Did you know: The key word in any appeal is... Thanks to California Medical Association (CMA) sponsored legislation (AB 1455) and the resulting regulations, payors are required to establish a fast, fair and cost-effective dispute resolution mechanism (i.e., “appeal process”) to resolve provider disputes. Anytime a payor contests, adjusts or denies a claim, they are required to advise the provider of the availability of the appeal process and instructions for submitting the appeal. Payors are also required to acknowledge receipt of a written appeal within two working days for electronic appeals or 15 working days for paper appeals. The payor ... August 6, 2015 General State Legislative Advocacy, Appeals 0 0 Comment Read More »
CMA Capitol Insight: August 5, 2015 CMA Capitol Insight is a biweekly column by veteran journalist Anthony York, reporting on the inner workings of the state Legislature. _________________________________________________________________________________________________________________ Recess, but not rest It may be recess for the Legislature, but that doesn’t mean a rest for politics. While lawmakers were scattered off to their districts or far-away lands for the summer junket season, the anti-vax forces were busy gathering signatures to recall Senator Richard Pan, M.D., for authoring Senate Bill 277, which removes the personal belief exemption from school vaccination requirements. While it is unclear whether an actual referendum ... August 6, 2015 General Anthony York, CMA Capitol Insight 0 0 Comment Read More »
Join us for our Walk With A Doc event Walking for as little as 30 minutes a day can reduce your risk of coronary heart disease, improve your blood pressure and blood sugar levels, elevate your mood, and reduce your risk of osteoporosis, cancer and diabetes. Join us for our Walk With A Doc event to take a step toward a healthier you! All you need to do is lace up a pair of comfortable shoes and join us for some fresh air, fun and fitness. Time: Saturday, September 19, 2015 at 7:00 a.m. Registration starts at 6:30 a.m. Flyer Location: ... August 6, 2015 General Walk With A Doc 0 0 Comment Read More »
Ask the Expert: Can my PA/NP see my patients when I'm on vacation? Summer generally means vacations for everyone, and physicians are no exception. But what happens to patients when their physicians are on vacation? There are options for physician offices to continue to provide care to their patients, but the question that seems to come up annually is whether the physician assistant (PA) or nurse practitioner (NP) can provide services when the physician is out of the office and still bill as “incident to” services. The answer is no. The Centers for Medicare and Medicaid Services (CMS) states that to qualify as ... August 5, 2015 General Nurse Practitioners, Physician Assistants, Allied Health 0 0 Comment Read More »
Noridian announces new audits Noridian, California's Medicare administrative contractor, has announced it will be conducting service-specific targeted audits of procedure codes 99205 and 99233 when rendered by providers with specific specialties: 99205 performed by cardiology (Centers for Medicare and Medicaid Services specialty designation 06) and pulmonary (29) 99233 performed by internal medicine (11) and hematology/oncology (83) Noridian conducts these targeted reviews based on data analysis. An analysis of these procedure codes, when performed by physicians in these specialties, indicated a higher utilization by California providers when compared ... August 5, 2015 Medicare Medicare, Noridian, Audits 0 0 Comment Read More »
AMA expands initiative to transform medical education The American Medical Association (AMA) announced that it will seek to triple the number of medical schools participating in its Accelerating Change in Medical Education Consortium, launched in 2013 to reshape medical education in the United States. AMA will provide $1.5 million over the next three years to fund up to 20 additional projects that support a significant redesign of undergraduate medical education. Interested medical schools must submit their proposals by September 16, 2015. The goal of the initiative is to work toward a significant redesign of undergraduate medical education ... August 3, 2015 General Medical School, Medical Students, American Medical Association 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 »
Covered California statewide premium costs to rise 4 percent in 2016 Californians insured through Covered California, the state’s health benefit exchange, will see their premiums rise an average of 4 percent in 2016, less than last year’s increase of 4.2 percent. However, consumers in some Bay Area and Sacramento counties will see higher premium increases—up to 8.2 percent in Sacramento and 12.8 percent in Santa Cruz, Monterey and San Benito—while Southern California counties will see increases of around 1.8 percent. However, Covered California Executive Director Peter Lee noted that consumers can see their premiums drop an average of 4.5 percent – ... July 29, 2015 Managed Care Covered California 0 0 Comment Read More »
CMS releases proposed 2016 Medicare physician fee schedule The Centers for Medicare and Medicaid Services (CMS) recently released the 2016 proposed Medicare physician payment rule. The rule reflects the 0.5 percent increase in payment as of July 1, 2015, and the additional 0.5 percent increase in payment on January 1, 2016, recently adopted by Congress. Overall, Medicare will pay physicians nearly $700 million more in 2016 than they will have paid in 2015. Most notable in the payment rule is CMS’ proposal to pay for advance care planning and end-of-life counseling. The fee schedule would establish two new ... July 29, 2015 Medicare CMS, Medicare, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
House passes bill to increase funding for medical research and speed FDA approvals Last week, the U.S. House of Representatives voted overwhelmingly (344-77) to pass a bill known as the "21st Century Cures Act," which would boost federal funding for medical research and speed up Food and Drug Administration (FDA) approvals for many new drugs and medical devices. The bill, HR 6, will give $8.75 billion to the National Institutes of Health (NIH) for research and another $550 million to the FDA over the next five years. A scaled-down bill has been introduced in the U.S. Senate and there are hopes that it ... July 29, 2015 General Food and Drug Administration, Research and Experimental Medicine, Federal Legislation, Medical Devices, Public Health 0 0 Comment Read More »
