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IEHP completes termination of Vantage contract; three plans extend termination dates

The California Medical Association (CMA) has confirmed that Inland Empire Health Plan (IEHP) completed its contract termination with Vantage on August 31, 2018. IEHP transitioned its 273,000 covered lives to the following delegated groups: Receiving Provider Group Number of Enrollees Alpha Care Medical Group 80,190 La Salle Medical Associates 74,428 IEHP Direct 74,176 ...

What you need to know about Blue Shield of California's Care1st integration

On January 1, 2019, Blue Shield of California will complete the integration of Care1st Health Plan into its operations, and Care1st’s name will change to Blue Shield of California Promise Health Plan. The newly renamed health plan will remain a separate company and a wholly owned subsidiary of Blue Shield of California. Care1st physicians serving Medicare Advantage HMO, Medi-Cal or Cal MediConnect members will not need to contract with Blue Shield of California to continue providing services, and participating physicians will receive a mailed contract amendment later this year that ...

Updated payor profiles for 2018 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 ...

CMA proposes site-neutral payments for some physician services

The Centers for Medicare and Medicaid Services (CMS) has proposed eliminating the Medicare site of service payment differential for physician services. Under the proposed policy, Medicare would pay the same amount for office visit services provided by physicians in “off-campus” hospital outpatient departments as it would for the same office visit service provided in a physician’s office. Currently, Medicare pays a “facility fee” that results in a much higher rate for the same service when performed in outpatient clinics owned by hospitals, rather than in a physician’s office. For example, ...

CMA pushes back on CMS' proposed Medicare payment changes

The California Medical Association (CMA) recently submitted comprehensive comments to the Centers for Medicare and Medicaid Services (CMS) on the proposed 2019 Medicare Physician Fee Schedule and MACRA Quality Payment Program rule. CMA is supporting CMS’s proposal to substantially reduce the Evaluation and Management (E/M) documentation requirements because it would reduce note bloat, improve workflow, and allow physicians to devote more time to their patients. However, CMA is strongly opposed to the proposal to restructure payment and coding for (E/M) office visits by collapsing the codes from five to two for ...

CMA urges CMS to simplify the Quality Payment Program

The California Medical Association (CMA) has submitted comments to the Centers for Medicare and Medicaid Services (CMS) on the proposed changes to the Medicare Quality Payment Program for 2019. CMA is disappointed that CMS did not reduce the reporting burdens in the Merit-based Incentive Payment System (MIPS) program in a more meaningful way. We also oppose the confusing new scoring tiers (gold, silver and bronze) and have urged CMS to simplify and overhaul the complex MIPS scoring system. CMA strongly urges CMS to maintain the 10 percent weight of the cost ...

Noridian announces improvements to Medicare portal

Noridian, the Medicare Administrative Contractor for California, recently announced improvements to the Noridian Medicare Portal (NMP) that will make it easier for providers to identify reasons behind eligibility-related claim denials. When a claim is denied for eligibility-related reasons, providers can select the link under Claim Status in the “Related Inquiries” portion of the page to access details to assist with determining their next steps. Effective July 27, 2018, all NMP users can also send secure online messages to Noridian regarding medical reviews or to voice concerns to be addressed by ...

Annual Medicare preventative exams now include review of opioid use

On August 28, the Centers for Medicare and Medicaid Services (CMS) published an update to the Initial Preventive Physician Examination and Annual Wellness Visit benefits, highlighting that a review of patient opioid use is now a component of medical and social history assessments. Per CMS, the review of opioid use during these annual preventative exams will help physicians identify patients using opioids, discuss alternative for non-opioid pain therapies, and assist in diagnosing and treatment for patients experiencing or at risk for opioid-use disorders. Additional CMS Resources Reducing opioid misuse The ABCs ...

Mosquitoes test positive for West Nile virus San Bernardino

Two mosquitoes collected in the City of San Bernardino tested positive for West Nile Virus. These are the first mosquitoes that tested positive in 2018 within the area served by the Division of Environmental Health Services Mosquito and Vector Control Program (MVCP). MVCP is taking steps to eliminate mosquito breeding hazards. People bitten by an infected mosquito may develop West Nile fever and experience flu-like symptoms which may include fever, body aches, skin rash, and fatigue. In some people, West Nile fever can develop into a more serious form of ...

Coding Corner: CPT reporting for preventive medicine services

CPR’s “Coding Corner” focuses on coding, compliance, and documentation issues relating specifically to physician billing. This month’s tip comes from John Verhovshek, the managing editor for AAPC, a training and credentialing association for the business side of health care. Preventive medicine services, or “well visits,” are evaluation and management (E/M) services provided to a patient without a chief complaint. The reason for the visit is not an illness or injury (or signs or symptoms of an illness or injury), but rather to evaluate the patient’s overall health, and to identify ...