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Don't miss out on increased Medi-Cal payments

The California Department of Health Care Services (DHCS) will soon be implementing rate increases for primary care physicians who treat Medicaid patients, as authorized under the Affordable Care Act. The increase also applies to services provided by physicians to Medi-Cal managed care patients. In order to see the bump in pay, providers must first attest to their eligibility. According to DHCS, less than half of eligible providers have completed the brief self-attestation process as of September 24.   For purposes of this regulation, primary care is defined as family medicine, general ...

NEPO surveys L.A. physicians' immunization practices for adults

Each year, vaccine preventable diseases impact the lives of millions of people in the United States. While there have been tremendous gains in vaccinating and preventing infectious diseases in children under the age of 18, due in part to the establishment of the Vaccines for Children Program in 1994, the complexity of reaching adults in need of recommended vaccinations often varies by age group, risk factors, existing medical conditions and medical insurance coverage.   Last year, the California Medical Association Foundation’s Network of Ethnic Physician Organizations (NEPO), in collaboration with the ...

FDA issues final guidance on mobile medical apps

The U.S. Food and Drug Administration (FDA) has issued final guidance for developers of mobile medical applications (apps) or software programs that run on mobile communication devices and perform the same functions as traditional medical devices. According to an agency press release, the FDA intends to focus its regulatory oversight on a subset of mobile medical apps that present a greater risk to patients if they do not work as intended. "Mobile apps have the potential to transform health care by allowing doctors to diagnose patients with potentially life-threatening conditions outside ...

DHCS to give webinar on Medi-Cal telehealth billing September 26

The Department of Health Care Services (DHCS) is hosting a telehealth billing webinar on September 26, from 10 to 11 a.m., to help Medi-Cal providers understand how to bill for telehealth services including reimbursement for transmission and facility fees. The webinar is open to all Medi-Cal providers.   During the one-hour webinar, DHCS will guide providers in completing accurate claims for timely payment by: defining billable telehealth services; explaining how to fill out claims; listing HCPCS and CPT-4 codes used for telehealth billing; and sharing the updated telehealth section of the ...

CMA Foundation hires health policy leader to head exchange education program for providers

The CMA Foundation has hired a health policy leader, Kena C. Burke, MPP, to manage a physician education program aimed at getting physicians up-to-speed on California’s health benefit exchange, Covered California. The program is expected to reach some 200,000 health care providers in the state.   This program was made possible thanks to a $1.5 million grant, recently awarded jointly to the California Medical Association, the CMA Foundation, Latino Physicians of California, the California chapter of the American Academy of Pediatrics and a number of county medical societies.   As program director, Burke ...

Legislative update: Year of challenges, victories

This year turned out to be a challenging year for the California Medical Association (CMA). We knew would be a historic year with the implementation of federal health care reform (ACA) and the wave of legislative freshman. We anticipated that many issues would arise as we helped to educate new legislators not only about the ACA, but about the many issues important to the physician community in California.   CMA faced an unprecedented number of scope of practice expansion bills introduced in the Legislature. These scope of practice bills were painted ...

Medicare transition update

September 16, 2013, marked the transition to the new Medicare Administrative Contractor, Noridian. In the first few days, the California Medical Association (CMA) heard about only minor problems with technology, including phone systems that went up and went down, a few issues with the online provider service tool and problems with printing of -PDF files from the Noridian website. Most issues have been resolved.   Traffic on the Noridian Provider Contact Center phone line is high, as expected. Wait times are sometimes four to five minutes, but practices report satisfaction with ...

Study finds that ACA Medi-Cal expansion could fuel ER use

A retrospective study conducted by researchers at the University of California, San Francisco (UCSF) found that the number of visits to California emergency rooms (ERs) rose by 13.2 percent between 2005 and 2010, from 5.4 million to 6.1 million annually, with a significant 35 percent increase in the number of ER patients insured through Medi-Cal. The authors suggest that the Medi-Cal expansion under the Affordable Care Act (ACA) could further increase these numbers, as millions of additional patients become eligible for Medi-Cal in 2014.   Researchers also found that Medi-Cal patients ...

CMA files a petition with the Supreme Court to block the 10 percent physician reimbursement cut

The California Medical Association (CMA) filed a petition today asking the United States Supreme Court to review the Ninth Circuit Court of Appeals ruling that cleared the way for the State of California to implement a 10 percent cut to Medi-Cal provider reimbursement rates.   Federal law requires that Medi-Cal patients have the same access to physicians and other health care providers as the general insured public. Despite this law, a three judge panel of the Ninth Circuit ruled that the state could move forward with the rate cuts, passed by ...

Reminder: Changes to Anthem Blue Cross reimbursement policies and claims software become effective November 1

In late July, Anthem Blue Cross sent physicians a notice advising of upcoming changes to the insurer’s reimbursement policies and claims editing software called ClaimsXten. The changes will go into effect on November 1, 2013. Because of these changes, physicians may notice a difference in how certain codes and code pairs are adjudicated.   Along with the notice, Anthem provided a comprehensive grid outlining all new, revised and existing reimbursement policies and claims editing rules as well as copies of Anthem’s reimbursement policies.   Changes include: denial of 3D rendering CPT codes 76376 ...