Time to verify your patients' eligibility and benefits for 2017 The beginning of a new year brings with it changes to your patients’ eligibility and benefits. Physicians are urged to be diligent in verifying each patient’s eligibility and benefits to ensure they will be paid for services rendered. The beginning of a new year also means that both calendar year deductibles and visit frequency limitations reset. And, with open enrollment, patients may even be covered by a new payor. Don’t get stuck with unnecessary denials or an upset patient. Do your homework before the patient arrives by obtaining updated ... December 21, 2016 General, Managed Care, Medi-Cal, Medicare Running a Practice, Eligibility 0 0 Comment Read More »
United Healthcare to introduce Navigate, new narrow network product, in 2017 United Healthcare (UHC) recently notified physicians that it will be introducing a new commercial narrow network PPO product, Navigate, to the California marketplace effective January 1, 2017. Due to an operational error, the notice issued to California providers inadvertently referenced United Healthcare of Nebraska, which is also launching the Navigate product. UHC has since issued a corrected notice. UHC says the Navigate plan is its most recent effort at providing a reduced-cost health care option to employers. This network offers access to a significantly narrowed network of PPO physicians, ... December 14, 2016 Managed Care United Healthcare 0 0 Comment Read More »
Be prepared for Covered California changes in 2017 In 2016, Covered California, California's health benefit exchange, enrolled approximately 1.4 million individuals in qualified health plans. It is critical that physician practices understand their participation status, which products are being offered and what changes to expect in 2017. Some of the most significant changes for Covered California in 2017 are: All Covered California enrollees, including those with a PPO or EPO, will be assigned to a primary care physician. The assignment will either happen by January 1, 2017, or within 60 days of the enrollee’s ... December 14, 2016 Managed Care Covered California, Affordable Care Act, Exchange Plans, Health Insurance Exchange 0 0 Comment Read More »
Health care spending rose modestly in 2015 In 2015, per-capita health care spending grew by 5 percent and overall health spending grew by 5.8 percent, according to a new study by the Office of the Actuary at the Centers for Medicare and Medicaid Services. While overall expenditures increased, the rate of growth is still substantially lower than the 9 percent average rate seen in the three decades before 2008. On a per-enrollee basis, overall spending increased in 2015 by 4.5 percent for private health insurance, 1.7 percent for Medicare and 3.8 percent for Medicaid. According to the ... December 14, 2016 General Affordable Care Act 0 0 Comment Read More »
Congress approves $6.3 billion medical innovation legislation After several years of hearings and negotiations, Congress has passed a $6.3 billion medical innovation package intended to accelerate the discovery, development and delivery of new therapies, including $1 billion to help states address the opioid epidemic. It also provides important electronic health record (EHR) reforms for physicians and for the first time will penalize vendors for failing to have interoperable systems. The bill (HR 6), known as the "21st Century Cures Act," is intended to bridge the gap between medical science and legislative action and regulations that slow ... December 14, 2016 General Federal Legislative Advocacy, Federal Legislation 0 0 Comment Read More »
U.S. divided about what should be done with ACA A Kaiser Family Foundation poll has found that Americans are divided on the future of the Affordable Care Act (ACA). The survey found that 26 percent of the country wants to repeal the entire law. Meanwhile, 30 percent want to expand the law, 19 percent want to keep it as-is and 17 percent want to scale it back. The poll found that Republican respondents were more likely to want to scale back the law, rather than fully repealing it. Among the 26 percent of Americans who want to see the ... December 14, 2016 General, Managed Care Affordable Care Act, ACA 0 0 Comment Read More »
Webinar: Preventing physician burnout The Physician’s Foundation biennial Survey of America’s Physicians has consistently shown the professional morale of physicians as problematic, with a majority of physicians in 2016 describing their feelings about the current state of the medical profession as somewhat or very negative. The California Medical Association (CMA) will host its first webinar of 2017, "Preventing Burnout: Individual and Organizational Intervention,” on Wednesday, January 11, from 12:15 to 1:15 p.m., to help physicians recognize and respond to burnout. The webinar is free to members and their staff. Our presenter, Karen Miotto, M.D., ... December 14, 2016 CMA, General Physician Burnout, Physician Well-Being, Physician Wellness, Webinars 0 0 Comment Read More »
Tip: Don't lose revenue by not working denials It’s no secret that claim rejections and denials can result in a significant amount of lost revenue. Consider this – a practice submitting 80 claims a day at an average reimbursement rate of $100 per claim should expect to receive $8,000 in daily revenue. If 10 percent of those claims were rejected or denied (eight claims per day at $100 per claim equals $800 per day), and the practice only appealed one out of every 10 rejections or denials ($720 per day loss), the practice could expect to lose ... December 13, 2016 General, Managed Care, Medi-Cal, Medicare Denials, Reimbursement, Tip of the Month 0 0 Comment Read More »
Orthopedic surgeon named new head of HHS Rep. Tom Price, M.D. (R-Ga.) was chosen by President-Elect Donald Trump to lead the U.S. Department of Health and Human Services (HHS). A six-term Congressman and former Georgia state Senator, Dr. Price was an orthopedic surgeon for 20 years before he went into politics and is the third generation of physicians in his family. Dr. Price would be the first physician to serve as the nation’s top health official since President George H.W. Bush appointed Louis W. Sullivan, M.D., in 1989 and only the third doctor to serve as secretary ... December 13, 2016 General Federal Legislative Advocacy 0 0 Comment Read More »
Talk to your patients about the flu shot With flu activity increasing and people planning gatherings for the holidays, now is the perfect time to talk to your patients about getting their flu shot. The Centers for Disease Control and Prevention (CDC) recommends that everyone 6 months of age and older get a flu vaccine every year. This season, however, CDC recommends only the flu shot (not the nasal spray vaccine). While seasonal flu activity varies, flu activity usually peaks between December and February, though activity can last as late as May. As long as flu activity is ... December 13, 2016 General Immunization, Influenza, Public Health, Vaccination, Flu 0 0 Comment Read More »
