IMQ offers free online course on identifying and reporting child abuse The California Medical Association's Institute for Medical Quality (IMQ) announced that it will offer free training on ways to recognize and report child abuse and neglect. This interactive online course was produced by the Child Abuse Prevention center in Sacramento and designed for physicians who, because of their training or their practice, may not be familiar with indications of child abuse. Nurses, social workers and other health care professionals can also benefit from the training, particularly because they often have more extensive contact with patients or families. IMQ has received ... June 2, 2015 General Institute for Medical Quality, Maternal and Child Health, Reporting Abuse/Violence, Continuing Medical Education 0 0 Comment Read More »
CMA supports bill to eliminate RAC incentives that cause punitive and burdensome auditing The California Medical Association (CMA) has announced its support of a bill introduced in Congress on May 22 that would reform the Medicare Recovery Audit Contractors (RAC) system. It is titled the Fair Medical Audits Act of 2015 and was introduced by North Carolina Congressman George Holding. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 established the Medicare RAC program to combat fraud and waste in the Medicare system. Initially launched in 2005 as a demonstration project in three states (California, Florida and New York), the Centers for ... June 2, 2015 Medicare Advocacy, Federal Legislation, Medicare, Recovery Audit Program 0 0 Comment Read More »
CMA Capitol Insight: May 26, 2015 CMA Capitol Insight is a biweekly column by veteran journalist Anthony York, reporting on the inner works of the state Legislature. Only time will tell As a bill to require children to receive vaccinations before entering public school moved off the Senate floor, the tactics of the California Chiropractic Association were brought into question through a number of independent journalism reports. The California Medical Association will continue to fight hard for what we believe is good public health policy. And while we understand that there can be honest and open disagreement ... June 2, 2015 General CMA Capitol Insight, State Legislative Advocacy, Anthony York 0 0 Comment Read More »
CMS to issue new Medicaid managed care rules for comment For the first time since 2002, the Obama administration has announced that it will propose new federal regulations for Medicaid managed care. The Centers for Medicare and Medicaid Services (CMS) is slated to issue a Notice of Proposed Rulemaking sometime in 2015. Industry stakeholders have already submitted input and recommendations to CMS to consider in the final drafting of the new rules. Indications from those who have already commented on agency drafts are that the new rules will address rate setting, stronger beneficiary protections and easing beneficiary transitions between Medicaid ... May 26, 2015 Managed Care, Medi-Cal CMS, Long Term Care, Medi-Cal, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
Fresno ER physician announces run for State Assembly On May 11, Joaquin Arambula, M.D., an emergency room physician at Adventist Medical Center in Selma, located in rural Fresno County, announced he is running for the California State Assembly. “I am running for Assembly to make our community a healthier place to live, work and raise a family,” Dr. Arambula said. “I will go to Sacramento to fight for access to quality health care, public education and our fair share of water.” Both the current Assembly representative from District 31, Henry T. Perea, who is not eligible to run because ... May 26, 2015 General Physician Leadership, State Assembly, California Assembly 0 0 Comment Read More »
California Medical Association supports the Fair Medical Audits Act of 2015 The California Medical Association (CMA) issued a strong endorsement for the “Fair Medical Audits Act of 2015,” introduced today by U.S. Representative George Holding of North Carolina. The legislation addresses many concerns that physicians have with regard to the extraordinary lack of transparency and expensive, time-consuming and often unfair processes that plague the current Medicare audit program. Representative Holding declared it time to fix the broken audit program: “Put simply, patients achieve the best health outcomes when practicing physicians do just that – practice medicine. My bill will bring transparency ... May 26, 2015 Medicare Federal Legislation, Medicare, Recovery Audit Program, Advocacy, Audits 0 0 Comment Read More »
DHCS reopens window for NICU/PICU claims submission under ACA PCP rate increase On May 18, the California Department of Health Care Services (DHCS) released additional information about Medi-Cal payment increases for primary care physicians under the Affordable Care Act (ACA) who file claims for patients treated in neonatal intensive care units (NICU) or pediatric intensive care units (PICU). In the past, NICU/PICU claims were billed to Medi-Cal using a local code. In order to be eligible for the ACA enhanced payments, physicians were required to submit claims with ACA modifiers beginning April 11, 2014, that linked the local code to an eligible ... May 26, 2015 Medi-Cal Affordable Care Act, Medi-Cal, Pediatrics, ACA 0 0 Comment Read More »
California seniors' state of health ranks 29th in national health study According to a study released June 20 from America’s Health Rankings, California’s seniors have decreased exercising in the past two years, have begun drinking more alcohol and are experiencing more mental health issues. Over the past two years, California’s senior population decreased exercising and dropped stopped from a national ranking of 18th in the nation to 29th -- this according to a study conducted by the United Health Foundation, a nonprofit arm of the United Health Group, which also owns the insurer United Healthcare. The study tracked 35 measures for senior ... May 26, 2015 Medicare Seniors and Persons with Disabilities, Medicare 0 0 Comment Read More »
Ask the Expert: If Medicare pays for a procedure, does a Medicare Advantage plan also have to pay? The California Medical Association (CMA) has received this question from physician practices many times over the past few years. The answer is – it depends. Title XVIII of the Social Security Act established regulations for the Medicare program, which includes provisions affecting Medicare Advantage (MA) plans. The Centers for Medicare and Medicaid Services (CMS) has interpreted these provisions through the Medicare Managed Care Manual (Chapter 4 – Benefits and Beneficiary Protections). The Manual provides guidance for MA plans under Internet-only manual (IOM) 100-16. These guidelines reflect CMS’ current interpretation ... May 21, 2015 Medicare Medicare Advantage, Medicare 0 0 Comment Read More »
United Healthcare to deactivate inactive physician TINs as part of provider directory cleanup Beginning August 1, 2015, United Healthcare (UHC) will initiate a cleanup of its participating provider database and directory. Participating physicians who have not submitted a claim to UHC for a period of one year will be deemed to have voluntarily ceased participation in the UHC physician network; United will initiate a termination of the physician agreement. UHC will contact impacted providers to advise of the termination and to clarify any concerns from the physician. The California Medical Association has inquired about when and how physicians will be notified. Additionally, ... May 21, 2015 General, Managed Care United Healthcare 0 0 Comment Read More »
