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California Physicians Congratulate Governor-elect Newsom, Lieutenant Governor-elect Kounalakis

Today, voters chose Gavin Newsom and Eleni Kounalakis to serve as California’s next Governor and Lieutenant Governor. In response, California Medical Association (CMA) President David H. Aizuss, M.D. issued the following statement: “The voters have decided, and CMA is proud to congratulate Governor-elect Newsom and Lt. Governor-elect Kounalakis for their respective wins tonight. “Governor-elect Newsom has a distinguished track record in championing health care for all, and Lieutenant Governor-elect Kounalakis showed voters that she has the passion and experience to help push California forward. We look forward to their continued leadership ...

SoFi doubling rate discount for CMA members

Earlier this year, the California Medical Association (CMA) and SoFi launched a new member benefit that will help physicians save thousands on their student loans. Sofi offers CMA members student loan refinancing options that include low-variable and fixed rates with terms ranging from five to 20 years. For a limited time, SoFi is offering CMA members a special double rate discount for a limited time. From now until December 20, 2018, you’ll pay 0.5 percent less in interest when you refinance at SoFi.com/CMA. Market interest rates are on the rise, check to ...

Prop. 56 webinar: Are you getting your share of the supplemental Medi-Cal funds?

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. A total of $325 million was allocated for physician payments in the budget for 2017-18, with $488 million proposed for 2018-19. The California Medical Association (CMA) is hosting a webinar with the California Department of Health Care Services on Wednesday, November 7, to discuss the status of distribution of ...

Coding Corner: Separate reporting of pre-intra- and post-procedure work

“Coding Corner” focuses on coding, compliance, and documentation issues relating specifically to physician billing. This month’s tip comes from G. John Verhovshek, the managing editor for AAPC, a training and credentialing association for the business side of health care. The global surgical package includes all “necessary services normally furnished” by a provider “before, during, and after a procedure,” as defined by the Centers for Medicare & Medicaid Service (CMS). When a provider is responsible for only a portion of the global package (e.g., an emergency department physician initiates fracture care, ...

UnitedHealthcare to implement outpatient advanced radiology policy

Effective January 1, 2019, UnitedHealthcare (UHC) will require prior authorization for certain advanced imaging procedures when performed in the outpatient hospital setting. As highlighted in the UnitedHealthcare Network Bulletin October 2018, certain magnetic resonance imaging, magnetic resonance angiography and computed tomography imaging procedures will now be subject to a site of care review when performed in the outpatient hospital under UHC’s Outpatient Radiology Notification/Prior Authorization Protocol. Site of care reviews will not be done as part of the prior authorization process if a procedure will be performed in a free-standing diagnostic ...

CDPH hosts webinar on California Parkinson's Disease Registry

On July 1, 2018, the California Department of Public Health (CDPH) launched the California Parkinson’s Disease Registry, a statewide population-based registry that will be used to measure the incidence and prevalence of Parkinson's disease.  MD’s, DO’s, PA’s, and NP’s who diagnose or treat Parkinson’s disease patients are required to report. The first deadline for data submission is March 29, 2019, for cases encountered during the first quarter the law was in effect (July 1 to September 30, 2018).  Details on the reporting obligation can be found in the Implementation Guide, ...

CMA Applauds the Enactment of Federal Opioid Legislation

The California Medical Association (CMA) applauded the enactment of H.R. 6 – a sweeping bipartisan bill that addresses nearly every component of the national opioid epidemic. The legislation would improve access to preventive services, opioid use disorder treatment programs, medication-assisted treatment (MAT) and non-opioid therapies, including mental health services. It would lift restrictions on using telemedicine for treatment of substance use disorders. To address the escalation in overdose deaths, it would also strengthen law enforcement efforts to crack down on international shipments of illicit drugs such as fentanyl. H.R. 6 ...

Medicare publishes 2018-2019 influenza vaccine pricing

The Center for Medicare and Medicaid Services (CMS) recently published an update on Medicare’s influenza vaccine payment allowances and effective dates for the 2018-2019 flu season. The Medicare Part B payment allowance limits for seasonal influenza and pneumococcal vaccines are calculated at 95 percent of the average wholesale price. Payment allowances and effective dates for the 2018-2019 flu season:‚Äč Code Labeler Name Drug Name Payment Allowance Effective Dates 90653 Seqirus ...

Last day to change your Medicare participation status for 2019 is December 31

Once again, it’s time for physicians to decide if they want to make changes to their Medicare participation status. Physicians have until December 31, 2018, to make changes for the 2019 participation year. As always, physicians have three choices regarding Medicare: Be a participating provider; be a non-participating provider; or opt out of Medicare entirely. Details on each of the three participations options are as follows: A participating physician must accept Medicare-allowed charges as payment in full for all Medicare patients.   A non-participating provider can make assignment decisions on ...

First-ever TRICARE open enrollment begins November 12

Beginning November 12 and running through December 10, 2018, TRICARE will initiate its first ever open enrollment period for beneficiaries to enroll in or change their TRICARE Prime or TRICARE Select health plan coverage. Beneficiaries already enrolled who want to continue with their current plan without changes do not need to do anything. Any changes made during the 2018 open enrollment will be effective January 1, 2019. Outside of open enrollment, beneficiaries enrolled in Prime or Select will only be able to make a plan change if they have ...