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CMA creates new resource summarizing Medicare incentive and penalty programs

Over the past few years, Congress has created a number of programs that call for payment incentives and reductions (referred to as “adjustments” by the Centers for Medicare and Medicaid Services) that impact physicians and their practices. At their inception, most of these programs offered an incentive to participate. However, most of the programs are entering their penalty phases, with complex and potentially conflicting requirements and implementation processes. To help physicians understand how these programs will affect their practices, the California Medical Association (CMA) has created a new resource, “Medicare ...

Congress passes a number of health care provisions in the current budget

Congress narrowly passed a $1.1 trillion federal budget that will fund most of the federal government through September 2015. Below is a summary of key health care provisions in the bill. Within the bill, Congress expressed concern that there had not been adequate opportunity for public comment on bundling of surgical codes in the final rule of the Medicare Physician Fee Schedule. The budget bill says that the appropriate methodology has not been tested to ensure that patient care and patient access are not negatively impacted ...

CMA elects new chair and vice chair of its board of trustees

On Sunday, December 7, 2014, the California Medical Association (CMA) Board of Trustees elected David H. Aizuss, M.D., as the new chair and Robert E. Wailes, M.D., as vice chair. Dr. Aizuss is a board certified ophthalmologist practicing in Los Angeles. Through the David H. Aizuss, M.D., Medical Corporation, and the Ophthalmology Associates of the Valley Medical Surgical Group, a partnership of medical corporations, Dr. Aizuss focuses exclusively on direct patient care. He also serves as an assistant clinical professor of Ophthalmology at the UCLA Geffen School of Medicine. Dr. Aizuss ...

Lame duck session of Congress adjourns, leaving SGR reform until 2015

In the final hours of the lame duck session, Congress passed a $1.01 trillion spending bill that will keep most of the federal government funded through next September, but it failed to pass a fix for the Medicare sustainable growth rate (SGR). Congress will leave it to be addressed before the April 1 deadline next year, when physicians will be faced with a 21 percent payment cut. Unfortunately, Congress will begin anew with many new members who have not been a part of the bipartisan, bicameral SGR Repeal and Medicare ...

Potential Medicare pay cuts coming in 2015; participation selections due Dec. 31

It's that time of year again – time for physicians to decide about their participation in Medicare. Physicians have until Dec. 31, 2014, to make changes to their status for 2015. In addition to the annual threat of steep payment cuts as a result of the sustainable growth rate (SGR) formula, another factor for physicians to consider is that 2015 will be the first year that the Centers for Medicare & Medicaid Services (CMS) will impose penalties under the value-based modifier (VBM) program for large medical groups of 100 ...

New prescription drug prior authorization form required on Jan. 1 for DMHC regulated products

On January 1, 2015, a new law will fully take effect that streamlines and standardizes the prior authorization process for prescription drugs. The law (SB 866) requires all insurers, health plans (and their contracting medical groups/IPAs) and providers to use a standardized two-page form for prior authorizations of prescription medications. The law also requires plans and insurers to make a determination on prescription drug prior authorization requests within two days of receipt, and if they fail to do so the requests will be deemed authorized. The new law does not ...

Be prepared for Covered California changes in 2015

In 2014, Covered California, California's health benefit exchange, enrolled approximately 1.4 million individuals statewide in new health plans. With Covered California aiming to enroll an additional 500,000 during the 2015 open enrollment period, it is critical that physician practices understand their participation status, which products are being offered and what changes to expect in 2015. To help physicians understand the changes taking place and how they will affect their practice, the California Medical Association (CMA) has published a new tip sheet titled, “Surviving Covered California: Preparing for 2015.”  

CMS announces new rules to curb Medicare fraud

The Centers for Medicare and Medicaid Services (CMS) announced new rules will improve CMS’ ability to deny or revoke the enrollment of entities and individuals that pose a program integrity risk to Medicare. According to a press release, the “new safeguards are designed to prevent physicians and other providers with unpaid debt from re-entering Medicare and remove providers with patterns or practices of abusive billing." These changes are expected to save more than $327 million annually. CMS announced it has already removed nearly 25,000 providers from Medicare. Its strategy for ...

DHCS identifies glitch in UCR web app for CHDP primary care rate increase payments

The California Department of Health Care Services (DHCS) has identified an error in its web application that was designed to allow physicians the ability to enter their usual and customary rates (UCR) for Child Health and Disability Prevention Program Services (CHDP) claims. Physicians who already entered their UCR data prior to November 26, 2014, will need to return to the portal and reenter their information. The web app was developed to address a problem with the Affordable Care Act primary care rate increase unique to CHDP providers. Before the rate increases ...

CMA passes five tobacco-related resolutions

The California Medical Association (CMA) has been a tireless advocate for stronger restrictions on the tobacco industry for decades. This weekend, the CMA House of Delegates (HOD) continued that tradition, adopting five antismoking resolutions. The resolutions address increasing the legal age for tobacco sales, the use of electronic cigarettes and a tobacco-free military. Resolution 104-14 asks CMA to support the removal of the tobacco control pre-emption from the California Penal Code so that local governments would have the ability to increase the legal age of tobacco sales to 21. Resolutions 101-14, ...