Anthem Blue Cross continuing medical record reviews and patient health assessments through Inovalon In the Anthem Blue Cross December Professional Network Update, the insurer published a reminder about how it is working with Inovalon, a secure clinical documentation service, to meet the patient reporting requirements specified under provisions of the Affordable Care Act (ACA). Physicians continue to report receiving requests for medical records from Anthem related to “risk adjustment.” These record requests are a result of the commercial risk adjustment program created by ACA Section 1343. The primary goal of the risk adjustment program is to spread the financial risk borne by ... December 21, 2016 Managed Care Affordable Care Act, Anthem Blue Cross 0 0 Comment Read More »
United Healthcare delays 2016-2017 Premium Designation physician results United Healthcare (UHC) has indicated that distribution of its 2016-2017 Premium Designation assessments will be delayed to December 30, 2016, with the results released to the public on March 1, 2017. UHC had previously announced that the next iteration of its Premium Designation assessment results would be sent to physicians in early November 2016, with the results to be released publicly via the payor's online physician directory on January 4, 2017. Physicians who encounter problems with their physician assessment reports or who have concerns regarding their Premium Designations can ... December 21, 2016 Managed Care United Healthcare 0 0 Comment Read More »
Time to verify your patients' eligibility and benefits for 2017 The beginning of a new year brings with it changes to your patients’ eligibility and benefits. Physicians are urged to be diligent in verifying each patient’s eligibility and benefits to ensure they will be paid for services rendered. The beginning of a new year also means that both calendar year deductibles and visit frequency limitations reset. And, with open enrollment, patients may even be covered by a new payor. Don’t get stuck with unnecessary denials or an upset patient. Do your homework before the patient arrives by obtaining updated ... December 21, 2016 General, Managed Care, Medi-Cal, Medicare Running a Practice, Eligibility 0 0 Comment Read More »
United Healthcare to introduce Navigate, new narrow network product, in 2017 United Healthcare (UHC) recently notified physicians that it will be introducing a new commercial narrow network PPO product, Navigate, to the California marketplace effective January 1, 2017. Due to an operational error, the notice issued to California providers inadvertently referenced United Healthcare of Nebraska, which is also launching the Navigate product. UHC has since issued a corrected notice. UHC says the Navigate plan is its most recent effort at providing a reduced-cost health care option to employers. This network offers access to a significantly narrowed network of PPO physicians, ... December 14, 2016 Managed Care United Healthcare 0 0 Comment Read More »
Be prepared for Covered California changes in 2017 In 2016, Covered California, California's health benefit exchange, enrolled approximately 1.4 million individuals in qualified health plans. It is critical that physician practices understand their participation status, which products are being offered and what changes to expect in 2017. Some of the most significant changes for Covered California in 2017 are: All Covered California enrollees, including those with a PPO or EPO, will be assigned to a primary care physician. The assignment will either happen by January 1, 2017, or within 60 days of the enrollee’s ... December 14, 2016 Managed Care Covered California, Affordable Care Act, Exchange Plans, Health Insurance Exchange 0 0 Comment Read More »
U.S. divided about what should be done with ACA A Kaiser Family Foundation poll has found that Americans are divided on the future of the Affordable Care Act (ACA). The survey found that 26 percent of the country wants to repeal the entire law. Meanwhile, 30 percent want to expand the law, 19 percent want to keep it as-is and 17 percent want to scale it back. The poll found that Republican respondents were more likely to want to scale back the law, rather than fully repealing it. Among the 26 percent of Americans who want to see the ... December 14, 2016 General, Managed Care Affordable Care Act, ACA 0 0 Comment Read More »
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 »
Court proceedings begin in Anthem-Cigna mega-merger lawsuit On Monday, the U.S. Justice Department (DOJ) and a bipartisan group of state attorneys started court proceedings to block the $48 billion mega-merger between Anthem and Cigna. The merger, if allowed to proceed, would reduce competition and increase health plan market power, compromising patients’ access to care and negatively impacting the quality and affordability of health care across the country. “The California Medical Association has opposed the Anthem-Cigna mega-merger since day one because it will hurt patients and increase health care costs,” said California Medical Association (CMA) President Ruth E. ... November 28, 2016 General, Managed Care Anthem, Cigna, Mega-mergers 0 0 Comment Read More »
Anthem-Cigna mega-merger compromises health care access, quality and affordability Today, the U.S. Department of Justice (DOJ) and a bipartisan group of state attorneys started court proceedings to block the $48 million mega-merger between Anthem and Cigna (U.S. v. Anthem Inc., 16-cv-1493). “The California Medical Association has opposed the Anthem-Cigna mega-merger since day one because it will hurt patients and increase health care costs,” said California Medical Association (CMA) President Ruth E. Haskins, M.D. “Limiting market competition would compel insurers to contract with fewer physicians, resulting in higher premiums and longer wait times for referrals – not to mention forcing ... November 22, 2016 Managed Care Anthem Blue Cross, Cigna, Insurance, Legal Advocacy 0 0 Comment Read More »
State's high court rules health plans cannot negligently delegate payment responsibility The California Supreme Court today ruled that health plans cannot absolve themselves of the responsibility to pay claims for emergency care by noncontracted providers by negligently delegating that responsibility to a risk-bearing organization that it knows—or should have known—to be financially insolvent. "Today's ruling is a huge victory for physicians," said Francisco Silva, Senior Vice President and General Counsel for the California Medical Association (CMA). "California's high court is unequivocally telling health plans they cannot get away with this morally blameworthy behavior. They cannot irresponsibly delegate risk and leave physicians ... November 21, 2016 Managed Care Amicus Briefs, California Supreme Court, Health Net, Legal Advocacy 0 0 Comment Read More »
