Are you ready for the new prescription drug prior authorization form required on October 1? Over the next several months, a new law will take effect that streamlines and standardizes the prior authorization process for prescription drugs. 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, and if they fail to do so the requests will be deemed authorized. The new law does ... September 22, 2014 General Drug Prescribing, Preauthorization, Prescription Drugs 0 0 Comment Read More »
DHCS announces additional delays for some ACA Medi-Cal primary care rate increases The California Department of Health Care Services (DHCS) has released additional information about the timing of the outstanding Affordable Care Act (ACA) Medi-Cal primary care rate increase for certain claim types. Specifically, DHCS had previously announced delays in payment of three types of claims, including certain NICU/PICU services, Child Health and Disability Prevention Program (CHDP) services and crossover claims (also referred to as Medi/Medi claims). Retroactive NICU/PICU claims – At the request of CMA and other stakeholders DHCS will allow claims data to be submitted via ... September 19, 2014 Medi-Cal Child Health and Disability Prevention Program, DHCS, Medi-Cal, CHDP 0 0 Comment Read More »
DHCS announces new continuity of care rules for duals demonstration project The California Department of Health Care Services (DHCS) recently announced new continuity of care rules for the Cal MediConnect duals demonstration project. The project – an effort to save money and better coordinate care for the state’s low-income seniors and persons with disabilities – transitions a large portion of the state's dual eligible beneficiaries to managed care plans. Although the program already had continuity of care provisions, the new rules make it easier for a patient to continue receiving needed care from out-of-network physicians without interruption. The new continuity of care ... September 19, 2014 Medi-Cal, Medicare DHCS, Medi-Cal, Medicare, Cal MedConnect, Dual Eligible 0 0 Comment Read More »
CMA responds to CMS 2015 Medicare fee schedule proposals The California Medical Association (CMA) sent a letter to the Centers for Medicare & Medicaid Services (CMS) commenting on the proposed rules that would impact many aspects of physician payment and federal regulatory programs for 2015. The 39-page letter strongly opposes the agency's plan to accelerate the implementation of the value-based modifier (VBM) payment methodology. CMS has said it will expand the VBM to all physicians in 2017 and increase the potential penalty from 2 percent to 4 percent. CMA also argued that because the agency is ignoring the law that ... September 18, 2014 Medicare Medicare, PQRS, CMS, Physicians Quality Reporting System 0 0 Comment Read More »
Medi-Cal audits began in September The California Department of Health Care Services (DHCS) has begun post-payment claims review of Medi-Cal claims in California. The purpose of this audit is to identify and correct improper Medicaid payments through the collection of overpayments and reimbursement of underpayments made on claims for health care services provided to Medicaid beneficiaries. The program will enable the Centers for Medicare and Medicaid Services (CMS) to implement actions that will prevent future improper payments in all 50 states. DHCS has contracted with Health Management Systems, Inc. (HMS) to act as the Recovery ... September 18, 2014 Medi-Cal Department of Health Care Services, DHCS, Medi-Cal, Audits 0 0 Comment Read More »
New version of POLST form effective October 1 Physicians across California are successfully using Physician Orders for Life-Sustaining Treatment (POLST) to improve patient care at the end of life. Effective October 1, 2014, a new version of POLST makes this tool even more effective. POLST is a physician order, signed by both doctor and patient, that specifies the types of medical treatment a patient wishes to receive toward the end of life. POLST is a tool that encourages conversation between physicians and patients about medically appropriate end-of-life treatment options. It also helps patients make more informed decisions and ... September 18, 2014 General POLST, Physician Orders for Life Sustaining Treatment 0 0 Comment Read More »
DEA announces new rules to expand opportunities for consumers to return unused controlled substances to pharmacies The U.S. Drug Enforcement Administration (DEA) announced Monday that it would allow consumers to return unused controlled substances to approved facilities, including hospitals with onsite pharmacies and retail pharmacies. Under the new rules, consumers and their families will also be allowed to mail unused prescription drugs to authorized collection agencies using packages that are expected to be available at pharmacies, libraries and senior centers. These new regulations will go into effect October 9. Up to now, controlled substances could not legally be returned to pharmacies. Instead, the Controlled Substances Act ... September 11, 2014 General Public Health, Prescription Drugs 0 0 Comment Read More »
DHCS revises Cal MediConnect 'Choice Forms' After advocacy from the California Medical Association (CMA) in conjunction with patient advocacy groups, the California Department of Health Care Services (DHCS) has revised its “Choice Forms” that allow dual eligibles to opt-out of the Cal MediConnect duals demonstration project and remain in traditional Medicare fee for service. The project was authorized by the state in July 2012 in an effort to save money and better coordinate care for the state’s low-income seniors and persons with disabilities. The program begins with a three-year demonstration project that transitions a large portion ... September 11, 2014 Medicare Department of Health Care Services, DHCS, Dual Eligible, Medicare, Cal MediConnect 0 0 Comment Read More »
System error causing some Anthem Blue Cross claims to be underpaid The California Medical Association (CMA) has received physician complaints that Anthem Blue Cross is applying a sequestration cut to their payments, causing some claims to be underpaid. The issue appears to affect claims in which Medicare is the patient’s primary plan and Anthem Blue Cross CalPERS is the supplemental plan. After Medicare processes the claim and forwards on, Anthem’s system appears to be applying a 2 percent sequestration cut to the amount they would normally pay as a supplemental plan in error. While the individual amounts are small, they can ... September 9, 2014 Managed Care Insurance/Reimbursement, Anthem Blue Cross 0 0 Comment Read More »
New CMS rule changes meaningful use timeline The Centers for Medicare and Medicaid Services (CMS) published a new final rule on September 4, 2014, that would provide eligible professionals participating in the Medicare and Medi-Cal electronic health record (EHR) incentive program an additional year to upgrade their certified electronic health record technology (CEHRT). The rule also revises the meaningful use timeline. Under the new rule, eligible professionals can use 2011 Edition CEHRT or a combination of 2011 and 2014 Edition CEHRT for the 2014 EHR reporting period to demonstrate meaningful use. Eligible professionals who were scheduled to ... September 5, 2014 General Certified EHRs, Electronic Health Record, Meaningful Use, CMS 0 0 Comment Read More »
