ...

Public Health Officer urges county residents to get the flu shot

The Public Health Officer is strongly encouraging County residents to get the flu shot. Initial influenza reports have sharply increased nearly 300% in the last week, going from 38 reports to 150 reports.  Within the last two weeks, the County has also confirmed three (3) flu-related deaths. “These deaths are a reminder that the flu can be serious and sometimes deadly,” said Dr. Maxwell Ohikhuare, Health Officer. “Flu shots are the most effective protection from the flu, and it’s not too late to get one.”  In light of the recent sharp ...