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DHCS receives approval on Medi-Cal supplemental tobacco tax payments for FY 2018-2019

Thu, 20 Sep 2018

The California Department of Health Care Services (DHCS) recently received federal approval on its plan to increase Medi-Cal fee-for-service physician payments for the 2018-2019 fiscal year. The supplemental payments—made possible by the Proposition 56 tobacco tax funding—will raise payments for a total of 23 CPT codes, including 10 new preventive CPT codes.

Have you received your supplemental Medi-Cal managed care payments?

Thu, 20 Sep 2018

Plans were required to issue supplemental payments to qualifying physicians within 90 days. The 90-day window ended August 31 and physicians should have already received their supplemental payments.

Tickets still available for Presidential Gala

Mon, 17 Sep 2018

Join the California Medical Association (CMA) on Saturday, October 13, 2018, at the Sacramento Convention Center for the 22nd annual Presidential Gala . The black-tie event will immediately follow CMA’s annual House of Delegates session that evening.

Vote on Senate opioid package expected this week

Mon, 17 Sep 2018

The U.S. Senate is expected to vote this week a bipartisan package of over 70 proposals intended to help combat the nation’s opioid crisis. Known as the Opioid Crisis Response Act of 2018, the package includes legislation intended to reduce opioid use, encourage recovery, support caregivers and families, and drive innovation and long-term solutions.

CMS identifies and corrects errors in MIPS scoring logic

Fri, 14 Sep 2018

The Centers for Medicare and Medicaid Services recently released 2017 Merit-based Incentive Payment System performance scores and payment adjustment information for the 2019 payment year. Physicians have been able to request targeted reviews if they believe an error was made in the calculation of their performance score. Based on these requests, CMS reviewed the concerns, identified a few errors in the scoring logic and implemented system-wide solutions.

CalHIPSO Webinar: MIPS Reporting for 2018

Fri, 14 Sep 2018

The Health Services Advisory Group and the California Health Information Partnership & Services Organization (CalHIPSO) are hosting a free educational webinar on Thursday, October 4, 2018, on the Medicare Merit-Based Incentive Payment System (MIPS). This webinar will cover what you and your practice need to know as you look forward to MIPS reporting for the 2018 performance year

CMA calls on CMS to reverse step therapy decision

Fri, 14 Sep 2018

The California Medical Association and an American Medical Association-led coalition of 94 medical societies delivered a letter to the Centers for Medicare and Medicaid Services about the serious concerns physicians have with the agency’s recent decision to allow Medicare Advantage plans to use step therapy for Part B drugs.  

Coding Corner: ICD-10 unveils new diagnostic codes to report human trafficking

Tue, 11 Sep 2018

CPR’s “Coding Corner” focuses on coding, compliance, and documentation issues relating specifically to physician billing.

Health Net addresses problems with explanation of payment

Tue, 11 Sep 2018

On August 21, 2018, Health Net notified providers that some paper explanation of payment (EOPs), commonly known as explanations of benefits, for commercial exchange enrollees were not displaying amounts correctly. This problem prevented providers from properly reconciling the amount Health Net is responsible for or the patient cost-sharing.

UnitedHealthcare to discontinue use of fax numbers for medical prior authorization requests

Tue, 11 Sep 2018

UnitedHealthcare announced in its September 2018 Network Bulletin that it will begin retiring fax numbers utilized for medical prior authorization requests beginning January 1, 2019. Providers will be directed to utilize the Prior Authorization and Notification tool on Link, the UHC website currently utilized to check eligibility and benefits, manage claims and update provider demographic information.