CMA advocacy results in DHCS revaluing two CPT codes The California Medical Association (CMA) received a call from a physician member with concerns that the California Department of Health Care Services (DHCS) had priced a CPT code for destruction of up to 14 benign skin lesions (CPT 17110) at a higher level than it priced a more complex procedure for the destruction of 15 or more lesions (CPT 17111). CMA escalated the issue to DHCS so it could investigate. Upon further inspection and months of discussions, DHCS announced in October that it was increasing reimbursement on both codes, resulting ... April 5, 2018 CMA, General, Medi-Cal Dermatology, DHCS, Economic Advoacy, Billing/Coding, CPT, Department of Health Care Services, Medi-Cal 0 0 Comment Read More »
Health plans terminate contracts with EHS and transition patients to other entities As previously reported, the California Department of Managed Health Care (DMHC) issued a cease-and-desist order on December 26, 2017, requiring nine health plans to terminate their contracts with Employee Health Systems (EHS) Medical Group Inc. This order comes after SynerMed—a company closely affiliated with EHS—was accused of blocking patient access to specialists to hold down costs. EHS has 600,000 patients statewide—90 percent of whom are Medi-Cal managed care patients. As required by DMHC, health plans affected by this order were required to submit a transition plan by January 3, 2018, ... February 5, 2018 Managed Care, Medi-Cal Continuity of Care, Department of Managed Health Care, DMHC, Health Plans, Insurance, Medi-Cal, Payor Contracting 0 0 Comment Read More »
DMHC orders 600,000 patients transferred from troubled medical group The California Department of Managed Health Care (DMHC) issued a cease-and-desist order on December 26, 2017, requiring nine health plans to terminate their contracts with Employee Health Systems (EHS) Medical Group Inc. This order comes after SynerMed—a company closely affiliated with EHS—was accused of blocking patient access to specialists to hold down costs. EHS has 600,000 patients statewide—90 percent of whom are Medi-Cal managed care patients. The health plans affected by this order must transfer all EHS patients to different health care providers by early February 2018. The plans were ... January 30, 2018 General, Managed Care, Medi-Cal Department of Managed Health Care, Managed Care, Medi-Cal 0 0 Comment Read More »
CMA, AMA and organized medicine were united in opposing Graham-Cassidy Last week, the latest effort to repeal the Affordable Care Act (ACA) collapsed, after three Republican Senators announced their opposition—Susan Collins (R-ME), Rand Paul (R-KY) and John McCain R-AZ). Further action is unlikely this year, as Senate Republican Leader Mitch McConnell (R-KY) said the Senate would now turn its focus to overhauling the tax code. However, several Republicans vowed to continue to work into next year to repeal the ACA. The California Medical Association (CMA), the American Medical Association (AMA) and all of organized medicine were united in opposing this ... October 13, 2017 CMA, General, Managed Care, Medi-Cal ACA, Affordable Care Act, Affordable Care Act (ACA) Repeal, Covered California, Federal Legislation, Federal Legislative Advocacy, Medicaid, Medi-Cal 0 0 Comment Read More »
California's physicians oppose Graham-Cassidy repeal bill The U.S. Senate is currently considering the Graham-Cassidy block grant bill, which would repeal the Affordable Care Act’s (ACA) insurance mandate, underfund health insurance subsidies and make drastic cuts to the Medicaid program. Under the bill, traditional Medicaid funding would be capped. Medicaid expansion and ACA subsidies for low- and middle-income families would be subject to an underfunded block grant and phased out in 2027. This bill would be disproportionately harmful to states like California, which embraced Medicaid expansion and increased coverage under the ACA. In response, the California Medical ... September 27, 2017 CMA, Medi-Cal Affordable Care Act, Affordable Care Act (ACA) Repeal, Federal Legislation, Federal Legislative Advocacy, Health Care Reform 0 0 Comment Read More »
CMA pushes top 10 priorities for Medicare/Medicaid regulatory relief California physicians are overwhelmed with unnecessary, burdensome regulations that take time and resources away from providing quality patient care. These regulations are a major contributing factor to the disturbing trend in physician burnout. The California Medical Association (CMA) submitted comprehensive comments urging the Centers for Medicare and Medicaid Services (CMS) to reduce the regulatory burdens under the Medicare and Medicaid programs. As part of the comment period for the proposed Medicare physician payment rule for 2018, CMS is soliciting ideas from physicians to reduce Medicare and Medicaid regulatory hassles. CMA ... September 27, 2017 Medi-Cal, Medicare Medicaid, Medicare, Regulatory Relief 0 0 Comment Read More »
CMS National Provider Calls include discussions on PQRS and Physician Compare in September The Centers for Medicare and Medicaid Service’s (CMS) September 2017 National Provider Call topics include the Physician Quality Reporting System (PQRS) on September 26 and on Physician Compare on September 28. PQRS provider call: While 2016 was the last program year for PQRS and the final data submission time frame for reporting 2016 PQRS quality data to avoid the 2018 payment penalty was January through March 2017, this call will cover PQRS penalties, feedback reports, and the informal review process for 2016 results and 2018 payment adjustment determinations. For more information ... September 27, 2017 Medi-Cal, Medicare CMS, Physician Compare, Physician Quality Reporting System, PQRS 0 0 Comment Read More »
CMS dedicates new webpage to Medicare Beneficiary Identification number change The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires the Centers for Medicare and Medicaid Services (CMS) to remove Social Security numbers from Medicare cards to prevent identity theft. CMS has said it will in 2018 begin issuing new Medicare cards that replace the current identification number—which is the beneficiary's Social Security Number—with an all-new Medicare Beneficiary Identification (MBI) number. CMS has developed a new webpage to help physicians navigate the transition to the new MBI number, including a recently developed resource on how to talk to your ... August 8, 2017 Medi-Cal, Medicare CMS, Medicare, Centers for Medicare and Medicaid Services, MACRA 0 0 Comment Read More »
Updated payor profiles for 2017 now available The California Medical Association’s (CMA) Center for Economic Services is publishing updated profiles on each of the major payors in California including Aetna, Anthem Blue Cross, Blue Shield of California, CIGNA, Health Net, UnitedHealthcare, 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 of charge ... August 1, 2017 CMA, Managed Care, Medi-Cal, Medicare Aetna, Anthem Blue Cross, Blue Shield, Cigna, Health Net, Insurance, Medi-Cal, Medicare, Noridian, Payor, Payor Profiles, Running a Practice, UnitedHealthcare 0 0 Comment Read More »
Medi-Cal postponing deactivation of inactive providers Earlier this month, the Department of Health Care Services (DHCS) notified approximately 30,000 Medi-Cal providers that they were being "deactivated" because they had not submitted a claim or rendered services reported on a Medi-Cal claim in the last 12 months. The notices indicated that the deactivation date would be July 22, 2017. DHCS has, however, decided not to proceed with the planned deactivation. DHCS will instead be reconsidering what is defined as "inactivity" after the department was made aware that such deactivation would be problematic for some providers—particularly those who see ... July 24, 2017 Medi-Cal Medi-Cal, Medi-Cal Provider Enrollment 0 0 Comment Read More »
