2014 election wrap up: Physician-friendly candidates win majority of their races On Election Day, the California Medical Association (CMA) made history by resoundingly defeating the trial attorneys' attempt to overturn California's Medical Injury Compensation Reform Act (MICRA) protections. This was one of the most contentious and high-stakes ballot fights in California history. The voters sent a clear message: Californians simply don’t want to increase health care costs and reduce health access so trial attorneys can file more lawsuits. But the Election Night celebration was not limited to Prop. 46: CMA’s priority candidates also performed exceedingly well. CMA participated in "independent expenditure" ... November 17, 2014 General CALPAC 0 0 Comment Read More »
Medicare finalizes fee schedule changes for 2015 The Centers for Medicare and Medicaid Services (CMS) published its 2015 Medicare Physician Fee Schedule final rule Thursday in the Federal Register. The 1,200 word payment rule contains several notable changes. As earlier proposed, the rule expands the services eligible for telemedicine reimbursement and extends the new payment policies for non-face-to-face care coordination. It allows primary care physicians to be paid for care management of Medicare beneficiaries with two or more chronic conditions. These are tasks (including managing lab and imaging reports, medications and care plans in addition to talking ... November 17, 2014 Medi-Cal, Medicare , Fee Schedule, Medicare, Centers for Medicare and Medicaid Services, CMS 0 0 Comment Read More »
ACA meets goal of covering more Americans A little over 10 million uninsured have gained health care coverage throughout the U.S., either through Medicaid or state and federal exchanges, since the Affordable Care Act (ACA) coverage expansion programs opened for enrollment last year, according to a new report from U.S. Department of Health And Human Services’ (HHS). According to the report, the uninsured rate among adults ages 18 to 64, as of June 2014, was 15.1 percent, down 5 percent from September 2013. The percentage of those with health coverage improved most among blacks and Latinos throughout the ... November 14, 2014 General Affordable Care Act, ACA 0 0 Comment Read More »
Ask the Expert: Do I enter a qualifier in box 14 of the claim form if the patient has Medicare prime and a secondary insurance? Recently a number of practices have inquired as to whether Medicare requires the three-digit qualifier to be populated in item/box 14 when submitting a claim. Item/box 14, Date of Current Illness, Injury, or Pregnancy (LMP), identifies the first date of onset of illness, the actual date of injury, or the last menstrual period (LMP) for pregnancy, and contains a field allowing one of two qualifiers to be entered. 431: Onset of Current Symptoms or Illness 484: Last Menstrual Period The Medicare Claims Processing ... November 14, 2014 Medicare Medicare, Billing/Coding 0 0 Comment Read More »
Counting down to ICD-10 implementation With less than a year until the October 1, 2015, implementation date for ICD-10, physicians should be evaluating the readiness of their practices to transition to the new code set. The one-year delay in implementation came as a welcome reprieve for many physician practices that were struggling to meet the October 2014 deadline. The extent to which physician practices made positive use of the delay remains to be seen. ICD-10 (The International Classification of Disease tenth revision) is a system of coding created in 1992 as the successor to the ... November 14, 2014 General ICD-10 0 0 Comment Read More »
CMA names Luther Cobb, MD as 147th president Sacramento – Humboldt County physician Luther Cobb, M.D. has been installed as the 147th President of the California Medical Association (CMA), taking the reins from Immediate Past President Richard Thorp, M.D. Dr. Cobb takes office on the heels of the momentous defeat of Proposition 46, a campaign in which doctors and health care providers across California rallied together to oppose the measure that ultimately failed 33-67 percent. “What a thrilling time to be assuming the role of CMA president,” said Dr. Cobb. “The health care community has stood tall ... November 14, 2014 General Physician Leadership 0 0 Comment Read More »
Supreme Court to hear ACA subsidy case Last Friday, the U.S. Supreme Court unexpectedly said it will hear King v. Burwell—a case that questions whether premium subsidies can be provided under the Affordable Care Act (ACA) to individuals purchasing health insurance coverage on exchanges run by the federal government. The lawsuit has the potential to affect 36 states that use the federal health care exchange, but would not change the subsidies in states like California that run their own exchanges. The decision to hear the case comes just one week before the second exchange open enrollment ... November 14, 2014 General Affordable Care Act, Health Insurance Exchange, United States Supreme Court, ACA 0 0 Comment Read More »
CMA wants to hear from practices experiencing problems with the new prescription drug prior authorization form A new law recently took effect that streamlines and standardizes the prior authorization process for prescription drugs for most patients with PPO products. The new law (SB 866) requires all insurers, health plans (and their contracting medical groups/IPAs) and providers to use a standardized two-page form for prior authorizations of prescription medications. The law also requires plans and insurers to make a determination on prescription drug prior authorization requests within two days of receipt. If they fail to do so, the requests will be deemed authorized. The new law does ... November 14, 2014 Managed Care Prescription Drugs, Preauthorization 0 0 Comment Read More »
Blue Shield announces changes to 2015 exchange/mirror products On October 1, 2014, Blue Shield of California notified participating physicians that it was making changes to its Individual and Family Plan (IFP) EPO and PPO products, which are its exchange/mirror products. According to Blue Shield, the changes aim to expand access for EPO enrollees and reduce confusion by simplifying its plan names. Effective January 1, 2015, Blue Shield exchange/mirror EPO patients will have access to additional providers who are located outside of their county of residence. Previously, the Blue Shield IFP EPO limited in-network services to providers within ... November 14, 2014 Managed Care Covered California, Exchange Plans, Health Insurance Exchange, Blue Shield 0 0 Comment Read More »
CMA Foundation launches free antibiotic clinical guidelines mobile app The week of November 17-23, 2014, is "Get Smart About Antibiotics Week" – a campaign to highlight the problem of antibiotic resistance and the importance of appropriate antibiotic use. Every year at least 2 million Americans become infected with antibiotic resistant bacteria and at least 23,000 people die from these infections. This cold and flu season, the California Medical Association (CMA) Foundation's Alliance Working for Antibiotic Resistance Education (AWARE) project reminds physicians and patients to reduce the unnecessary use of antibiotics. To assist physicians and other clinicians in these efforts, ... November 14, 2014 General AWARE, CMA Foundation, Public Health, Antibiotic Resistance 0 0 Comment Read More »
