DHCS expands phone system for Medi-Cal recipients in wake of critical June audit report In June, the California State Auditor’s office released a report that found the Medi-Cal phone system for beneficiaries to be “severely deficient”; the auditor urged the Department of Health Care Services (DHCS) to make upgrades. The report found that DHCS had an average of 12,500 unanswered calls each month, between February 2014 and January 2015. Some months, the telephone system rejected as many as 45,000 calls. On September 30, 2015, DHCS announced that the ombudsman phone system has been expanded. The new system is expected to improve data collection, reduce ... October 14, 2015 Medi-Cal Medi-Cal, Audits 0 0 Comment Read More »
Medi-Cal to use ICD-10 crosswalk for claims payment The California Department of Health Care Services (DHCS) did not convert from ICD-9 to the ICD-10 coding system by the federally mandated October 1, 2015, conversion date. DHCS has received approval from the Centers for Medicare and Medicaid Services to take incoming claims coded with ICD-10 codes and convert them back to ICD-9 using a crosswalk in order to calculate payments. DHCS reports the crosswalk is a temporary workaround until the department is able to transition to a new claims processing system. The California Medical Association (CMA) has requested that DHCS ... October 14, 2015 Medi-Cal DHCS, ICD-10, Medi-Cal, Department of Health Care Services 0 0 Comment Read More »
ICD-10 Has Arrived! The ICD-10 implementation date has finally arrived. While concerns remain as to the preparedness of physician practices, vendors and payors for this monumental transition, the full impact of the ICD-10 conversion will likely not be felt for several weeks or until the first payment remittances are received. In an effort to help practices navigate the transition, CMA has just published an FAQ titled, “Surviving ICD-10: An FAQ for physician practices." This resource is available free for CMA members (it is not accessible at all for non-members). We will be ... October 1, 2015 Managed Care, Medi-Cal, Medicare ICD-10 0 0 Comment Read More »
DHCS implements period of "deemed eligibility" for Cal MediConnect plans Effective September 1, 2015, Cal MediConnect will have the option to offer a one- or two-month period of “deemed eligibility,” defined as a grace period, to beneficiaries that lose Medi-Cal eligibility due to a change in circumstance. Cal MediConnect plans have the option to, but are not required to, offer this “grace period." According to the 2013 Medicare-Medicaid Plan Enrollment and Disenrollment Guidance, a Cal MediConnect plan may choose to provide a one- or two-month period of deemed continued eligibility for individuals who lose Medicaid eligibility, if the individual ... September 8, 2015 Medi-Cal Cal MediConnect 0 0 Comment Read More »
CMS clarifies ICD-10 grace period guidance In early July, the Centers for Medicare & Medicaid Services (CMS) announced that for a period of one year, it will allow for flexibility in claims payment, auditing and quality reporting processes as the medical community gains experience using the new ICD-10 code set. CMS specifically clarified its statement that during the 12 months after ICD-10 implementation, contractors would not deny claims based solely on the specificity of the ICD-10 diagnosis code. However, according to the latest FAQ, claims will be rejected if they do not contain a valid ICD-10 ... August 28, 2015 Managed Care, Medi-Cal, Medicare CMS, ICD-10, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
Medi-Cal providers: Are you ready for ICD-10? The California Department of Health Care Services (DHCS) is asking Medi-Cal providers to take a brief survey about their readiness for the October 1, 2015, transition to ICD-10. The purpose of the survey is to determine provider and submitter health care transaction preparedness. DHCS is encouraging Medi-Cal providers and submitters, including Family Planning, Access, Care and Treatment (Family PACT) providers, to take the survey. While participation is not required, provider responses to the survey will help Medi-Cal assess any issues or concerns that may hinder ICD-10 compliance. All answered surveys ... August 28, 2015 Medi-Cal Family PACT, ICD-10, Medi-Cal, DHCS 0 0 Comment Read More »
CMS to hold webinars for providers on Physician Compare website The Centers for Medicare and Medicaid Services (CMS) will host a series of one-hour webinars about public quality reporting and the Physician Compare website. The Affordable Care Act required CMS to create a website that would allow consumers to search for and compare physicians and other health care professionals who provide Medicare services. That site—the "Physician Compare" website, initially launched in 2010—provides contact information, specialties and clinical training, hospital affiliations and group practice information. In 2014, the website also began phasing in physician quality data from the Physician Quality Reporting System ... August 17, 2015 Managed Care, Medi-Cal, Medicare CMS, Quality Reporting, Webinars, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
Gallup poll says rates of uninsured continue to drop in most states According to a Gallup poll released Monday, the national uninsured rate has fallen to 11.7 percent, down from 17.3 percent in 2013. The poll shows that states that have expanded Medicaid under the Affordable Care Act – and have at least helped in the running of their health insurance marketplaces, rather than leaving it entirely to the federal government – have seen larger drops in uninsured rates. In the 22 states that took both of those measures, including California, the uninsured rate dropped to an average of 7.1 percent. California's uninsured ... August 17, 2015 Managed Care, Medi-Cal, Medicare Affordable Care Act, Health Insurance Exchange, Uninsured, ACA, Insurance 0 0 Comment Read More »
Spending for federal health programs is expected to remain 'modest' over the next 10 years Total health care spending growth for federal health programs such as Medicare and Medicaid is expected to average 5.8 percent in aggregate over 2014-2024, according to a report published by the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary. The authors noted that this rate of growth is still substantially lower than the 9 percent average rate seen in the three decades before 2008. “Growth in overall health spending remains modest even as more Americans are covered, many for the first time. Per-capita spending and medical ... July 30, 2015 Medi-Cal, Medicare Centers for Medicare and Medicaid Services, Medicaid, Medicare, Affordable Care Act 0 0 Comment Read More »
Senate panel pushes HHS to delay stage 3 meaningful use The Senate Health, Education, Labor and Pensions Committee is asking the U.S. Department of Health and Human Services (HHS) to delay the stage 3 meaningful use rules, its chairman, Lamar Alexander (R-Tenn.) said during a news conference Thursday. The Centers for Medicare and Medicaid Services (CMS) issued proposed rules for stage 3 in March 2015. What's concerning providers is that this stage differs from the others in the degree to which a medical provider, to fulfill its requirements, must depend on other providers to document electronically that they have fulfilled ... July 29, 2015 Medi-Cal, Medicare CMS, Meaningful Use, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
