CMA Foundation joins international effort to bring awareness to appropriate use of antibiotics The California Medical Association (CMA) Foundation this week joins hundreds of organizations across the globe including the Centers for Disease Control and Prevention (CDC) in raising awareness about appropriate antibiotic use in honor of “Get Smart About Antibiotics Week.” Educating physicians and patients about appropriate use of antibiotics has been a priority of the CMA Foundation for the past 15 years, through its Alliance Working for Antibiotic Resistance Education (AWARE) project. The AWARE project was formed in 2001 when the CMA Foundation, together with the California State Parent Teacher Association, ... November 16, 2016 CMA, General Antibiotic Resistance, AWARE, CMA Foundation (CMAF), Public Health 0 0 Comment Read More »
Know Your Rights: Timely filing denials CMA’s “Know Your Rights” series summarizes vital protections under state and federal law that physicians should be aware of in their dealings with payors. Health plans typically impose claim filing deadlines, which require physicians to submit claims within a certain time period after the date of service. If the physician fails to meet the deadline, the health plan will not pay for the service provided. However, California law prohibits commercial health plans and insurers from imposing claim filing deadlines that are less than 90 days after the date of service ... November 16, 2016 General Denials, Know Your Rights 0 0 Comment Read More »
AHIP conducting follow-up survey on Provider Directory Pilot America's Health Insurance Plans (AHIP) is conducting a follow-up survey of providers to evaluate the process and results of its earlier Provider Directory Pilot program. This program was aimed at meeting the requirements of California Senate Bill 137, which requires that physician directories are more accurate and up-to-date. AHIP has contracted with independent research organization NORC, at the University of Chicago, to reach out to providers as part of the evaluation phase of the provider directory pilot. Outreach to providers will include an online survey of provider office staff who ... November 16, 2016 General, Managed Care Network Adequacy, Provider Directories, Provider Directory Accuracy Law 0 0 Comment Read More »
United to issue new 2016-2017 Premium Designation physician results In its October Network Bulletin, United Healthcare (UHC) announced that the next iteration of its Premium Designation assessment results will be sent to physicians in early November. These results will be released publicly via the payor's online physician directory beginning January 4, 2017. Physicians within 16 specialties (allergy, cardiology, ENT, endocrinology, family medicine, gastroenterology, general surgery, internal medicine, nephrology, neurology, neurosurgery, OB/GYN, pediatrics, pulmonology, rheumatology and urology) and their 47 credentialed sub-specialties will again be ranked by UHC on both national and specialty-specific measures for quality and various cost-efficiency benchmarks. ... November 16, 2016 Managed Care United Healthcare 0 0 Comment Read More »
New Health Laws 2017: Are you ready? The California Legislature had an active year, passing many new laws affecting health care. In particular, there was a strong focus on health care coverage, drug prescribing, public health and workers’ compensation issues. The California Medical Association has published a summary of the most significant new health laws of interest to physicians. For more details, see "Significant New California Laws of Interest to Physicians for 2017." November 16, 2016 General California Physician's Legal Handbook 0 0 Comment Read More »
Pharmacy board warns of fraudulent prescriptions for controlled substances The California State Board of Pharmacy recently warned pharmacies of an uptick in fraudulent California security prescription forms for controlled substances. The pharmacy board is encouraging pharmacies to take appropriate precautions to verify the legitimacy of prescriptions written by prescribers who have been identified as victims of this fraud. The pharmacy board maintains a list by county of prescribers who have reported stolen or fraudulent California security prescription forms. Pharmacies that receive prescriptions from a provider on this list have been advised to verify the prescription by contacting the provider's ... November 16, 2016 General Drug Prescribing, Fraud and Abuse 0 0 Comment Read More »
2017 Medicare fee schedule includes $140 million in additional funding for primay care The Centers for Medicare and Medicaid Services (CMS) on Wednesday released the final 2017 Medicare physician fee schedule. The fee schedule transforms how Medicare pays for primary care through a new focus on care management and behavioral health, which is expected to result in an additional $140 million in payments next year for physicians providing these services. The 2017 physician fee schedule focuses on improving Medicare payments for services provided by primary care physicians for patients with multiple chronic conditions, mental and behavioral health issues, and cognitive impairment or mobility-related ... November 14, 2016 Medicare Fee Schedule, Geographic Practice Cost Index, GPCI, MACRA, Medicare 0 0 Comment Read More »
Don't forget: Last day to change your Medicare participation status for 2017 is December 31 Once again, it’s time for physicians to decide if they want to make changes to their Medicare participation status. Physicians have until December 31, 2016, to make changes for 2017. Although Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) penalties will not kick in until 2019, there are two more years of penalties that will be applied based on 2015 performance—tied to the meaningful use, Physician Quality Reporting System and Value-Based Modifier reporting programs. This will also decrease the limiting charge amounts that nonparticipating physicians can bill to ... November 14, 2016 Medicare Medicare 0 0 Comment Read More »
Physicians have until November 30 to dispute 2015 PQRS and QRUR findings The Centers for Medicare and Medicaid Services (CMS) recently released data that indicates which physicians will be subject to the 2017 payment penalties associated with the Physician Quality Reporting System (PQRS) and Value-Based Payment Modifier (VM) programs. Physicians who have concerns about the findings in their report(s) have until November 30 to file for an informal review of their data. The penalties in question stem from policies in effect prior to the enactment of the Medicare Access and CHIP Reauthorization Act (MACRA). Failure to successfully complete required PQRS reporting ... November 14, 2016 Managed Care, Medi-Cal, Medicare Quality Reporting, Medicare, Physician Quality Reporting System, PQRS 0 0 Comment Read More »
California Medical Association applauds voter approval of Proposition 52 The California Medical Association (CMA) today applauded voter approval of Proposition 52, the California Medi-Cal Hospital Reimbursement Initiative. Voters passed the measure, which will maximize the amount of federal funds available to California to provide health care services to children, seniors and working families through Medi-Cal. “One in three Californians rely on Medi-Cal care so it’s critical that we invest in health care services needed by our most vulnerable populations,” said CMA Immediate Past President Steven E. Larson, M.D., MPH. “Prop. 52 will help provide essentials like check-ups, immunizations, prescriptions, ... November 14, 2016 Medi-Cal Ballot Measures, Election, Medi-Cal, Political Advocacy 0 0 Comment Read More »
