CHDP group providers must re-attest by April 17 to receive ACA primary rate increase The California Department of Health Care Services (DHCS) has experienced various difficulties issuing the Affordable Care Act (ACA) primary care rate increase funds on Child Health and Disability Prevention (CHDP) Program claims. Most recently, the California Medical Association learned that CHDP providers practicing as part of a group would be required to re-attest as a group to get paid. Previously, physicians had been instructed to only attest as individuals. DHCS issued an updated “NewsFlash” on March 30 to explain the additional steps that will be required. Groups and clinics that ... April 14, 2015 General Affordable Care Act, CHDP, Child Health and Disability Prevention Program, ACA 0 0 Comment Read More »
DHCS identifies another glitch in issuing primary care rate increase for CHDP claims The California Department of Health Care Services (DHCS) has experienced various difficulties issuing the Affordable Care Act primary care rate increase funds on Child Health and Disability Prevention (CHDP) Program claims. Before the rate increases were implemented, some practices had been instructed by DHCS to bill CHDP claims at their Medi-Cal rates. This caused concern – based on DHCS’s pricing logic of paying the lesser of Medicare’s rate or the billed charges – that some practices would not qualify for the retroactive increases once the systems were updated to ... March 17, 2015 Medi-Cal, Medicare CHDP, Child Health and Disabilityh Prevention Program, Affordable Care Act, DHCS 0 0 Comment Read More »
Gallup poll finds U.S. uninsured rate at lowest level in seven years. According to a nationwide Gallup Poll, the Affordable Care Act (ACA) has steadily reduced the number of people without insurance across the United States. The group conducted phone interviews (landline and cell) in 2013 and 2014, as part of the Gallup-Healthways Well-Being Index, with a random sample of 178,072 adults in 2013 and 176,702 adults in 2014. The survey found that the nationwide rate of uninsured adults declined from 17.3 percent in 2013 to 13.8 percent in 2014. The lowest uninsured rates continue to be primarily in the Northeast and ... March 9, 2015 Managed Care Insurance, Uninsured, Affordable Care Act 0 0 Comment Read More »
Open Payments database available for physician review in April The Centers for Medicare and Medicaid Service (CMS) announced last week that it will make the Open Payments database available to physicians for their review of payments made to them by drug and medical device companies. The Open Payments database is a part of the Physician Payments Sunshine Act, a provision of the Affordable Care 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 ... February 18, 2015 Medi-Cal, Medicare Physician Payments Sunshine Act, Affordable Care Act 0 0 Comment Read More »
NEJM study shows primary care rate increase for Medicaid patients increased access to care A study published in the New England Journal of Medicine last week shows that the increase in Medicaid reimbursement for primary care providers, a key provision of the Affordable Care Act (ACA), resulted in a 7.7 percent increase in new patient appointment availability without longer wait times. The study, conducted by the University of Pennsylvania and the Urban Institute, used “secret shoppers” to call primary care doctors offices seeking new appointments in 10 states: Arkansas, Georgia, Illinois, Iowa, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania and Texas. Calls were made in ... February 4, 2015 Medi-Cal Affordable Care Act, ACA, Medi-Cal, We Care for California 0 0 Comment Read More »
Poll shows people want Congress to act to make all states eligible for ACA subsidies A new poll has found that nearly six in 10 people believe that Congress or states should act to restore health insurance subsidies if the U.S. Supreme Court strikes them down when it rules on King v. Burwell, a case that questions whether premium subsidies can be provided under the Affordable Care Act (ACA) to individuals purchasing health insurance coverage on exchanges run by the federal government. The poll, conducted by the Kaiser Family Foundation in early January, found that 64 percent wanted Congress to act to make all states ... January 29, 2015 General Affordable Care Act, Health Insurance Exchange, United States Supreme Court, ACA 0 0 Comment Read More »
U.S. Supreme Court to hear ACA subsidy case on March 4 The U.S. Supreme Court has scheduled oral arguments for March 4, 2015, in King v. Burwell; a case that questions whether premium subsidies can be provided under the Affordable Care Act (ACA) to individuals purchasing health insurance coverage on exchanges run by the federal government. The lawsuit has the potential to affect 36 states that use the federal health care exchange, but would not change the subsidies in states like California that run their own exchanges. If the subsidies are struck down, some 5.4 million Americans who signed up for ... January 6, 2015 General Affordable Care Act, Health Insurance Exchange, ACA, U.S. Supreme Court 0 0 Comment Read More »
DHCS identifies glitch in UCR web app for CHDP primary care rate increase payments The California Department of Health Care Services (DHCS) has identified an error in its web application that was designed to allow physicians the ability to enter their usual and customary rates (UCR) for Child Health and Disability Prevention Program Services (CHDP) claims. Physicians who already entered their UCR data prior to November 26, 2014, will need to return to the portal and reenter their information. The web app was developed to address a problem with the Affordable Care Act primary care rate increase unique to CHDP providers. Before the rate increases ... December 9, 2014 Managed Care, Medi-Cal Medi-Cal, Pediatrics, Affordable Care Act, Department of Health Care Services 0 0 Comment Read More »
Physicians encouraged to familiarize themselves with exchange plan changes heading into Covered California open enrollment Covered California began enrollment for its second year on November 15 and exchange officials are predicting a 45 percent jump in enrollment, from 1.2 million in 2014 to 1.7 million in 2015. Last year, open enrollment was a six-month process, this year it will be half as long, starting Nov. 15 and ending Feb. 15. In anticipation of this year's open enrollment, some payors have updated their exchange plan offerings for 2015, including plan types and plan names. The California Medical Association (CMA) will be publishing details of these changes ... November 17, 2014 Managed Care Affordable Care Act, Health Insurance Exchange, ACA, Covered California 0 0 Comment Read More »
ACA meets goal of covering more Americans A little over 10 million uninsured have gained health care coverage throughout the U.S., either through Medicaid or state and federal exchanges, since the Affordable Care Act (ACA) coverage expansion programs opened for enrollment last year, according to a new report from U.S. Department of Health And Human Services’ (HHS). According to the report, the uninsured rate among adults ages 18 to 64, as of June 2014, was 15.1 percent, down 5 percent from September 2013. The percentage of those with health coverage improved most among blacks and Latinos throughout the ... November 14, 2014 General Affordable Care Act, ACA 0 0 Comment Read More »
