SBCMS News

rss

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 ...

UnitedHealthcare to discontinue use of fax numbers for medical prior authorization requests

UnitedHealthcare announced in its September 2018 Network Bulletin that it will begin retiring fax numbers utilized for medical prior authorization requests beginning January 1, 2019. Providers will be directed to utilize the Prior Authorization and Notification tool on Link, the UHC website currently utilized to check eligibility and benefits, manage claims and update provider demographic information. The following fax numbers will be retiring as of January 1, 2019: (877) 269-1045 (866) 362-6101 (866) 892-4582 (866) 589-4848 ...

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. ...

Health Net Federal Services continues to address TRICARE transition issues

As previously reported, Health Net Federal Services (HNFS) has experienced implementation issues since taking over as the new Defense Heath Agency (DHA) managed care contractor for the TRICARE West Region on January 1. In recent discussions with the California Medical Association (CMA), HNFS said it continues to address the breakdowns in process and resulting consequences that have impacted TRICARE providers in the areas of provider contracting and credentialing, beneficiary reassignment and provider directory inaccuracies. Updates are as follows: Contracting and Credentialing Because of staffing and operational issues, physicians may have experienced ...

CA pharmacy board launched drug take-back database

The California Board of Pharmacy has launched an online drug take-back tool to help consumers looking for a place to safely dispose of unwanted or expired prescription drugs. The searchable online database includes pharmacies statewide offering drug take-back services authorized by the California State Board of Pharmacy. The drug take-back search tool is available at pharmacy.ca.gov. Users can enter a pharmacy name, city or zip code to easily find a nearby location for disposing of unused medications. Pharmacies operating take-back programs registered with the Board of Pharmacy may offer two types ...

CMA and AMA oppose CMS proposal to collapse E/M codes

More than 150 health care organizations, including the California Medical Association (CMA) and the American Medical Association (AMA), sent a joint letter to the Centers for Medicare and Medicaid Services (CMS), opposing the agency’s proposal to collapse evaluation and management (E/M) code and payment levels. The proposal was included in the draft 2019 Medicare Physician Fee Schedule and MACRA Quality Payment Program rule released earlier this summer. CMA and AMA appreciate CMS’s genuine desire to reduce documentation burdens on physicians to allow them to focus on patients over paperwork. Several ...