Important information about 2016 and 2017 Medi-Cal EHR incentive program attestations, including delays for groups The California Department of Health Care Services (DHCS) has extended the attestation deadline for the Medi-Cal electronic health record (EHR) incentive program reporting for the 2016 program year. The deadline has been pushed to May 23, 2017. After that date, DHCS will only accept 2017 attestations. Eligible providers should be aware that 2016 is the last year that they can sign up for the program. Providers who have not received at least one incentive payment by the end of the 2016 reporting year won’t be able to receive any ... May 22, 2017 General, Managed Care, Medi-Cal Electronic Health Record, Meaningful Use, Medi-Cal 0 0 Comment Read More »
CMS to issue MIPS participation status notices Starting in late April, the Centers for Medicare & Medicaid Services (CMS) began notifying physicians whether they will be subject to Medicare's new Merit-Based Incentive Payment System (MIPS). MIPS is part of the new Medicare Quality Payment Program established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Providers with less than $30,000 in Medicare payments or fewer than 100 Medicare patients are exempt from the MIPS reporting requirements. Physicians who exceed this threshold are subject to MIPS and are encouraged to participate in MIPS for the 2017 ... May 22, 2017 General, Managed Care, Medicare CMS, MACRA, Medicare, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
AMA urges quick action to stabilize individual insurance market With the window quickly closing to properly price individual insurance products for 2018, the American Medical Association (AMA) is urging President Trump and Congressional leaders to commit to continued funding for the cost-sharing reductions that are critical to stabilizing the individual market. AMA, along with other groups representing insurers, hospitals, health plan purchasers and physicians, sent a letter urging quick action to deliver short-term stability and affordable coverage while broader marketplace stabilization efforts are developed. Nearly 60 percent of all individuals who purchase coverage via the exchange receive financial assistance to ... April 19, 2017 General, Managed Care ACA, Affordable Care Act, AMA, American Medical Association, Health Insurance Exchange, Insurance 0 0 Comment Read More »
Open Payments review and dispute period open Drug and medical device manufacturers have completed their submission of data to the Open Payments system on payments or transfers of value made to physicians during 2016. Physicians now have 45 days to review and dispute records attributed to them. The review and dispute period is open until May 15, 2017. The review and dispute process is voluntary, but encouraged. The Centers for Medicare and Medicaid Services (CMS) will publish the 2016 payment data, along with updates to the 2013 and 2014 data, on June 30, 2017. Disputes that are ... April 19, 2017 General, Managed Care, Medicare Centers for Medicare and Medicaid Services, CMS, Medical Devices, Physician Payments Sunshine Act, Prescription Drugs 0 0 Comment Read More »
Ask the expert: Making a business case to join a payor network When physicians identify a payor network they wish to join, typically their first step is to submit a letter of interest or intent signaling their desire to join. However, physicians often fail to adequately present a “business case” as to why the payor would want to add the practice into their network. Failure to present a business case often results in a quick reply from the payor indicating that they have no interest or need to add providers to their network at this time. To prevent the “auto-reply,” the ... April 19, 2017 General, Managed Care Economic Advocacy, Insurance/Reimbursement, Payor Contracting 0 0 Comment Read More »
CHPI publishes physicians' quality ratings for cycle 2 On March 22, 2017, the California Healthcare Performance Initiative System (CHPI) released its second cycle of physician quality ratings to the public. The ratings can be accessed at CHPI’s newly launched website, CAqualityratings.org, which allows consumers to search ratings on approximately 10,000 California physicians. As previously reported in September 2016, approximately 13,000 physicians in California received their individual quality measurement scores for the second cycle of the CHPI quality rating program. The program rates physicians using claims data from Medicare fee-for-service, Anthem Blue Cross, Blue Shield of California and UnitedHealthcare. ... April 19, 2017 Managed Care, Medicare Managed Care, Medicare, CHPI, Quality of Care 0 0 Comment Read More »
CMA updates MACRA preparation checklist The California Medical Association’s (CMA) Center for Economic Services has published an update to its Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) preparation checklist. The checklist, “MACRA: What Should I Do Now to Prepare?”, is available in CMA's MACRA resource center at www.cmanet.org/macra. CMA published this important checklist to help physicians understand MACRA payment reforms and what they can do now to start preparing for the transition. Also available in the MACRA resource center is an overview of MACRA, and a comprehensive list of tools, resources and information ... April 19, 2017 Managed Care, Medicare Practice Management, Insurance/Reimbursement, Medicare 0 0 Comment Read More »
UnitedHealthcare requiring stricter notification requirements for out-of-network ASC referral UnitedHealthcare (UHC) recently issued a notification to approximately 80 California physicians reminding them that their participation agreement requires them to refer to in-network ambulatory surgical centers (ASC) for elective services. This notice comes on the heels of an August 2016 announcement that UHC will begin enforcing stricter notification requirements related to out-of-network ASC referrals. According to the UHC letter, physicians wishing to perform services at an out-of-network ASC will be required to notify UHC at least five days in advance of the procedure. Additionally, physicians will be expected to ... April 18, 2017 Managed Care Ambulatory Surgical Centers, ASC, UnitedHealthcare 0 0 Comment Read More »
Health Net Federal Services begins TRICARE contracting initiative As previously reported, the Department of Defense awarded the $17.7 billion TRICARE West Region contract to Health Net Federal Services (HNFS). As the recipient of the contract, HNFS will provide managed care services to 2.9 million TRICARE beneficiaries in 19 western states, including California, beginning October 1, 2017. In preparation for the transition, Health Net has sent recruitment notices to physicians soliciting interest in participation in the new Health Net Federal Services (HNFS) West Region network. Included in the recruitment packet is a “Join our Network” form. Physicians interested in ... April 18, 2017 Managed Care Health Net Federal Services, HNFS, Managed Care, TRICARE 0 0 Comment Read More »
U.S. District Court blocks Anthem-Cigna merger A federal judge has blocked the $48 billion mega-merger between Anthem and Cigna (U.S. v. Anthem Inc., 16-cv-1493). The ruling favored the U.S. Department of Justice (DOJ) and 11 states, including California, who argued that the Anthem-Cigna merger would limit price competition and lower the quality of care that Americans receive. “The California Medical Association (CMA) has opposed the Anthem-Cigna mega-merger since day one because it would hurt patients and increase health care costs,” said CMA President Ruth E. Haskins, M.D. “Limiting market competition would compel insurers to contract ... March 2, 2017 Managed Care Anthem Blue Cross, Cigna 0 0 Comment Read More »
