Anthem Blue Cross announces changes to reimbursement policies and claims software In late July, Anthem Blue Cross sent physicians a notice advising of upcoming changes to the insurer’s reimbursement policies and claims editing software called ClaimsXten. The changes will go into effect on November 1, 2013. Because of these changes, physicians may notice a difference in how certain codes and code pairs are adjudicated. Along with the notice, Anthem provided a comprehensive grid outlining all new, revised and existing reimbursement policies and claims editing rules as well as copies of Anthem’s reimbursement policies. Changes include: denial of 3D rendering CPT codes 76376 ... August 7, 2013 Managed Care Insurance/Reimbursement, Managed Care, Anthem Blue Cross 0 0 Comment Read More »
Nurse practitioner scope-of-practice bill fails in committee A bill that would give California's nurse practitioners more autonomy failed on a vote of 6-3 Tuesday in an Assembly Business, Professions and Consumer Protection Committee. The bill (SB 491) would allow nurse practitioners to open practices without any oversight from a trained medical doctor and prescribe dangerous, addictive drugs without supervision. Although the bill failed to pass committee today, it was granted reconsideration and will be voted on again next week. While an important part of the health care delivery system, nurse practitioners simply do not have adequate training ... August 7, 2013 General Advocacy, Nurse Practitioners, Scope of Practice 0 0 Comment Read More »
Resources to assist physicians with the Medicare contractor transition Goal: Provide members with information and resources to prepare their practices for the transition of Medicare contractors from Palmetto to Noridian on September 16 (Part B). Current CMA Resources 1. CMA’s Medicare Transition webpage – CMA has created a dedicated Medicare transition webpage, www.cmanet.org/medicare-transition, offering practices the ability to access updates and important information regarding the transition in one easy-to-access to location. All resources related to the Medicare transition will be accessible through this site. 2. CMA’s Medicare Transition Guide: What physicians need to know – This guide, which members can download free ... August 1, 2013 Medicare Medicare Contractors, Noridian, Palmetto, Medicare 0 0 Comment Read More »
Medicare locality reform ("The California GPCI Fix") clears House Congressional Committee as part of the Medicare SGR overhaul legislation On July 31, the House Energy and Commerce Committee voted unanimously to approve a BIPARTISAN Medicare Sustainable Growth Rate (SGR) overhaul legislation, H.R. 2810. Included in the bill is the CMA-sponsored California Medicare locality reform known as the “California GPCI Fix.” The California locality provision is a compromise between Committee Chairman Fred Upton (R-MI) and Ranking Democrat Henry Waxman (D-CA) who insisted the California update be part of the committee bill. It is based on legislation by Congressman Sam Farr (D-Santa Cruz/Monterey) and Darrell Issa (R-San Diego) who are ... July 31, 2013 Medicare California GPCI Fix, SGR, Sustainable Growth Rate, Medicare 0 0 Comment Read More »
CMA urges CMS to postpone changes to QIO program The Centers for Medicare and Medicaid Services (CMS) recently called for public comments on how it can best organize the national cadre of Medicare Quality Improvement Organization (QIO) contractors. The mission of the QIO program is to improve the effectiveness, efficiency, economy and quality of services delivered to Medicare beneficiaries. Currently, CMS contracts with one organization in each state to serve as that state's QIO contractor. QIOs are private, mostly not-for-profit organizations, staffed by physicians and other health care professionals who are trained to review medical care, help beneficiaries with ... July 25, 2013 Medicare Centers for Medicare and Medicaid Services, Insurance/Reimbursement, Quality of Care, Medicare 0 0 Comment Read More »
CMA files amicus brief in physician whistle-blower case Last week, the California Medical Association (CMA) and the American Medical Association (AMA) filed an amicus curiae brief in the California Supreme Court to urge for broad protection of physician whistleblowers in hospitals. The brief focuses on a medical staff physician’s rights as a whistleblower under Health & Safety Code section 1278.5. In the case, Fahlen v. Sutter Central Valley Hospitals et al., the plaintiff physician alleged that his staff privileges were terminated in retaliation for reporting nursing errors and insubordination to the hospital. He sued the hospital under section ... July 25, 2013 General Hospitals and Health Facilities, Peer Review, Legal Advocacy 0 0 Comment Read More »
House committee releases bipartisan Medicare SGR reform bill Three congressional committees have been hard at work over the past few months on legislation that would eliminate the desperately broken Medicare sustainable growth rate (SGR) formula that is used to determine physician payment rates. On Friday, the health subcommittee of the U.S. House of Representatives Energy and Commerce Committee's health subcommittee released its bill to repeal the SGR. One Tuesday the bill was approved by the subcommittee and now heads to the full committee for consideration. The House Ways and Means Committee and the Senate Finance Committee have ... July 25, 2013 Medicare Insurance/Reimbursement, Medicare, SGR, Advocacy, Sustainable Growth Rate 0 0 Comment Read More »
CMA publishes Medicare quality reporting guide The Medicare Physician Quality Reporting System (PQRS) is a reporting program that uses a combination of incentive payments and payment reductions to promote reporting of quality information by eligible professionals. Up until now, this program has been voluntary and physicians have received bonuses for participating. That's about to change. Failure to participate now means physicians could face significant penalties in 2015 and beyond. Find out more in CMA's new guide, "Getting Started with the Medicare Physician Quality Reporting System." The guide is avaialble to members only. Contact: CMA's reimbursement help line, (888) ... July 25, 2013 Medicare Insurance/Reimbursement, PQRS, Medicare, Physicians Quality Reporting System 0 0 Comment Read More »
Get involved: Submit a resolution to the 2013 House of Delegates The most effective way an individual member can influence CMA's policies and activities is to submit resolutions to the House of Delegates, the association's legislative body. The delegates meet annually to debate and act on resolutions and reports dealing with myriad medical practice, public health, and CMA governance issues. This year's annual meeting is October 11-13 at the Disneyland Hotel in Anaheim, and the deadline to submit resolutions is August 12. Any CMA member may author a resolution, but a delegate, alternate delegate, component medical society, or specialty delegation must ... July 19, 2013 General House of Delegates, CMA Governance, CMA Policy 0 0 Comment Read More »
CMA Launches Exchange Resource Center In 2010, Congress passed historic sweeping health care legislation, the Patient Protection and Affordable Care Act (ACA), which reformed the individual and small group health insurance markets and, beginning in 2014, will provide health insurance to much of the nation's uninsured. Under the ACA, two-thirds of California's uninsured may be eligible to purchase coverage through the health benefit exchange. The exchange's goal is to begin open enrollment on October 1, 2013 – with coverage beginning on January 1, 2014. To help educate physicians about the exchange and ensure that they are ... July 16, 2013 General, Managed Care Covered California, health insurance exchange, Affordable Care Act (ACA) 0 0 Comment Read More »
