Tip: Don't lose revenue by not working denials It’s no secret that claim rejections and denials can result in a significant amount of lost revenue. Consider this – a practice submitting 80 claims a day at an average reimbursement rate of $100 per claim should expect to receive $8,000 in daily revenue. If 10 percent of those claims were rejected or denied (eight claims per day at $100 per claim equals $800 per day), and the practice only appealed one out of every 10 rejections or denials ($720 per day loss), the practice could expect to lose ... December 13, 2016 General, Managed Care, Medi-Cal, Medicare Denials, Reimbursement, Tip of the Month 0 0 Comment Read More »
New online Medi-Cal provider enrollment portal to launch Friday The California Department of Health Care Services (DHCS) is ready to launch its new online Medi-Cal provider enrollment portal. The system, called the Provider Application and Validation for Enrollment (PAVE), will transform provider enrollment from a manual paper-based process to a web-based portal that providers can use to complete and submit their applications and verifications and to report changes. The new portal will go live this Friday, November 18, 2016. Initially, PAVE will be available for most physician and allied providers who enroll to serve fee-for-service beneficiaries directly through the ... November 16, 2016 Medi-Cal Medi-Cal, Medi-Cal Provider Enrollment, PAVE 0 0 Comment Read More »
Physicians have until November 30 to dispute 2015 PQRS and QRUR findings The Centers for Medicare and Medicaid Services (CMS) recently released data that indicates which physicians will be subject to the 2017 payment penalties associated with the Physician Quality Reporting System (PQRS) and Value-Based Payment Modifier (VM) programs. Physicians who have concerns about the findings in their report(s) have until November 30 to file for an informal review of their data. The penalties in question stem from policies in effect prior to the enactment of the Medicare Access and CHIP Reauthorization Act (MACRA). Failure to successfully complete required PQRS reporting ... November 14, 2016 Managed Care, Medi-Cal, Medicare Quality Reporting, Medicare, Physician Quality Reporting System, PQRS 0 0 Comment Read More »
California Medical Association applauds voter approval of Proposition 52 The California Medical Association (CMA) today applauded voter approval of Proposition 52, the California Medi-Cal Hospital Reimbursement Initiative. Voters passed the measure, which will maximize the amount of federal funds available to California to provide health care services to children, seniors and working families through Medi-Cal. “One in three Californians rely on Medi-Cal care so it’s critical that we invest in health care services needed by our most vulnerable populations,” said CMA Immediate Past President Steven E. Larson, M.D., MPH. “Prop. 52 will help provide essentials like check-ups, immunizations, prescriptions, ... November 14, 2016 Medi-Cal Ballot Measures, Election, Medi-Cal, Political Advocacy 0 0 Comment Read More »
CMS and AMA schedule MACRA webinars The Centers for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) have scheduled a number of educational webinars to help physicians understand and prepare for the new Medicare Quality Payment Program for physicians created by the Medicare Access and CHIP Reauthorization Act (MACRA). Below is a list of upcoming webinars: Title: Quality Payment Program Final Rule Presented by: CMS Date: Tuesday, November 15, 2016 Time: 10:30 a.m. to 12 p.m. PT Register: Click here Title: MACRA Education Presented by: AMA Date: Monday, November 21, 2016 Time: 4 to 5:30 p.m. PT Register: Click here Title: MACRA Education Presented ... November 4, 2016 Managed Care, Medi-Cal, Medicare MACRA, Webinars 0 0 Comment Read More »
Study finds fewer California physicians accept Medi-Cal despite a surge in patients Under the Affordable Care Act (ACA), the numbers of patients enrolled in Medi-Cal has increased over the past three years, but a new study published by the California Health Care Foundation shows that fewer physicians are accepting these patients—largely because of the dismal payment rates. Medi-Cal has long been underfunded, resulting in decreased access to health care for patients and dangerously low reimbursement rates for participating physicians. Currently, payments to doctors for a typical office visit under Medi-Cal are far less than the cost of providing care. In 2013, according to ... November 4, 2016 Medi-Cal Prop.56 (tobacco tax), Ballot Measures, Election, Medi-Cal, Political Advocacy, Prop.55 0 0 Comment Read More »
Hardware upgrades will impact Medi-Cal systems in October Required systems upgrades to the California Medicaid Management Information System (CA-MMIS) are scheduled to take place during two weekends in October. This is an upgrade of the hardware where many Medi-Cal services run. Upgrades will start during the regular daily maintenance period, which begins at midnight, and will continue through extended maintenance windows on October 9 and October 16. During these windows, providers will be unable to submit transactions. To reduce the impact on providers, upgrades are scheduled during a period when the systems are used less frequently. A System Status ... October 13, 2016 Medi-Cal Medi-Cal 0 0 Comment Read More »
New CMA resource clarifies prohibitions on balance billing Medi-Medi patients The California Medical Association (CMA) often receives questions from physician members regarding the ability to collect the 20 percent that Medicare does not cover when the physician is not a Medi-Cal provider, but provides services to Medi-Medi (Medicare/Medi-Cal) patients. Both state and federal laws provide broad protections to such individuals and prohibit billing a Medi-Cal patient in most circumstances. Running afoul of these laws can put you at risk of a CMS audit and sanctions. CMA has created a new resource on this topic, “Ask the Expert: Billing Medi-Medi Patients,” ... September 13, 2016 Medi-Cal, Medicare Balance Billing, Medi-Cal, Medicare 0 0 Comment Read More »
ICD-10 grace period ends October 1 Physicians are reminded that the Centers for Medicare and Medicaid Services' (CMS) one-year grace period for ICD-10-coded claims is coming to an end on October 1, 2016. As of that date, providers will be required to use the correct degree of specificity in their coded claims. When ICD-10 went live last year, CMS said it would not deny or audit claims as long as providers used codes in the correct "family" related to the treatment. According to CMS, the ICD-10 grace period ensured that contractors performing medical reviews would not deny ... September 12, 2016 Medi-Cal, Medicare Coding and Documentation, ICD-10, Billing/Coding 0 0 Comment Read More »
Reminder: 2016 is last year to start Medi-Cal EHR Incentive Program The Medicaid Electronic Health Record (EHR) Incentive Program provides funding to Medicaid (Medi-Cal in California) providers and hospitals to adopt, implement, upgrade and make meaningful use of certified EHR technology. Eligible providers should be aware that 2016 is the last year that eligible providers can sign up for the program. Since the program began in 2011, more than 20,000 Medi-Cal professionals have qualified, receiving more than $500 million in incentive payments. Professionals can individually receive up to $63,750 in incentive payments over six years, with the largest payment of $21,250 in ... September 12, 2016 Medi-Cal EHR, Certified EHRs, Electronic Health Record, Medi-Cal 0 0 Comment Read More »
