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Coding Corner: CPT reporting for preventive medicine services

CPR’s “Coding Corner” focuses on coding, compliance, and documentation issues relating specifically to physician billing. This month’s tip comes from John Verhovshek, the managing editor for AAPC, a training and credentialing association for the business side of health care. Preventive medicine services, or “well visits,” are evaluation and management (E/M) services provided to a patient without a chief complaint. The reason for the visit is not an illness or injury (or signs or symptoms of an illness or injury), but rather to evaluate the patient’s overall health, and to identify ...

CMA statement on proposed policy linking safety net benefits and immigration status

Statement attributable to:  Theodore M. Mazer, M.D., President of the California Medical Association (CMA) “CMA believes that everyone, regardless of immigration status, should have access to needed affordable and quality health care. The proposed policy makes utilizing health programs a disqualifier for immigration, and it would have a chilling effect on families accessing health care services while decreasing public health in communities across California. Health care should remain a safe place for all, and we urge the Trump Administration to rethink this irresponsible policy.”

DHCS receives approval on Medi-Cal supplemental tobacco tax payments for FY 2018-2019

The California Department of Health Care Services (DHCS) recently received federal approval on its plan to increase Medi-Cal fee-for-service physician payments for the 2018-2019 fiscal year. The supplemental payments—made possible by the Proposition 56 tobacco tax funding—will raise payments for a total of 23 CPT codes, including 10 new preventive CPT codes. DHCS will be increasing the supplemental payment for the previously eligible CPT codes to 85 percent of Medicare (a 40 percent average increase in payments for these eligible codes compared with 2017 – 2018 payment levels). The 10 ...

Have you received your supplemental Medi-Cal managed care payments?

The California Health Care, Research and Prevention Tobacco Tax Act of 2016 (Prop 56) created new revenues dedicated to the Medi-Cal program. Physicians receive supplemental payments in both fee-for-service and Medi-Cal managed care when providing Medi-Cal services under certain CPT codes.  While the California Department of Health Care Services (DHCS) began disbursing FY 2017-2018 supplemental fee-for-service payments in January 2018, federal approval of the supplemental Medi-Cal managed care payments was delayed. This resulted in delayed payment for Medi-Cal managed care services. DHCS began dispersing the FY 2017-2018 funds to the plans ...

Vote on Senate opioid package expected this week

The U.S. Senate is expected to vote this week a bipartisan package of over 70 proposals intended to help combat the nation’s opioid crisis. Known as the Opioid Crisis Response Act of 2018, the package includes legislation intended to reduce opioid use, encourage recovery, support caregivers and families, and drive innovation and long-term solutions. The California Medical Association (CMA) is working with AMA and our other partners to resolve several outstanding issues, such as the mandate to e-prescribe opioids, despite the difficult DEA process. We have, however, successfully stopped all ...

CMS identifies and corrects errors in MIPS scoring logic

Centers for Medicare and Medicaid Services (CMS) recently released 2017 Merit-based Incentive Payment System (MIPS) performance scores and payment adjustment information for the 2019 payment year. Physicians have been able to request targeted reviews if they believe an error was made in the calculation of their performance score. The requests CMS received through targeted reviews led them to take a closer look at a few prevailing concerns. Those concerns included the application of the 2017 Advancing Care Information and Extreme and Uncontrollable Circumstances hardship exceptions, the awarding of Improvement Activity ...

CalHIPSO Webinar: MIPS Reporting for 2018

The Health Services Advisory Group and the California Health Information Partnership & Services Organization (CalHIPSO) is hosting a free educational webinar on Thursday, October 4, 2018, on the Medicare Merit-Based Incentive Payment System (MIPS). This webinar will cover what you and your practice need to know as you look forward to MIPS reporting for the 2018 performance year. There are many factors to consider that effect your scores. The 2018 reporting year is very similar to 2017, with slightly higher thresholds and benchmarks. The webinar will explore various scenarios and ...

CMA calls on CMS to reverse step therapy decision

The California Medical Association (CMA) and an American Medical Association (AMA)-led coalition of 94 medical societies delivered a letter to the Centers for Medicare and Medicaid Services (CMS) about the serious concerns physicians have with the agency’s recent decision to allow Medicare Advantage plans to use step therapy for Part B drugs.  The letter calls on CMS to reinstate its 2012 policy prohibiting Medicare Advantage plans from utilizing step therapy protocols for Part B physician administered medications. The growing burdens generated by step therapy and prior authorization programs create a ...

Coding Corner: ICD-10 unveils new diagnostic codes to report human trafficking

CPR’s “Coding Corner” focuses on coding, compliance, and documentation issues relating specifically to physician billing. This month’s tip comes from Brad Ericson, the director of publishing for AAPC, a training and credentialing association for the business side of health care. Effective for fiscal year 2019, ICD-10 will include new diagnostic codes to report confirmed and suspected cases of human trafficking. Additionally, new codes will be available for patient history of labor or sexual exploitation, encounters for examination and observation following sexual or labor exploitation, and to identify multiple perpetrators of ...

Health Net addresses problems with explanation of payment

On August 21, 2018, Health Net notified providers that some paper explanation of payment (EOPs), commonly known as explanations of benefits, for commercial exchange enrollees were not displaying amounts correctly. This problem prevented providers from properly reconciling the amount Health Net is responsible for or the patient cost-sharing.  Health Net reports it has resolved all issues related to the misprinted EOPs, except in instances where the enrollee’s cost share may not be correctly displaying a figure that includes any coinsurance amount. Health Net advises that a fix for the cost ...