Surviving the Second Month of Covered California Surviving the Second Month of Covered California As of January 15, Covered California reports that more than 625,000 individuals have enrolled in exchange plans. With that figure expected to grow by the end of the 2014 open enrollment period, it is critical that physicians and their staff know what to expect. To help answer some of the more common questions, the California Medical Association (CMA) offers this second tip sheet to help physicians survive the second month of Covered California. CLICK HERE TO DOWNLOAD THIS TIPSHEET Click Here to Download CMA's Surviving ... January 8, 2014 ACA, Covered California, Member Benefits ACA, Covered California 0 0 Comment Read More »
Update on Duals Demonstration CMA received notice that beginning in January 2014 the state plans to mail notices to those beneficiaries who will be enrolled in the demonstration on April 1, 2014. Below, please see detailed information on the state’s plan and resources for physicians to help them through this transition. Background The 2012 budget authorized the Coordinated Care Initiative (CCI), which would allow persons eligible for both Medicare and Medi-Cal (dual eligibles) to receive medical, behavioral, long-term supports and services (LTSS), and home- and community-based services coordinated through a single health plan in eight ... January 7, 2014 Medi-Cal Duals Demonstration Project, Medi-Cal 0 0 Comment Read More »
Important Notice From MBC: Annual $6 Fee to Support CURES Important Notice: Additional Fees Effective April 1, 2014, to Implement Senate Bill 809 (DeSaulnier, Chapter 400, Statutes of 2013) Senate Bill 809, regarding the Controlled Substance Utilization Review and Evaluation System (CURES), Prescription Drug Monitoring Program (PDMP), was signed by the governor and becomes effective January 1, 2014. The CURES / PDMP is a valuable tool for healthcare professionals as it allows pre-registered users, including licensed healthcare prescribers eligible to prescribe controlled substances, pharmacists authorized to dispense controlled substances, law enforcement, and regulatory boards, to access timely patient controlled substance ... January 6, 2014 CURES, MBC CURES, MBC 0 0 Comment Read More »
Recent Alerts Concerning pH1N1 Influenza From the California Health Alert Network — January 3, 2014 This health alert provides summaries of recent advisories on influenza from the Centers for Disease Control and Prevention (CDC) and the California Department of Public Health (CDPH), summarizes current influenza activity in San Diego County, and provides links to useful influenza resources. On December 24, CDC issued a Health Alert Network (HAN) advisory discussing recent reports from several states of severe infection associated with influenza A (H1N1) pdm09 (pH1N1) virus infection. The advisory described critically-ill young and middle-aged adults infected with ... January 6, 2014 Flu, Influenza, Public Health H1N1, Influenza 0 0 Comment Read More »
CMS Publishes 2014 Medicare Fee Schedule From CMA's December 16, 2013, CMA Alert On November 27, the Centers for Medicare and Medicaid Services (CMS) released the 1,369-page 2014 Medicare Physician Fee Schedule final rule, which was published in the December 10 Federal Register. Most provisions take effect January 1, 2014, although a few issues are open for public comment by January 27, 2014. The American Medical Association (AMA) has published a summary of the final rule. Below are a few key points: Although the final rule contains the 23.7 percent physician payment cut ... December 18, 2013 CMS, Medicare, Physician Fee Schedule CMS, Medicare, Physician Fee Schedule 0 0 Comment Read More »
Voluntary Submission of the New CMS 1500 Claim Form Begins in January From CMA's December 16, 2013, CMA Alert The White House Office of Management and Budget (OMB) approved the revised Centers for Medicare & Medicaid Services (CMS) 1500 claim form, version 02/12, OMB control number 0938-1197. The CMS 1500 claim form is the required format for submitting paper claims to Medicare. The revised form, among other changes, adds the following functionality: Indicators for differentiating between ICD-9 and ICD-10 diagnosis codes. Expansion of the number of possible diagnosis codes to 12. Qualifiers to identify ... December 18, 2013 CMS CMS 1500 Claim Form 0 0 Comment Read More »
CMS Delays Stage 3 Reporting Requirements for Meaningful Use Until 2017 From CMA's December 16, 2013, CMA Alert Late last week, the Centers for Medicare & Medicaid Services (CMS) announced proposed updates to the electronic health records (EHR) incentive program timeline that extends stage 2 meaningful use for an additional year through 2016. That means that providers participating in the program will now not be required to start stage 3 until January 2017 at the earliest. The goal of this change is two-fold: first, to allow CMS to focus efforts on the successful implementation of the enhanced patient engagement, interoperability and health ... December 18, 2013 Meaningful Use Meaningful Use, Reporting Requirements, Stage 3 0 0 Comment Read More »
CMA Updates Exchange Toolkit to Reflect Key Developments From CMA's December 16, 2013, CMA Alert In February, CMA published a comprehensive toolkit on Covered California: "CMA’s Got You Covered: A Physician’s Guide to Covered California, the State’s Health Benefit Exchange." The guide has been updated to reflect key developments in the exchange including the grace period, how plans are building their exchange networks, how to check physician participation status on the Covered California website, and steps physicians can take if they disagree with their participation status in the exchange plans. The toolkit is available free to members only at ... December 18, 2013 ACA, Covered California ACA, Covered California 0 0 Comment Read More »
New Workers' Compensation RBRVS Physician Fee Schedule Effective January 1, 2014 From CMA's December 16, 2013, CMA Alert As part of the reforms instituted by SB 863, the Division of Workers’ Compensation (DWC) will begin utilizing a new fee schedule based on the resource-based relative value scale (RBRVS) effective January 1, 2014. The new RBRVS-based physician fee schedule will apply to services rendered on or after January 1, 2014, and will replace the current Official Medical Fee Schedule, which has not been updated to reflect new procedure codes and relative value units (RVU) since 1999. This newly adopted physician fee schedule will ... December 18, 2013 Physician Fee Schedule, Workers' Compensation Physician Fee Schedule, Workers' Compensation 0 0 Comment Read More »
Low Income Health Plan Transition Begins January 1 From CMA's December 16, 2013, CMA Alert As part of a multi-faceted Medi-Cal expansion, the California Department of Health Care Services (DHCS) will be transitioning roughly 600,000 enrollees with incomes at or below 133 percent of the federal poverty level from the Low Income Health Program (LIHP) to Medi-Cal managed care effective January 1, 2014. LIHP is a county-based program established under California’s “Bridge to Reform” SS1115 Medicaid Demonstration Waiver, and was created to prepare for health coverage options authorized through the Affordable Care Act of 2010 (ACA). The program provides ... December 18, 2013 Medi-Cal DHCS, LIHP, Medi-Cal 0 0 Comment Read More »