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Earn 10 CME at La Jolla cardiology conference: Landmark Clinical Trials Revisited

On February 24, 2017, California physicians have the opportunity to earn up to 10 continuing medical education (CME) units during “Landmark Clinical Trials Revisited: 3 and 5 Year Results,” held at La Valencia Hotel in La Jolla. Attendees will learn about the main advances in cardiology over the last five years and how these advances have impacted the major disease processes in cardiovascular medicine. Put on by Vimal I. Nanavati, M.D., a long-time California Medical Association (CMA) member, CMA Political Action Committee (CALPAC) board member and CMA Organized Medical Staff ...

Anthem Blue Cross continuing medical record reviews and patient health assessments through Inovalon

In the Anthem Blue Cross December Professional Network Update, the insurer published a reminder about how it is working with Inovalon, a secure clinical documentation service, to meet the patient reporting requirements specified under provisions of the Affordable Care Act (ACA). Physicians continue to report receiving requests for medical records from Anthem related to “risk adjustment.” These record requests are a result of the commercial risk adjustment program created by ACA Section 1343. The primary goal of the risk adjustment program is to spread the financial risk borne by ...

United Healthcare delays 2016-2017 Premium Designation physician results

United Healthcare (UHC) has indicated that distribution of its 2016-2017 Premium Designation assessments will be delayed to December 30, 2016, with the results released to the public on March 1, 2017. UHC had previously announced that the next iteration of its Premium Designation assessment results would be sent to physicians in early November 2016, with the results to be released publicly via the payor's online physician directory on January 4, 2017. Physicians who encounter problems with their physician assessment reports or who have concerns regarding their Premium Designations can ...

Time to verify your patients' eligibility and benefits for 2017

The beginning of a new year brings with it changes to your patients’ eligibility and benefits. Physicians are urged to be diligent in verifying each patient’s eligibility and benefits to ensure they will be paid for services rendered. The beginning of a new year also means that both calendar year deductibles and visit frequency limitations reset. And, with open enrollment, patients may even be covered by a new payor. Don’t get stuck with unnecessary denials or an upset patient. Do your homework before the patient arrives by obtaining updated ...

United Healthcare to introduce Navigate, new narrow network product, in 2017

United Healthcare (UHC) recently notified physicians that it will be introducing a new commercial narrow network PPO product, Navigate, to the California marketplace effective January 1, 2017. Due to an operational error, the notice issued to California providers inadvertently referenced United Healthcare of Nebraska, which is also launching the Navigate product. UHC has since issued a corrected notice. UHC says the Navigate plan is its most recent effort at providing a reduced-cost health care option to employers. This network offers access to a significantly narrowed network of PPO physicians, ...

Be prepared for Covered California changes in 2017

In 2016, Covered California, California's health benefit exchange, enrolled approximately 1.4 million individuals in qualified health plans. It is critical that physician practices understand their participation status, which products are being offered and what changes to expect in 2017. Some of the most significant changes for Covered California in 2017 are: All Covered California enrollees, including those with a PPO or EPO, will be assigned to a primary care physician. The assignment will either happen by January 1, 2017, or within 60 days of the enrollee’s ...

Health care spending rose modestly in 2015

In 2015, per-capita health care spending grew by 5 percent and overall health spending grew by 5.8 percent, according to a new study by the Office of the Actuary at the Centers for Medicare and Medicaid Services. While overall expenditures increased, the rate of growth is still substantially lower than the 9 percent average rate seen in the three decades before 2008. On a per-enrollee basis, overall spending increased in 2015 by 4.5 percent for private health insurance, 1.7 percent for Medicare and 3.8 percent for Medicaid. According to the ...

Congress approves $6.3 billion medical innovation legislation

After several years of hearings and negotiations, Congress has passed a $6.3 billion medical innovation package intended to accelerate the discovery, development and delivery of new therapies, including $1 billion to help states address the opioid epidemic. It also provides important electronic health record (EHR) reforms for physicians and for the first time will penalize vendors for failing to have interoperable systems. The bill (HR 6), known as the "21st Century Cures Act," is intended to bridge the gap between medical science and legislative action and regulations that slow ...

U.S. divided about what should be done with ACA

A Kaiser Family Foundation poll has found that Americans are divided on the future of the Affordable Care Act (ACA). The survey found that 26 percent of the country wants to repeal the entire law. Meanwhile, 30 percent want to expand the law, 19 percent want to keep it as-is and 17 percent want to scale it back. The poll found that Republican respondents were more likely to want to scale back the law, rather than fully repealing it. Among the 26 percent of Americans who want to see the ...

Webinar: Preventing physician burnout

The Physician’s Foundation biennial Survey of America’s Physicians has consistently shown the professional morale of physicians as problematic, with a majority of physicians in 2016 describing their feelings about the current state of the medical profession as somewhat or very negative. The California Medical Association (CMA) will host its first webinar of 2017, "Preventing Burnout: Individual and Organizational Intervention,” on Wednesday, January 11, from 12:15 to 1:15 p.m., to help physicians recognize and respond to burnout. The webinar is free to members and their staff. Our presenter, Karen Miotto, M.D., ...