AHIP conducting follow-up survey on Provider Directory Pilot America's Health Insurance Plans (AHIP) is conducting a follow-up survey of providers to evaluate the process and results of its earlier Provider Directory Pilot program. This program was aimed at meeting the requirements of California Senate Bill 137, which requires that physician directories are more accurate and up-to-date. AHIP has contracted with independent research organization NORC, at the University of Chicago, to reach out to providers as part of the evaluation phase of the provider directory pilot. Outreach to providers will include an online survey of provider office staff who ... November 16, 2016 General, Managed Care Network Adequacy, Provider Directories, Provider Directory Accuracy Law 0 0 Comment Read More »
United to issue new 2016-2017 Premium Designation physician results In its October Network Bulletin, United Healthcare (UHC) announced that the next iteration of its Premium Designation assessment results will be sent to physicians in early November. These results will be released publicly via the payor's online physician directory beginning January 4, 2017. Physicians within 16 specialties (allergy, cardiology, ENT, endocrinology, family medicine, gastroenterology, general surgery, internal medicine, nephrology, neurology, neurosurgery, OB/GYN, pediatrics, pulmonology, rheumatology and urology) and their 47 credentialed sub-specialties will again be ranked by UHC on both national and specialty-specific measures for quality and various cost-efficiency benchmarks. ... November 16, 2016 Managed Care United Healthcare 0 0 Comment Read More »
Physicians have until November 30 to dispute 2015 PQRS and QRUR findings The Centers for Medicare and Medicaid Services (CMS) recently released data that indicates which physicians will be subject to the 2017 payment penalties associated with the Physician Quality Reporting System (PQRS) and Value-Based Payment Modifier (VM) programs. Physicians who have concerns about the findings in their report(s) have until November 30 to file for an informal review of their data. The penalties in question stem from policies in effect prior to the enactment of the Medicare Access and CHIP Reauthorization Act (MACRA). Failure to successfully complete required PQRS reporting ... November 14, 2016 Managed Care, Medi-Cal, Medicare Quality Reporting, Medicare, Physician Quality Reporting System, PQRS 0 0 Comment Read More »
CMS and AMA schedule MACRA webinars The Centers for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) have scheduled a number of educational webinars to help physicians understand and prepare for the new Medicare Quality Payment Program for physicians created by the Medicare Access and CHIP Reauthorization Act (MACRA). Below is a list of upcoming webinars: Title: Quality Payment Program Final Rule Presented by: CMS Date: Tuesday, November 15, 2016 Time: 10:30 a.m. to 12 p.m. PT Register: Click here Title: MACRA Education Presented by: AMA Date: Monday, November 21, 2016 Time: 4 to 5:30 p.m. PT Register: Click here Title: MACRA Education Presented ... November 4, 2016 Managed Care, Medi-Cal, Medicare MACRA, Webinars 0 0 Comment Read More »
Cloud computing providers need to sign business associate agreements, says OCR The U.S. Department of Health and Human Services Office of Civil Rights (OCR) recently released updated guidance on the use of cloud computing for the storage or transmission of electronic personal health information (ePHI). The new guidance clarifies that cloud service providers are considered "business associates" under HIPAA, even if the provider only stores encrypted data and doesn't have a decryption key to view the data. This means that if a covered entity (or business associate) uses a cloud service provider to maintain ePHI without entering into a business associate ... November 1, 2016 EHR, Managed Care Health Information Technology (HIT), Electronic Health Record 0 0 Comment Read More »
MACRA final rule exempts one-third of Medicare physicians from MIPS Nearly a third of Medicare physicians could be exempt from Medicare's new merit-based incentive payment system (MIPS) under the final rule implementing the Medicare Access and CHIP Reauthorization Act (MACRA). The rule was released today by the Centers for Medicare and Medicaid Services (CMS). In the final rule, CMS raised the low-volume threshold, so that providers with less than $30,000 in Medicare payments or fewer than 100 Medicare patients are exempt from the MIPS reporting requirements. The earlier proposed rule would only have exempted physicians with less than $10,000 ... November 1, 2016 Managed Care, Medicare Centers for Medicare and Medicaid Services, MACRA, Medicare 0 0 Comment Read More »
CMA publishes FAQ on controversial new law to end "surprise billing" In September 2016, Governor Jerry Brown signed into law a controversial bill (AB 72) that will change the billing practices of non-participating physicians providing non-emergency care at in-network hospitals, ambulatory surgery centers and laboratories. While the enactment of AB 72 can never be described as favorable, the end result is a law that puts to rest the issue of so-called “surprise billing” in a way that preserves the ability of physicians to continue collecting their usual rate (as long as they obtain the consent of the patient), implements a statutory ... October 14, 2016 General, Managed Care Network Adequacy, Out of Network Care, Provider Networks 0 0 Comment Read More »
Know Your Rights: Managed care contractual protections CMA’s “Know Your Rights” series summarizes vital protections under state and federal law that physicians should be aware of in their dealings with payors. Thanks to legislation sponsored by the California Medical Association (CMA), all health plan contracts with physicians are required to be fair, reasonable and consistent with California law and regulations. Contractual clauses that are specifically prohibited cover the following: Claims filing deadlines that are inconsistent with the law (see "Unfair Payment Practice: Timely Filing Denials") Financial incentives to deny, reduce, limit ... October 13, 2016 Managed Care Know Your Rights, Managed Care, Payor Contracting 0 0 Comment Read More »
Blue Shield to update fee schedule effective December 1 Blue Shield recently announced changes to its physician fee schedule that will take effect December 1, 2016. The new rates are now available on the Blue Shield website (under "Helpful Resources," click “Professional Fee Schedule” then click “Search the Claims Fee Schedule”). To view the new fees, change the default date of service on the “Search Fee Schedule” page to December 1, 2016, (effective date of the change) or later. Physicians can also request a copy of the new fees for up to 20 codes by completing the allowance review ... October 13, 2016 General, Managed Care Blue Shield 0 0 Comment Read More »
Physicians encouraged to verify CHPI data by November 11 Earlier this month, approximately 13,000 physicians in California received their individual quality measurement scores for the second cycle of the California Healthcare Performance Initiative System (CHPI) quality rating program. Physicians can review and verify the accuracy of the data used to calculate their scores through the CHPI online portal through November 11, 2016. The program rates physicians using claims data from Medicare fee-for-service, Anthem Blue Cross, Blue Shield of California and United Healthcare. This claims data includes both commercial and self-funded health plan data from HMO, PPO, POS and Medicare ... September 22, 2016 Managed Care, Medicare Medicare, Quality of Care, United Healthcare, Anthem Blue Cross, Blue Shield, CHPI 0 0 Comment Read More »
