UnitedHealthcare to issue latest cycle of Peer Comparison Reports UnitedHealthcare (UHC) has announced that the next iteration of its Peer Comparison Reports will be sent to physicians beginning in November. The Peer Comparison Reports, formerly known as performance reports, contain analysis of a physician’s UHC paid claims data in comparison to nationally-based and risk-adjusted benchmarks. Only physicians whose paid claims data shows patterns that vary significantly from the identified benchmarks will receive a Peer Comparison Report. According to UHC, approximately 550 physicians in the following specialties will receive a Peer Comparison Report notification indicating that their paid claims data ... October 19, 2017 General, Managed Care UnitedHealthcare 0 0 Comment Read More »
Anthem Blue Cross to implement restrictive outpatient advanced radiology policy Effective December 1, 2017, Anthem Blue Cross will implement a new policy restricting outpatient advanced radiologic imaging procedures in the hospital setting. The updated policy, originally scheduled to become effective October 1 but recently delayed, indicates that advanced radiologic imaging procedures in the hospital outpatient department are only considered medically necessary under the follow circumstances: If services are only available in the hospital setting; or The patient requires obstetrical observation; or The patient is receiving perinatology services; or ... October 19, 2017 General, Managed Care Anthem Blue Cross, Radiology 0 0 Comment Read More »
Blue Shield updates fee schedule effective December 1 Blue Shield of California recently announced changes to its physician fee schedule that will take effect December 1, 2017. While the notice indicated that the new rates would be available on the Blue Shield website by October 1, CMA has learned that Blue Shield experienced technical difficulties that will delay the availability of the new rates on the website, until October 9, 2017 (tentatively). The rates will be located under "Helpful Resources," then “Professional Fee Schedule,” then click “Search the Claims Fee Schedule” using a “Date of Service” of December ... October 13, 2017 Managed Care Blue Shield, Payor Contracting 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 »
CMA guide helps physicians challenge AB 72 interim payments The California Medical Association (CMA) has published a new guide to help physicians challenge “interim payments” under the new AB 72 out-of-network billing and payment law. The guide is free and available exclusively to members in CMA’s AB 72 resource center at www.cmanet.org/ab-72. On July 1, 2017, the new law (AB 72) took effect changing the billing practices of non-participating physicians providing covered, non-emergent care at in-network facilities including hospitals, ambulatory surgery centers and laboratories. The law requires plans and insurers to reimburse physicians at the greater of either the payor’s ... October 13, 2017 General, Managed Care AB 72, Economic Advocacy, Out of Network Care 0 0 Comment Read More »
Anthem Blue Cross offering fall seminars on 2017 operational updates Throughout October, the Anthem Blue Cross Provider Network Education Team will offer live seminars to discuss 2017 operational updates. Topics will include participation in the California health care marketplace, Blue Cross and Blue Shield alpha prefix change, and details on the new website for radiology services. Each seminar runs from 8:30 a.m. to 12 p.m. The first session is slated for October 3 in San Mateo, and the series will conclude on October 26 in Fresno. Practices interested in attending should register on the Anthem website. Click here for the ... September 25, 2017 Managed Care Anthem Blue Cross, Seminars 0 0 Comment Read More »
Webinar: How to challenge the AB 72 interim payment for out-of-network services On July 1, 2017, a new law (AB 72) took effect that changes the billing practices of non-participating physicians providing covered, non-emergent care at in-network facilities including hospitals, ambulatory surgery centers and laboratories. The law was designed to reduce unexpected medical bills when patients go to an in-network facility but receive care from an out-of-network doctor. Under the new law, plans/insurers are required to make “interim payments” to non-contracted physicians for covered, non-emergent services performed at in-network health facilities. The interim payment is the greater of either the plan/insurer’s average ... September 25, 2017 General, Managed Care AB 72, Out of Network Care, Webinars 0 0 Comment Read More »
Physicians report Anthem not complying with AB 72 interim payment rules The California Medical Association (CMA) has received reports from physician offices that Anthem Blue Cross is not paying the “interim payment” as required under the recently effective law (AB 72) limiting out-of-network billing for covered, non-emergent services performed at an in-network facility. The new law requires fully insured commercial plans and insurers to make “interim payments” to non-contracted physicians for 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 defined in AB 72 ... September 25, 2017 General, Managed Care AB 72, Anthem Blue Cross, Out of Network Care 0 0 Comment Read More »
CMA urges CMS to further reduce MACRA administrative burdens The California Medical Association (CMA) recently submitted comments on proposed 2018 changes to the Medicare Quality Payment Program (QPP), established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Though not perfect, CMA is pleased that the Centers for Medicare and Medicaid Services (CMS) has listened to physician feedback and has made changes that will significantly reduce the administrative burdens on physicians, particularly for small and rural practices. We appreciate the agency’s responsiveness to many of our concerns about the ability of physicians to successfully participate in the ... September 25, 2017 CMA, EHR, Managed Care CalHIPSO, MACRA, Medicare, Medicare Quality Payment Program, QPP, Webinars 0 0 Comment Read More »
Anthem Blue Cross rescinds termination of Medicare Advantage agreement with Brown and Toland Anthem Blue Cross has reached an agreement to extend its Medicare Advantage contract with Brown & Toland Physicians. Although Anthem Blue Cross previously announced the contract would be terminated effective October 1, 2017, the parties have since signed a contract extension through December 2018. The termination would have affected approximately 1,900 Medicare Advantage enrollees in San Francisco. Click here to see the letter sent from Brown & Toland. Physicians with questions can contact Brown & Toland Physician Services at physicianservices@btmg.com. August 17, 2017 Managed Care, Medicare Anthem Blue Cross, Medicare Advantage, San Francisco Medical Society 0 0 Comment Read More »
