State issues report cards for HMOs, PPOs and large medical groups The California Office of the Patient Advocate yesterday released its 14th annual “California Health Care Quality Report Cards” that rate the state's health plans and medical groups on a four-star scale. Available in English, Spanish and Chinese, the report cards allow consumers to compare the quality of care that more than 16 million commercially insured consumers receive from the state’s 10 largest HMOs, six largest PPOs and more than 200 medical groups. The data for the report cards is drawn from claims data and patient surveys for 2013. Users can drill-down ... October 17, 2014 General Insurance/Reimbursement, Insurance 0 0 Comment Read More »
AMA assembles Ebola resources for physicians The Centers for Disease Control and Prevention (CDC) on Sept. 30 confirmed the first U.S. case of Ebola, and developments associated with the virus continue to unfold. In the past week, two Dallas nurses have been diagnosed with Ebola after treating Thomas Eric Duncan, the first U.S. ebola patient, who died last week after travelling from Liberia to Texas to visit family. Both health care workers were with Duncan during what the CDC says is the highest risk period—when a patient is vomiting and having diarrhea. To help you prepare ... October 16, 2014 General Department of Public Health, Ebola, CDC, Infectious Diseases 0 0 Comment Read More »
Blue Shield makes positive changes to reimbursement policy for physicians treating out-of-network exchange PPO patients Blue Shield of California recently announced a two-part reimbursement policy change for contracted providers that do not currently participate in the plan’s Individual and Family Plan (IFP) PPO product, otherwise known as its exchange/mirror PPO product. Effective with September 14, 2014 dates of services, Blue Shield will implement changes to the out-of-network claims payment process and will now reimburse providers directly when PPO exchange/mirror product patients are seen out of network. Previously, Blue Shield issued payment directly to the patient. The notice also states that out-of-network physicians may continue bill ... October 15, 2014 General Out of Network Care, Blue Shield 0 0 Comment Read More »
CMA Capitol Insight: Oct. 13, 2014 CMA Capitol Insight is a biweekly column by veteran journalist Anthony York, reporting on the inner workings of the state Legislature. Rules of the Road The jury is still out about how California’s new election rules have changed the ideology of the legislature. Voters changed the rules in 2010, not only creating independently drawn legislative districts instead of seats designed by legislators themselves, but by changing the primary system so that the top two vote-getters, regardless of party, advance to the fall runoff. From 2000-2010, the old rules virtually eliminated electoral competition. ... October 15, 2014 General CMA Capitol Insight, Anthony York 0 0 Comment Read More »
CMA leaders meet with Congress on Capitol Hill before election recess California Medical Association (CMA) physician leaders were in Washington, D.C., for the last week of the Congressional session, reminding California legislators about priority physician issues, such as the repeal of the Medicare sustainable growth rate (SGR) and adoption of long-term Medicare payment reform. Congress has scheduled a very short lame duck session following the November election during which leadership on both sides hopes to come to an agreement on a spending bill to keep the government running. Earlier this year, both houses of Congress were very close to a permanent repeal ... October 10, 2014 General Medicare, SGR, Sustainable Growth Rate, Federal Legislative Advocacy 0 0 Comment Read More »
CMS reopening meaningful use hardship exception deadline The Centers for Medicare and Medicaid Services (CMS) announced that it is reopening the submission period for meaningful use hardship exception applications so that physicians can avoid the 2015 payment penalty. The new deadline will be November 30, 2014. As part of the American Recovery and Reinvestment Act of 2009, Congress mandated payment adjustments under Medicare for eligible professionals that are not meaningful users of Certified Electronic Health Record Technology (CEHRT). The Act allows the Secretary to consider, on a case-by-case basis, hardship exceptions for eligible professionals to avoid the ... October 10, 2014 Medi-Cal, Medicare EHR, Electronic Health Record, Medicare, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
Medical Board produces video to assist new applicants with the licensing process In response to the many inquiries regarding how to correctly complete the application for a California medical license, the Medical Board of California has produced a 20 minute video to assist new applicants with the licensing process. The video is available here. In addition, applicants can go to the medical board website, click on an individual form and see an instructional video just for that form. Contact: Medical Board of California, (800) 633-2322. October 10, 2014 General Medical Board of California, Licensure 0 0 Comment Read More »
HHS urges physicians to help control spread of Ebola in U.S. The first case of Ebola Virus Disease (Ebola) diagnosed in the United States was laboratory-confirmed by Centers for Disease Control and Prevention (CDC) on September 30, 2014, in a person who had traveled from Liberia to Dallas, Texas. The U.S. Department of Health and Human Services (HHS) is urging all health care professionals to assist in our country’s response to the Ebola outbreak and to be ready and aware to help control the spread of Ebola domestically. Early recognition is critical to controlling the spread of Ebola virus. Specifically, physicians ... October 10, 2014 General Infectious Diseases, Public Health, CDC 0 0 Comment Read More »
How much revenue is your practice losing by not working denials? It’s no secret that claim rejections and denials can result in a significant amount of lost revenue. Consider this – a practice submitting 80 claims a day at an average reimbursement rate of $100 per claim should expect to receive $8,000 in daily revenue. If 10 percent of those claims were rejected or denied (eight claims per day at $100 per claim equals $800 per day), and the practice only appealed one out of every 10 rejections or denials ($720 per day loss), the practice could expect to lose ... October 10, 2014 General Denials, Insurance/Reimbursement, Practice Resources, Billing/Coding 0 0 Comment Read More »
IMQ's 2014 Medical Staff Conference - Oct. 30 There’s still time to register for the 2014 Medical Staff Conference! If you are a physician, hospital leader, a Medical Staff Director, credentialing specialist, or a Quality Improvement professional, you want to attend this one day course that helps you solve many problems facing medical staff leaders. Responding to requests from previous program attendees, this program will include interactive panel discussions on the following: • What do you do with an Aging Physician? • How do you handle a Disruptive/Impaired professional? • What is the appropriate way to counsel or communicate ... October 9, 2014 General Institute for Medical Quality (IMQ) 0 0 Comment Read More »
