Changes to Anthem Blue Cross reimbursement policies and claims software Anthem Blue Cross recently notified physicians of upcoming changes to the insurer’s reimbursement policies and claims editing software, called ClaimsXten. The changes will go into effect on July 1, 2015. 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 the new, revised and existing reimbursement policies and claims editing rules as well as copies of Anthem’s reimbursement policies. The changes include additions to the types of service Anthem will consider bundled ... May 15, 2015 Managed Care Billing/Coding, Insurance, Managed Care, Anthem Blue Cross 0 0 Comment Read More »
Open Payments database now available for physician review The Centers for Medicare and Medicaid Services (CMS) Open Payments database, based on 2013 data, is available to physicians for their review of payments made to them by drug and medical device companies. The review period opened on April 6, 2015, and will be open until at least May 21. The Open Payments database is a part of the Physician Payments Sunshine Act, a provision of the Affordable Care Act. The California Medical Association (CMA) recommends that physicians review their data for accuracy as it will be published on ... April 29, 2015 Medicare CMS, Physician Payments Sunshine Act, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
Senate Bill 277 clears Senate Judiciary Committee Sacramento – Senate Bill 277 (Pan/Allen) passed overwhelmingly out of the Senate Judiciary Committee today. The California Medical Association (CMA), American Academy of Pediatrics, California (AAPCA), California Immunization Coalition (CIC), Vaccinate California and Health Officers Association of California (HOAC) recently launched the I Heart Immunity Campaign supporting the bill. “Our thanks to the Senate Judiciary Committee along with Senators Pan and Allen for their commitment to this very important issue,” said Luther F. Cobb, M.D., CMA president. “Vaccines are a proven way to keep children healthy and communities safe ... April 29, 2015 General Senate Bill 277, Immunizations, Vaccinations 0 0 Comment Read More »
CMA urges physicians to thank Congress for SGR vote Congress was able to put differences aside and overwhelmingly pass H.R. 2—historic bipartisan, bicameral Medicare reform legislation—once and for all! The California members of Congress who supported H.R. 2 deserve a hearty "thank you" for their bold action to repeal Medicare's broken sustainable growth rate (SGR) formula and ensure significant reforms are made to Medicare, shifting the focus to better care and better patient outcomes. H.R.2 also extends the expiring Children’s Health Insurance Program. For more details on the bill, click here for the California Medical Association’s (CMA) summary. Only two ... April 29, 2015 Medicare Advocacy, Medicare, SGR, Sustainable Growth Rate, Federal Legislation 0 0 Comment Read More »
Physicians warned of identity theft tax scam For a second year, the California Medical Association (CMA) has received reports from physicians that fraudulent federal income tax returns have been filed using physician names, addresses and social security numbers. In many cases the fraudulent tax return includes the name of an unknown person listed as the physician's spouse. Generally, this other name is a prior patient of the physician. Affected physicians are likely to learn of the scam by receiving a 5071C letter from the IRS alerting them of possible fraud. Physicians may also have received a rejection ... April 29, 2015 General CPLH, Identity Theft, Legal Advocacy, Tax, California Physician Legal Handbook 0 0 Comment Read More »
Leadership Academy opening session to feature Congressional leaders describing how SGR reform finally passed For nearly two decades, physicians have had to work with the threat of massive cuts to Medicare hanging over their head from the sustainable growth rate (SGR). Somehow, during the most virulent Congressional partisanship in our history, a solution was reached and overwhelmingly passed both houses in April. The Western Health Care Leadership Academy is pleased to confirm that House Majority Leader Kevin McCarthy will be joining the Leadership Academy faculty, along with Charlotte Ivancic, Policy Advisor for the Office of Speaker John Boehner, and Wendell Primus, Senior Policy Advisory ... April 29, 2015 General Sustainable Growth Rate, Western Health Care Leadership Academy, Federal Legislation, SGR 0 0 Comment Read More »
CMA Capitol Insight: April 27, 2015 CMA Capitol Insight is a biweekly column by veteran journalist Anthony York, reporting on the inner workings of the state Legislature. What's new in the Capitol It’s been a wild, tumultuous couple of weeks for the fight to remove the personal belief exemption for school-required vaccinations. It began when Sen. Richard Pan, M.D., first presented his proposal to the Senate Education Committee, and ran into some unanticipated opposition. Democratic Sens. Carol Liu and Loni Hancock expressed reservations about the measure, as did Republican Sen. Bob Huff. At the urging of the committee ... April 29, 2015 General CMA Capitol Insight, Anthony York 0 0 Comment Read More »
California Medical Association responds to vote on Senate Bill 622 After today’s vote in the Senate Business, Professions and Economic Development Committee, California Medical Association President Luther F. Cobb, M.D., responded with the following statement regarding Senate Bill 622: "The amount of training to perform eye surgery stipulated by SB 622, even with the amendments adopted today, is still inadequate to ensure patient safety. Medical doctors perform hundreds more procedures and have tens of thousands more hours of training than what would be required of optometrists under this bill. All Californians deserve to have well-trained physicians to provide high-quality care, ... April 29, 2015 General Scope of Practice, State Legislation, State Legislative Advocacy, Optometrists 0 0 Comment Read More »
Second bill to increase Medi-Cal rates advances through first committee California’s policymakers are continuing to show support for legislation that would fully fund the state’s Medicaid (Medi-Cal) program. Two bills would restore a 10 percent reimbursement rate cut and raise those rates to Medicare levels, allowing better access to health care for patients. Assembly Bill 366 (Bonta, D-Oakland) and Senate Bill 243 (Hernandez, D-West Covina) are currently moving through the legislature. AB 366 took its first step through the legislative process when it advanced to the Assembly Appropriations Committee with unanimous approval on April 14. Last week, it was SB ... April 29, 2015 Medi-Cal Medi-Cal Cuts, State Legislation, State Legislative Advocacy, Medi-Cal 0 0 Comment Read More »
CMA files amicus brief in health care provider whistleblower case Last week, the California Medical Association (CMA) filed an amicus curiae brief in the California Supreme Court to urge a broad interpretation of the hospital whistleblower statute (Health and Safety Code section 1278.5). In Shaw v. Superior Court, defendant Los Angles Kindred Hospital terminated the plaintiff for complaining that the hospital was employing unlicensed and uncertified healthcare professionals. Following the termination, the plaintiff sued Kindred, arguing that health care providers who are categorized as whistleblowers are protected from retaliation by California Health & Safety Code section 1278.5. Last year, in Fahlen ... April 29, 2015 General Legal Advocacy, Amicus Briefs 0 0 Comment Read More »
