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 »
United Healthcare fails to provide proper notification on rollout of clinical data submission protocol The California Medical Association (CMA) is concerned that United Healthcare (UHC) failed to properly notify physicians before implementation of its Clinical Data Submission Protocol. Although California law (California Insurance Code §10133.65 and Health & Safety Code §1375.7) requires payors to provide contracted physicians with the 45 business days’ advance notice of any material contracting changes, UHC's only notification to physicians about this new protocol was in its Network Bulletin. First introduced in 2015, the program originally targeted only Medicare benefit plans and required physicians to submit all laboratory test ... September 13, 2016 Managed Care, Medicare United Healthcare, 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 »
Last chance for some providers to prevent deactivation by Medicare Noridian, Medicare’s administrative contractor for California, will soon begin deactivating billing privileges for physicians who received revalidation notices from Noridian but have not submitted completed applications to the Centers for Medicare and Medicaid Services (CMS). Last month, Noridian reported that only 19 percent of providers had responded to the most recent Medicare Part B revalidation notices. Since the passage of the Affordable Care Act (ACA), all Medicare providers and suppliers have been required to revalidate their Medicare enrollment information under new enrollment screening criteria in an effort to prevent ... August 8, 2016 Medicare Noridian, Medicare 0 0 Comment Read More »
CMA publishes MACRA preparation checklist On April 16, 2015, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), changing the health care financing system in the most significant and far-reaching way since the program's inception in 1965. To help physicians understand MACRA payment reforms, and what they can do now to start preparing for the transition, the California Medical Association (CMA) has published an important checklist titled, “MACRA: What Should I Do Now to Prepare?” The checklist is available in CMA's MACRA resource center at www.cmanet.org/macra. There you will ... August 8, 2016 CMA, Medicare Practice Resources, Running a Practice, MACRA, Medicare 0 0 Comment Read More »
CMS Releases Proposed 2017 Medicare Physician Fee Schedule The Centers for Medicare and Medicaid Services (CMS) recently released the proposed 2017 Medicare physician payment rule. According to CMS, the new payment rule will transform how Medicare pays for primary care through a new focus on care management and behavioral health. The proposed rule also begins to implement the California Geographic Practice Cost Index (GPCI) fix, which will overhaul California’s outdated geographic payment localities. This long-overdue fix updating California’s Medicare physician payment regions will raise payment levels for 14 urban California counties misclassified as rural, while holding the remaining ... July 25, 2016 General, Medicare 2017 Medicare physician payment rule , Centers for Medicare and Medicaid Services (CMS) 0 0 Comment Read More »
MACRA webinar now available on-demand A recording of the California Medical Association’s (CMA) recently held webinar – MACRA: What Is CMA Doing to Improve It? What Steps Can You Take to Prepare Now? – is now available to download in CMA’s online resource library. The webinar is available free to members; the cost is $99 for nonmembers. In this webinar, CMA Vice President of Federal Government Relations Elizabeth McNeil provides a brief overview of the new Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) payment changes. She also discusses CMA’s advocacy efforts with the ... July 20, 2016 Medicare MACRA, Webinars, Medicare 0 0 Comment Read More »
Noridian reports low response rate for Medicare Part B revalidations Noridian, Medicare’s administrative contractor for California, reports that only 19 percent of physicians have responded to the most recent Medicare Part B revalidation notices. Noridian is in the process of deactivating Medicare billing privileges for physicians who received a revalidation notice from Noridian but did not turn in a completed application to the Centers for Medicare and Medicaid Services (CMS) prior to the most recent deadline of May 31. If you are deactivated for failure to respond to a revalidation notice, you must submit a reactivation application. The date ... July 14, 2016 Medicare Noridian, Medicare 0 0 Comment Read More »
Noridian begins deactivation of providers who failed to revalidate The due date for physicians to revalidate their Medicare enrollment information has passed for the most recent cycle of physician revalidation required by the Centers for Medicare and Medicaid Services (CMS). Physicians who received a revalidation notice from Noridian, CMS’ Medicare contractor for California, and who did not turn in a completed application to CMS prior to the May 31 deadline, will have their Medicare billing privileges deactivated. If you are deactivated for failure to respond to a revalidation notice, you must submit a reactivation application. The date of receipt ... June 8, 2016 Medicare Noridian, Medicare 0 0 Comment Read More »
Reminder: CMS meaningful use hardship exception deadline is July 1 Physicians should be aware that July 1, 2016, is the extended deadline for physicians to file hardship exception applications from the electronic health record incentive program meaningful use requirements. In mid-December 2015, Congress adopted a last-minute bill that gave the Centers for Medicare and Medicaid Services (CMS) the authority to grant a blanket exception for all eligible physicians who applied for an exception from the 2015 meaningful use penalties. CMS reports the extension is being granted “so providers have sufficient time to submit their applications to avoid adjustments to their Medicare ... June 8, 2016 Medicare Meaningful Use, Medicare, Important Deadline 0 0 Comment Read More »
