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CMA and AMA urge exemptions from Open Payments reporting

The American Medical Association, the California Medical Association (CMA) and more than 80 other health care organizations recently submitted a joint letter in response to a request from the Centers for Medicare and Medicaid Services (CMS) for feedback on the Open Payments Program reporting requirements. Under the Open Payments program, drug and medical device manufacturers are required to report their financial interactions with licensed physicians – including consulting fees, travel reimbursements, research grants and other gifts. The joint letter urges CMS to exempt journal reprints and medical textbooks from “Open Payments” ...

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 ...

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 ...

L.A. Care partially rescinds recoupment requests

Between June and August of this year, L.A. Care issued a large number of overpayment requests to physicians. According to L.A. Care, it was requesting refunds on overpaid Medi-Medi claims. However, some of the requests were for very old claims, dating back to 2012. The California Medical Association (CMA) raised concerns with L.A. Care about the timeliness of some of the refund requests, as California’s Knox Keene act limits plans’ ability to request refunds to 365 days from the date of payment, except in cases of fraud or misrepresentation. After ...

Updated payor profiles for 2018 now available

The California Medical Association’s (CMA) Center for Economic Services is publishing updated profiles on each of the major payors in California including Aetna, Anthem Blue Cross, Blue Shield of California, Cigna, Health Net, UnitedHealthcare, Medicare/Noridian and Medi-Cal. Each profile includes key information on health plan market penetration; a description of the plan’s dispute resolution process; and the name and contact numbers for medical directors, provider relations, and other key contacts. Don’t waste your time searching the internet for this information – members can download CMA’s Payor Profiles free of charge ...

CMA urges CMS to simplify the Quality Payment Program

The California Medical Association (CMA) has submitted comments to the Centers for Medicare and Medicaid Services (CMS) on the proposed changes to the Medicare Quality Payment Program for 2019. CMA is disappointed that CMS did not reduce the reporting burdens in the Merit-based Incentive Payment System (MIPS) program in a more meaningful way. We also oppose the confusing new scoring tiers (gold, silver and bronze) and have urged CMS to simplify and overhaul the complex MIPS scoring system. CMA strongly urges CMS to maintain the 10 percent weight of the cost ...

Noridian announces improvements to Medicare portal

Noridian, the Medicare Administrative Contractor for California, recently announced improvements to the Noridian Medicare Portal (NMP) that will make it easier for providers to identify reasons behind eligibility-related claim denials. When a claim is denied for eligibility-related reasons, providers can select the link under Claim Status in the “Related Inquiries” portion of the page to access details to assist with determining their next steps. Effective July 27, 2018, all NMP users can also send secure online messages to Noridian regarding medical reviews or to voice concerns to be addressed by ...

Annual Medicare preventative exams now include review of opioid use

On August 28, the Centers for Medicare and Medicaid Services (CMS) published an update to the Initial Preventive Physician Examination and Annual Wellness Visit benefits, highlighting that a review of patient opioid use is now a component of medical and social history assessments. Per CMS, the review of opioid use during these annual preventative exams will help physicians identify patients using opioids, discuss alternative for non-opioid pain therapies, and assist in diagnosing and treatment for patients experiencing or at risk for opioid-use disorders. Additional CMS Resources Reducing opioid misuse The ABCs ...

L.A. Care issues recoupment letters for services dating back to 2012

The California Medical Association (CMA) has learned that L.A. Care Health Plan, the publicly operated Medi-Cal health plan serving more than 2 million Los Angeles County residents, issued letters to physicians in late July requesting the refund of claim overpayments dating back to 2012. The letters, dated July 28 and received by practices through mid-August, cited that the overpayments were a result of processing errors, including the following: L.A. Care incorrectly processed Medi-Medi claims as the primary payor instead of secondary to Medicare. ...