Error on Anthem ID cards results in claim denials In late March, the California Medical Association (CMA) began receiving complaints from physicians in San Diego, Orange and Bay Area counties about denials from Anthem Blue Cross. Practices reported that patients presented to their offices with Anthem ID cards that indicated they had a Covered California/mirror PPO product and subsequent eligibility verification also indicated the patient had a PPO product. However, Anthem later denied the claims stating the services were not covered under the patients' benefit plans because they received services from out-of-network providers. CMA escalated the issue to Anthem and ... July 1, 2014 General Covered California, Health Insurance Exchange, Anthem Blue Cross 0 0 Comment Read More »
Leader's Toolkit course coming to San Diego in September The California Medical Association (CMA) is offering a two-day leadership course, titled the Leader’s Toolkit, for physicians who are seeking leadership roles in organized medicine. The course will be held in San Diego on September 27-28. Participants will learn real world skills and will leave with actionable behaviors, tools and concepts to help them be effective leaders in organized medicine. Some of the issues covered include change management, leading a team, responsibilities of a leader, setting boundaries and priorities, time management, parliamentary procedure and understanding and leveraging critical relationships. Tom Gehring, ... July 1, 2014 General San Diego County Medical Society, Physician Leadership 0 0 Comment Read More »
Provider access issues plague Anthem and Blue Shield as DMHC begins investigation The Department of Managed Health Care (DMHC) recently began conducting a "non-routine audit" of Anthem Blue Cross and Blue Shield of California to investigate the accuracy of the plans' provider directories and identify whether either plan violated any network adequacy laws. According to the DMHC, consumer complaints about access issues for both plans prompted the investigation. Blue Cross and Blue Shield are the only two exchange plans using narrowed provider networks for their exchange and "mirror" products. The state is looking at whether the networks are too narrow in some ... July 1, 2014 General Department of Managed Health Care, Covered California, Payor Contracting 0 0 Comment Read More »
Deadline to submit meaningful use hardship exception is July 1 Beginning January 1, 2015, Medicare physicians who have not successfully attested to meaningful use of a certified electronic health record (EHR) system may incur payment penalties, as mandated by the Health Information Technology for Economic and Clinical Health (HITECH) Act. These payment adjustments will be 1-2 percent of total Medicare charges in 2015, to 2 percent in 2016 and 3-5 percent in 2017 and beyond. The 2015 penalties are based on 2013 reporting data. Physicians who failed to successfully demonstrate meaningful use in 2013 can apply for a hardship exception ... June 25, 2014 Medicare EHR, Electronic Health Record, HIT, Medicare, Certified EHRs 0 0 Comment Read More »
Sugary drink warning labeling bill stalls in Assembly Health committee Legislation that would have required sugar-sweetened beverages to bear a label warning consumers of their negative health effects failed to clear the Assembly Health committee yesterday. Senate Bill 1000, California’s Sugary Drink Safety Warning Act, which the California Medical Association co-sponsored, would have placed a simple warning label on the front of all bottles and cans of sugary drinks sold in California. The label, developed by a national panel of nutrition and public health experts, would have read: STATE OF CALIFORNIA SAFETY WARNING: Drinking beverages with added sugar(s) contributes to ... June 19, 2014 General Public Health, State Legislative Advocacy 0 0 Comment Read More »
State budget includes $7 million for new primary care residency slots Following the unprecedented grassroots advocacy by the physician and medical student community, the Legislature approved a state budget that includes $7 million for new primary care residency slots. The budget is now on Governor Brown's desk awaiting his signature. The California Medical Association is urging all physicians to contact the governor's office and urge him to maintain this critical funding, which will help California meet the increased demand for medical services now that millions of additional patients are insured under the Affordable Care Act. Three million dollars would be applied ... June 19, 2014 General Residents and Fellows, State Legislative Advocacy, Graduate Medical Education 0 0 Comment Read More »
California budget does not restore 10 percent cut to Medi-Cal providers California lawmakers approved a $156.4 billion state budget plan yesterday that does not restore a 10 percent cut to Medi-Cal for providers – meaning that California continues to balance its budget on the backs of California's neediest and most vulnerable patients. Thanks to California Medical Association (CMA) advocacy, in coordination with the "We Care for California" coalition, the budget does, eliminate retroactive collection of the 10 percent Medi-Cal cut that would have dated back to June 2011, saving Medi-Cal providers more than $42.1 million in retroactive "clawbacks." “Eliminating the retroactive collection ... June 19, 2014 Medi-Cal Medi-Cal, State Legislative Advocacy, California State Budget 0 0 Comment Read More »
AMA HOD adopts CMA's meningococcal vaccination resolution The American Medical Association (AMA) House of Delegates (HOD) adopted a resolution proposed by the California Medical Association (CMA) that supports meningococcal vaccinations for school children. Resolution 414 asks that the AMA support efforts to require school children to be vaccinated against meningococcal virus under the Advisory Committee on Immunization Practices guidelines. Testimony on the issue reminded the delegates that this is a complex issue and recommended further investigation into why 30 percent of school children are not getting the meningococcal vaccine. The AMA Council on Science and Public Health ... June 19, 2014 General Immunization, Public Health, Vaccination, AMA 0 0 Comment Read More »
California Teachers Association joins campaign to defeat MICRA lawsuit measure The California Teachers Association (CTA), the nation’s largest statewide teacher organization and one of the state’s leading voices for public education, has announced its opposition to the MICRA lawsuit initiative. This addition makes CTA the latest major organization to join the historically-broad and bipartisan coalition of California organizations lining up to oppose the measure. CTA joins a growing list of California public and private organizations – including physicians, health providers, community clinics, civil liberties advocates, school boards, labor unions and business groups – that have expressed concerns about the ballot ... June 18, 2014 General MICRA 0 0 Comment Read More »
CMA files brief in case challenging the constitutionality of MICRA The California Medical Association (CMA), together with the American Medical Association (AMA), has filed an amicus brief supporting the constitutionality of the non-economic damages cap of California's landmark Medical Injury Compensation Reform Act (MICRA). This appeal is the latest in a protracted line of cases challenging MICRA's constitutionality since the Legislature enacted the statute in 1975. The California Supreme Court has previously upheld the constitutionality of MICRA's cost saving provisions, including MICRA's $250,000 cap on non-economic damages. Despite Supreme Court precedent, after a trial court reduced the non-economic damages awarded ... June 18, 2014 General MICRA, Professional Liability, CMA Legal Case List, Legal Advocacy 0 0 Comment Read More »
