CMA applauds U.S. House of Representatives for passing monumental Medicare-CHIP reform in landslide vote, urges U.S. Senate to act swiftly Sacramento – Today, the California Medical Association (CMA) congratulates the U.S. House of Representatives for passing monumental Medicare reform and the Children’s Health Insurance Program (CHIP) extension, and urgently asks their colleagues in the Senate to do the same before spring recess. The 392-37 vote clearly shows that now is the time to make Medicare reform a reality. The legislation, H.R. 2, known as the “The Medicare and CHIP Reauthorization Act,” will reform the broken Medicare sustainable growth rate (SGR) physician payment system and extend the expiring Children’s Health Insurance ... March 26, 2015 Medicare Federal Legislative Advocacy, Medicare, SGR, Sustainable Growth Rate, Federal Legislation 0 0 Comment Read More »
CMS prepares to make 21% Medicare rate cut should Congress fail to act before April 1 With an April 1 deadline looming, Congress has a week left to stop the 21 percent sustainable growth rate (SGR) cuts to the Medicare reimbursement rate. While Congress works to pass bills H.R. 2 and S. 810 to permanently end the SGR and implement new Medicare funding models, the Centers for Medicare and Medicaid Services (CMS) has announced that without Congressional action, the 2015 Medicare Physician Fee Schedule is scheduled to take effect on April 1, 2015. House Speaker John Boehner (R-OH) and Minority Leader Nancy Pelosi (D-CA) have negotiated ... March 26, 2015 Medicare CMS, Legislative Advoacy, SGR, Sustainable Growth Rate, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
Reminder: July ICD-10 end-to-end testing forms due in April The Centers for Medicare and Medicaid Services (CMS) announced that those providers who want to volunteer for ICD-10 end-to-end testing July 20-24 need to submit their information by April 17. The July testing will give a group of 850 volunteers the opportunity to find out if they are prepared to submit digital information to CMS for ICD-10. CMS intends to select volunteers representing a broad cross-section of provider, claim and submitter types, including claims clearinghouses that submit claims for large numbers of providers. Testers who participated in the January and ... March 23, 2015 Medi-Cal, Medicare ICD-10 0 0 Comment Read More »
Medicare RAC court case keeps collections on uncertain footing The U.S. Court of Appeals for the Federal Circuit issued a decision in early March in a case filed by one of the Medicare Recovery Audit Contractors (RAC) after the Centers for Medicare and Medicaid Services (CMS) changed the timing for the payment of contingency fees on collections. The decision means the auditing program will be put on hold until CMS determines how to contract with its RACs. The RAC program is responsible for identifying fraud and waste in the Medicare system by detecting improper Medicare payments. Since 2008, when ... March 18, 2015 Medi-Cal, Medicare Centers for Medicare and Medicaid Services, Medicare, Recovery Audit Contractor, Audits 0 0 Comment Read More »
Is your Medicare practice information up-to-date? The February issue of CMA Practice Resources (CPR) contained an article discussing the importance of maintaining up-to-date practice demographic information with contracted managed care payors (see “Ensure your practice information is up-to-date with contracted payors”). This advice applies equally to government payors, such as Medicare, that you are enrolled in. Medicare administrative contractors (MAC), such as Noridian in California, obtain practice contact information from a practice’s Medicare enrollment application, from either the Internet-based Provider Enrollment, Chain and Ownership System (PECOS), or through a paper application. The MAC may contact ... March 17, 2015 Medicare Practice Resources, Medicare 0 0 Comment Read More »
DHCS identifies another glitch in issuing primary care rate increase for CHDP claims The California Department of Health Care Services (DHCS) has experienced various difficulties issuing the Affordable Care Act primary care rate increase funds on Child Health and Disability Prevention (CHDP) Program claims. Before the rate increases were implemented, some practices had been instructed by DHCS to bill CHDP claims at their Medi-Cal rates. This caused concern – based on DHCS’s pricing logic of paying the lesser of Medicare’s rate or the billed charges – that some practices would not qualify for the retroactive increases once the systems were updated to ... March 17, 2015 Medi-Cal, Medicare CHDP, Child Health and Disabilityh Prevention Program, Affordable Care Act, DHCS 0 0 Comment Read More »
United Healthcare introduces Group Medicare Advantage PPO product Effective June 1, 2015, United Healthcare (UHC) will be introducing its Group Medicare Advantage PPO product in several southern California counties. The California Medical Association (CMA) has learned that contract amendments were mailed on February 24 to over 10,000 currently contracted UHC physician practices in Imperial, Orange, Los Angeles, Riverside, San Bernardino and San Diego counties that the payor intends on including in its provider network for this new product. The insurer states that the new product, offered exclusively to employer/union group retirees, will offer greater access to a national ... March 17, 2015 Medicare Contract Amendment, Payor Contracting, United Healthcare 0 0 Comment Read More »
We Care for California coalition introduces legislation to increase Medi-Cal rates to Medicare levels Senate Health Committee Chair Ed Hernandez and Assembly Health Committee Chair Rob Bonta joined health care providers, medical students, patients and advocates on the steps of the Capitol on Wednesday to introduce AB 366 and SB 243, legislation that would not only restore a 10 percent cut to Medi-Cal reimbursement rates, but would also place reimbursement on par with Medicare, increasing payments rates for inpatient hospital services and most outpatient services. The proposals would also require the Department of Health Care Services to pay Medi-Cal managed care plans at ... March 9, 2015 Medi-Cal, Medicare Medic-Cal Cuts, We Care for California, Legislative Advocacy, Medi-Cal 0 0 Comment Read More »
Physician groups urge CMS to create contingency plans for ICD-10 transition The California Medical Association (CMA), American Medical Association (AMA), and 98 other state and specialty societies urged the Centers for Medicare and Medicaid Services (CMS) to put contingency plans in place for the October transition from ICD-9 to ICD-10 to avoid possible failures that could result in significant disruptions for physicians and Medicare patients. Now that CMS and the chairmen of the three Congressional health committees have announced they will not support a further delay in the implementation of ICD-10, organized medicine has turned its attention to CMS to ... March 9, 2015 Medi-Cal, Medicare CMS, ICD-10, ICD-9, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
CMS extends PQRS reporting deadline for some reporting methods The Centers for Medicare and Medicaid Services (CMS) has extended the submission deadlines for two Physician Quality Reporting System (PQRS) reporting methods from February 28 to March 20 at 8 p.m., EST. The two affected reporting methods are: Direct electronic health record (EHR) submission or submission via a vendor using certified EHR technology Qualified clinical data registry (using the QRDA III format) reporting for PQRS and the clinical quality measure component of meaningful use for the EHR Incentive Program Submission timeframes for other PQRS reporting ... March 9, 2015 Medi-Cal, Medicare EHR, Physician Quality Reporting System, PQRS, CMS, Meaningful Use 0 0 Comment Read More »
