ICD-10 less than two weeks away; are you ready? With less than two weeks until the implementation of ICD-10, practices should be in the final stages of preparation and training for conversion to the new code set on October 1, 2015. The California Medical Association (CMA) has a number of resources to help members prepare. ICD-10 Transition Guide: This guide will help practices of all sizes successfully make the switch to the new ICD-10 coding system. It answers frequently asked questions and includes CMA’s ICD-10 Transition Preparation Checklist to help ensure the transition is a smooth one. The guide ... September 23, 2015 Managed Care Practice Resources, ICD-10, Webinars 0 0 Comment Read More »
CMA defeats bill that would have transferred negotiating power to health plans at the expense of physicians The California Medical Association (CMA) has defeated a bill that would have drastically changed the current health care marketplace by allowing a massive transfer of negotiating power to the health plans at the expense of physicians. Assembly Bill 533 was an attempt to shield patients from billing disputes between providers and health plans and would have required non-contracted physicians and dentists to accept Medicare rates as payment in full when performing services in a contracted or “in-network” facility. Although CMA is in favor of removing patients from billing disputes between ... September 23, 2015 Managed Care Advocacy, Medical Provider Networks, State Legislation, Health Plans 0 0 Comment Read More »
United Healthcare identifies physician chemotherapy claims processing error UnitedHealthcare (UHC) has identified an error in the processing of physician claims related to its Injectable Outpatient Chemotherapy Prior Authorization program requirement, which became effective June 1, 2015. Between June 1 and July 18, 2015, incorrect denials of “lack of prior authorization” may have been generated for injectable chemotherapy claims submitted with valid authorizations on file or submitted for patients with self-insured employer policies where preauthorization of injectable chemotherapy is not required. UHC has advised that a system fix was implemented on July 18, 2015, and all claims after ... September 8, 2015 General, Managed Care Cancer; United Healthcare 0 0 Comment Read More »
United Healthcare to implement several new multiple procedure payment reductions effective November 15 In its August 2015 Network Bulletin, United Healthcare (UHC) announced that, beginning with November 15, 2015, dates of service, multiple procedure payment reductions (MPPR) will be applied to several types of services, including: Technical component of diagnostic cardiovascular and ophthalmology procedures Professional component of diagnostic imaging services Some endoscopy procedures UHC reports that it is implementing the reductions to better align with the Centers for Medicare & Medicaid Services (CMS). The new claim edits will apply for UHC commercial claims. ... September 8, 2015 Managed Care United Healthcare 0 0 Comment Read More »
CMS clarifies ICD-10 grace period guidance In early July, the Centers for Medicare & Medicaid Services (CMS) announced that for a period of one year, it will allow for flexibility in claims payment, auditing and quality reporting processes as the medical community gains experience using the new ICD-10 code set. CMS specifically clarified its statement that during the 12 months after ICD-10 implementation, contractors would not deny claims based solely on the specificity of the ICD-10 diagnosis code. However, according to the latest FAQ, claims will be rejected if they do not contain a valid ICD-10 ... August 28, 2015 Managed Care, Medi-Cal, Medicare CMS, ICD-10, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
CMS to hold webinars for providers on Physician Compare website The Centers for Medicare and Medicaid Services (CMS) will host a series of one-hour webinars about public quality reporting and the Physician Compare website. The Affordable Care Act required CMS to create a website that would allow consumers to search for and compare physicians and other health care professionals who provide Medicare services. That site—the "Physician Compare" website, initially launched in 2010—provides contact information, specialties and clinical training, hospital affiliations and group practice information. In 2014, the website also began phasing in physician quality data from the Physician Quality Reporting System ... August 17, 2015 Managed Care, Medi-Cal, Medicare CMS, Quality Reporting, Webinars, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
CMA continues to monitor health plan network directory accuracy Last November, the California Department of Managed Health Care (DMHC) released the results of an audit of the Anthem Blue Cross and Blue Shield Covered California networks. Among other things, the audit found that 12.8 percent of the physicians listed on Anthem’s network were not accepting Covered California patients, while 12.5 percent were not in practice at the location listed in Anthem’s directory. In the case of Blue Shield, only 56.7 percent of the physicians listed in Blue Shield's Covered California directory could be verified as accepting Covered California patients. ... August 17, 2015 Managed Care Blue Shield, Covered California, Network Adequacy, Anthem Blue Cross 0 0 Comment Read More »
Gallup poll says rates of uninsured continue to drop in most states According to a Gallup poll released Monday, the national uninsured rate has fallen to 11.7 percent, down from 17.3 percent in 2013. The poll shows that states that have expanded Medicaid under the Affordable Care Act – and have at least helped in the running of their health insurance marketplaces, rather than leaving it entirely to the federal government – have seen larger drops in uninsured rates. In the 22 states that took both of those measures, including California, the uninsured rate dropped to an average of 7.1 percent. California's uninsured ... August 17, 2015 Managed Care, Medi-Cal, Medicare Affordable Care Act, Health Insurance Exchange, Uninsured, ACA, Insurance 0 0 Comment Read More »
Covered California statewide premium costs to rise 4 percent in 2016 Californians insured through Covered California, the state’s health benefit exchange, will see their premiums rise an average of 4 percent in 2016, less than last year’s increase of 4.2 percent. However, consumers in some Bay Area and Sacramento counties will see higher premium increases—up to 8.2 percent in Sacramento and 12.8 percent in Santa Cruz, Monterey and San Benito—while Southern California counties will see increases of around 1.8 percent. However, Covered California Executive Director Peter Lee noted that consumers can see their premiums drop an average of 4.5 percent – ... July 29, 2015 Managed Care Covered California 0 0 Comment Read More »
CMA updates ICD-10 transition guide With less than three months until the transition to ICD-10, will your practice be ready on October 1, 2015? To help physicians prepare for the transition, the California Medical Association (CMA) has updated its “ICD-10 Transition Guide,” which includes an ICD-10 transition preparation checklist. New information includes: new table indicating code categories that are expanded as well as those that are reduced under ICD-10; information on how payors will handle prior authorizations around the transition date; listing and links to CMA’s live ICD-10 training courses; information on the Centers for ... July 24, 2015 Managed Care ICD-10 0 0 Comment Read More »
