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Noridian sends out another wave of Medicare revalidation requests

As called for under the Affordable Care Act (ACA), Medicare Administrative Contractors (MACs) have been requiring physicians to revalidate their Medicare enrollments. Between now and March 23, 2015, MACs will continue reaching out to physicians, notifying them of the need to revalidate. The most recent round of revalidations requests went out by December 30, 2013.   The revalidation requirement is necessitated by new screening criteria called for under the ACA. Newly enrolling and revalidating providers will be placed in one of three screening categories representing the level of risk to the ...

Don't miss out on increased Medi-Cal payments

The California Department of Health Care Services (DHCS) will soon be implementing rate increases for primary care physicians who treat Medicaid patients, as authorized under the Affordable Care Act. The increase also applies to services provided by physicians to Medi-Cal managed care patients. In order to see the bump in pay, providers must first attest to their eligibility. According to DHCS, less than half of eligible providers have completed the brief self-attestation process as of September 24.   For purposes of this regulation, primary care is defined as family medicine, general ...

Federal regulations bring delays to ACA milestones

Deadlines and milestones relating to the Affordable Care Act (ACA) are beginning to slide, as the federal government gets a better picture of how capable it will be of implementing the massive changes called for in the law. In July, the federal government announced that the penalty on employers for not providing employees health insurance would be delayed until 2015, while also scaling back income verification requirements that would have been used to determine subsidy levels for individuals purchasing coverage through the new insurance marketplaces. The income verification announcement, which came ...

Attestation for Medi-Cal primary care rate increase to begin in July

The Centers for Medicare & Medicaid Services (CMS) released regulations in early November 2012 implementing rate increases for primary care physicians who treat Medicaid patients. The goal of the increase is to recruit more physicians to treat low-income patients who will be newly eligible for health coverage under the Affordable Care Act (ACA). Under the ACA, primary care physicians will see their reimbursement rates raised to Medicare levels in 2013 and 2014. According to CMS, states must also incorporate the increased payment rates into their contracts with managed care ...

Budget deal jump starts special session bills

Almost six months have passed since Gov. Jerry Brown opened a special session on health care reform in California, and members of the state Legislature are now beginning to tie up the final loose ends. Of the three sets of bills put forward under the special session’s parameters, all but one appeared to be stalled indefinitely until members of the Legislature reached a budget deal. These bills, which outlined California’s plans to expand the Medi-Cal program and establish a so-called "bridge plan" between Medi-Cal and exchange plans, were sprung from ...

Physicians are encouraged to check Covered California's provider database in July

As previously reported, there remain some uncertainties around the process of physician contracting with exchange plans. Beginning sometime in July, the exchange should alleviate much of the uncertainty as to who is and is not considered to be an exchange provider. This is because Covered California will be unveiling a centralized online provider database for the first time in July. Using this database, exchange patients will be able to see which providers are included in the respective exchange plans’ networks. This centralized database will also be utilized by the exchange’s eligibility ...

ACA: Medicaid Primary Care Rate Increase FAQ

Under the provisions of the Federal Affordable Care Act (ACA), state Medicaid programs (Medi-Cal in California) are required to pay primary care physicians at Medicare rates for primary care services for two years. The increase is fully funded by the federal government. The requirement began January 1, 2013 and ends December 31, 2014. The California Department of Health Care Services (DHCS) submitted their state plan amendment (SPA) to implement the rate increase on March 29, 2013. Approval of the SPA is required by the Centers for Medicare and Medicaid Services ...

Inland Empire Provider Positioning for Growth in Reform

Monday, March 11, 2013 Inland Empire Provider Positioning for Growth in Reform by Lauren McSherry, California Healthline Regional Correspondent SAN BERNARDINO -- Marking yet another step in the steady expansion of its reach in the Inland Empire, Loma Linda University Health is planning to construct a medical and educational complex in San Bernardino that could serve up to 250,000 patients each year. Experts said the expansion is likely part of the health system's strategy to better position itself for changes to health care reimbursement and hospital patient volume expected as a ...