CMA Practice Resources (CPR) is a free monthly e-bulletin from the California Medical Association’s practice management experts that focuses on critical payor and health care industry changes and how they directly impact the business of a physician practice. Each issue includes tips on reimbursement and contracting related issues along with information on the latest practice management news.
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In this issue:
- Medicare transition update
- Don’t forget! PQRS payment adjustment exemption deadline Oct. 15
- Don’t miss out on increased Medi-Cal payments
- Blue Shield announces fee schedule changes effective December 1
- CMA updates exchange toolkit
- Cigna recontracting with thousands of providers in Southern California
- Exchange’s provider directories yet to be published, staff targeting Oct. 1 release
- Health Net to allow physicians to obtain a retroactive authorization
- Medicare reconsiders overpayments associated with incarcerated beneficiaries
- Reminder: Changes to Anthem Blue Cross reimbursement policies and claims software become effective November 1
- What will Medicare reimburse for flu vaccine?
- FYI: Anthem Blue Cross moving inquiry functions to Availity web portal
- Anthem Blue Cross sends “Exchange 101” mailer to physicians in its exchange networks
- CMS launches new online ICD-10 implementation guide
- The Coding Corner: Document carefully for same-day preventive, complaint-driven services
Regular features:
- CMA advocacy at work
- Payor updates
- Save the date
- Problems getting paid?
- Health plan provider newsletters
Medicare transition update
September 16, 2013, marked the transition to the new Medicare Administrative Contractor, Noridian. The first few days saw only minor problems with technology including systems that went down for brief periods of time, minor issues with the online provider service tool Endeavor and problems with printing of pdf files from the Noridian website. Most issues have been resolved.
Traffic on the Provider Contact Center line is high, as expected. Wait times are sometimes four to five minutes, but practices report satisfaction with customer service provided. One of the most commonly asked questions has been around how to locate remittance advices on the Endeavor tool. While this option was provided by Palmetto, it is not a Centers for Medicaid & Medicare required element.
Noridian wants to maintain the level of service that Palmetto provided and is working to add that option to Endeavor in the coming weeks. In the meantime, practices can still access their remittance advices by mail or electronically through their clearinghouse or billing service.
Also Noridian has cross-walked the remittance advice remarks and messages as closely as possible to what Palmetto used for claim processing. However, there may be differences. If you encounter different or unusual messages, please call Michele Kelly with the California Medical Association (CMA) at (213) 226-0338 so we can work with Noridian on the issue.
Noridian provides one toll-free number for its interactive voice response (IVR) and customer service representatives for all departments, (855) 609-9960. Navigating the IVR to reach the department you need can be confusing. Noridian provides several resources to assist you. To reach areas such as provider enrollment, appeals, and re-openings, refer to the Provider Contact Center link under “Contact Us.” Noridian also provides an IVR Guide, with a link in the footer box under Contact.
Noridian released claims submitted on and after September 12 on the evening of September 16. It may be two weeks or so before we know if there are any issues affecting payment. CMA encourages practices to review their remittance advices carefully looking for unexpected denials or rejections and for payment differences as the claims start to settle, and to let CMA know of any issues that arise. We will work with Noridian on the physician member’s behalf to resolve issues as needed.
Contact: Michele Kelly, (213) 226-0338 or mkelly@cmanet.org.
Don’t forget! PQRS payment adjustment exemption deadline Oct. 15
The Center for Medicare and Medicaid Services' (CMS) has made available the Physician Quality Reporting System (PQRS) "administrative claims-based reporting mechanism" as an alternative method of avoiding the 1.5 percent payment penalty in 2015. Physicians who cannot or choose not to participate in PQRS can sign up for an exemption via the administrative claims-based reporting mechanism before October 15, 2013.
Providers who choose the administrative claims-based reporting will be automatically evaluated from claims data on 19 quality measures for 100 percent of their applicable Medicare Part B fee-for-service beneficiaries to whom the measure applies.
Physicians must sign up for this exemption on the CMS Enterprise Portal by October 15, 2013.
For details on how to apply for the exemption, refer to the CMA guide, Getting Started with the Medicare Physician Quality Reporting System. For more detailed information, click here.
Don’t miss out on increased Medi-Cal payments
The California Department of Health Care Services (DHCS) will soon be implementing rate increases for primary care physicians who treat Medicaid patients, as authorized under the Affordable Care Act. The increase also applies to services provided by physicians to Medi-Cal managed care patients. In order to see the bump in pay, providers must first attest to their eligibility. According to DHCS, less than half of eligible providers have completed the brief self-attestation process as of September 24.
For purposes of this regulation, primary care is defined as family medicine, general internal medicine, pediatric medicine or related pediatric subspecialties. Pediatric subspecialists must be recognized by the American Board of Medical Specialties, American Board of Physician Specialties or the American Osteopathic Association to receive the increased fees. If a physician is not board certified, eligibility can be determined by the physician’s billing history. Physicians will qualify if 60 percent of the codes they bill are for evaluation and management codes and vaccine administration codes covered by this rule. Physicians can self-attest to their board certification or billing history.
Although the regulations implementing the pay raise were released by the Centers for Medicare & Medicaid Services (CMS) in November 2012, DHCS is still awaiting approval of its State Plan Amendment, which details California's proposed payment methodology for both fee-for-service and managed care payments. DHCS expects to receive approval soon and plans to implement the increase in late October. Once approved, the increases will be retroactive to January 1, 2013.
The goal of the increase is to recruit more physicians to treat low-income patients who will be newly eligible for health coverage under the ACA. Under the ACA, primary care physicians will see their reimbursement rates raised to Medicare levels in 2013 and 2014. According to CMS, states must also incorporate the increased payment rates into their contracts with managed care plans so that primary care physicians contracting with Medi-Cal managed care plans see the higher rates.
Physicians are encouraged to complete the attestation form, which is available on the Medi-Cal website. The attestation form must be completed online (paper copies will not be accepted).
Medi-Cal managed care plans have the option of either using the DHCS online attestation system or developing their own attestation tools. However, when CMA queried the major Medi-Cal managed care plans on how their attestation processes would work, all that responded indicated they would utilize the DHCS attestation process. Physicians are encouraged to check with their Medi-Cal managed care plans to confirm, however.
The rate increase applies to evaluation and management codes 99201 through 99499 and vaccine administration codes 90460, 90461 and 90471 – 90474.
For more information on the increase, including which specialties qualify, see CMA’s Medi-Cal Primary Care Physician Rate Increase FAQs.
Blue Shield announces fee schedule changes effective December 1
Blue Shield announced changes to its physician fee schedule that will take effect December 1, 2013. In a September 23 notice to physicians, the insurer said that it would be increasing payment for evaluation and management services for preventive care. Additionally, Blue Shield notes payment increases for the more commonly billed office visit codes 99204, 99205, 99213 and 99214.
The new rates will be available on the Blue Shield website (under Helpful Resources) beginning October 1. Physicians can also request a copy of the new fees by completing the allowance review form enclosed with the notice, or by calling the Blue Shield Provider Services Department at (800) 258-3091.
Physicians are encouraged to carefully review all proposed amendments to health plan or medical group/IPA contracts. CMA reminds physicians that they do not have to accept substandard contracts that are not beneficial to their practice.
To help physicians understand their rights when a health plan has sent notice of a material change to a contract, the California Medical Association (CMA) has published "Contract Amendments: an Action Guide for Physicians," available in the CMA Resource Library. The guide includes a discussion of options available to physicians when presented with a material change to a contract. Additionally, the guide includes a financial impact worksheet that will help physicians calculate the net impact of the fee schedule changes on their practice.
Click here to view a copy of the notice that was recently sent to physicians.
Contact: Reimbursement Helpline, (888) 401-5911 or economicservices@cmanet.org.
CMA updates exchange toolkit
In 2010, Congress passed historic sweeping health care legislation, the Patient Protection and Affordable Care Act (ACA), which reformed the for-profit health insurance industry – and beginning in 2014, will provide health insurance to most of the nation’s uninsured. Under the ACA, two-thirds of California’s uninsured will be covered by private insurance through a health insurance exchange purchasing pool. California’s exchange, Covered California, will begin pre-enrollment in October 2013.
The California Medical Association’s (CMA) recently updated toolkit, "CMA’s Got You Covered: A physician’s guide to Covered California, the state’s health benefit exchange," was developed to educate physicians on the exchange and ensure that they are aware of important issues related to exchange plan contracting. The toolkit is available free to CMA members at www.cmanet.org/exchange.
Cigna recontracting with thousands of providers in Southern California
In May, Cigna began a five-phase roll out of new reimbursement rates and contract terms to approximately 5,000 Southern California providers who are currently operating under older versions of Cigna contracts. According to the notice, the updates reflect not only changes to the fee schedule, but also changes to contract language to ensure compliance with federal and state regulatory requirements. The next phase is set for a mail date of early October with a January 1, 2014, effective date.
Cigna has advised the California Medical Association (CMA) that it is migrating physicians currently tied to its 2003 fee schedule to its updated 2012 standard fee schedule, which incorporates new codes and coding updates.
The notice provides 90 days’ advance notice of the change and instructs physicians who do not agree to the changes to send written notice of their objection within 20 business days of receipt to Cigna (Attn: Contracting Department #300, 400 North Brand Boulevard, Glendale, CA 91203). Physicians who do so will receive a call from Cigna to discuss the contract changes further. If an agreement cannot be reached, the contract may be terminated.
CMA has received calls from practices expressing concerns that the 20 business day deadline is too short. Additionally, practices have expressed concern that the fee schedule included with the notice is not a complete fee schedule, reflecting only the top 100 billed CPT codes. Some practices reported that they contacted the Cigna Customer Service Center to obtain the full fee schedule, without success.
CMA brought these concerns to Cigna's attention. In response, Cigna provided the following clarifications:
- 20 business day deadline – The notice states physicians must notify Cigna within 20 business days of receipt if they do not agree with the changes. However, to allow time for the physician to evaluate the changes, the insurer will accept written notices from physicians who do not agree to the changes up until 15 days prior to the effective date.
- Access to the full and complete fee schedule – CMA has communicated the difficulties some physicians have experienced in obtaining the new fee schedule from Cigna. In response, Cigna has provided additional education to its staff to ensure that requests for the fee schedule are complied with in a timely manner. Physicians can call Cigna at (800) 882-4462 and request the new fee schedule. Cigna has advised that it will send the full fee schedule via email in excel format. Practices who continue to experience difficulties obtaining the fee schedule are encouraged to call CMA at (888) 401-5911.
Affected physicians are encouraged to carefully review all proposed amendments to payor contracts. CMA has develop a simple financial impact worksheet to help physicians analyze proposed fee schedules and assess the impact any fee schedule change may have based on the practices’ commonly billed CPT Codes. This worksheet is available free to CMA members at www.cmanet.org/ces.
Additionally, to help physicians understand their rights when it comes to payor contract amendments, CMA has published, Contract Amendments: An Action Guide for Physicians, which walks through a physician’s options when a payor makes a material change to a contract.
Questions about the contract can be directed to the Cigna Customer Service Center at (800) 882-4462.
Exchange’s provider directories yet to be published, staff targeting Oct. 1 release
In what has been one of the most fluid deadlines put forth by the state’s health benefit exchange, staff members at Covered California are now saying it will be on or around Oct. 1 before the provider directories for participating health plans are made available to the public.
Despite the importance of this directory, as voiced by both provider and patient advocates wanting to know which providers are being included in the exchange networks, the deadline for release has continued to slide.
In late May, Covered California said it was hoping to have the online provider database up and running by the end of July. The July deadline, however, came and went with almost no mention. The information containing the timelines was also quietly removed from the exchange’s consumer website.
Since that time, the release date for the online directory has been rather nebulous, with Covered California being hesitant to target an actual date. Instead, conjectures such as “end of summer” or “early August” have been tossed around, but not much else has been said.
In late September, Peter Lee, executive director for Covered California, told members of the Assembly Committee on Health that the provider directory would be accessible through the exchange’s website, www.coveredca.com, on Oct. 1.
It remains to be seen whether the directories will be ready to go for the first days of open enrollment and if they are, what Covered California's plans will do should the accuracy of these directories be called into question.
Once the directories are available, the California Medical Association (CMA) recommends physicians review their status with plans offered in their area to determine whether they are showing as participating or non-participating. Questions about participation status can be directed to the plans.
For more information on Covered California, see CMA’s exchange resource center at www.cmanet.org/exchange.
Health Net to allow physicians to obtain a retroactive authorization
Effective October 1, 2013, Health Net is implementing a new “retroactive review and authorization program” in partnership with MedSolutions, the company Health Net uses for utilization management determinations and prior authorization for outpatient imaging services. While the program title is confusing, the new program actually allows contracted physicians the ability to request a retroactive authorization for up to three business days beyond the date of service if an authorization was required and not obtained prior to the rendering of care.
The program also can be utilized in instances where additional services were rendered beyond those pre-approved on the original authorization or where alternative procedures were performed in lieu of the services previously authorized.
The complete list of services that require prior authorization is available in the provider operations manual on the Health Net provider website.
Medicare reconsiders overpayments associated with incarcerated beneficiaries
In June and July 2013, the Centers for Medicare & Medicaid Services (CMS) initiated recoveries from providers and suppliers based on data that indicated a beneficiary was incarcerated on the date of service. Medicare identified previously paid claims that contained a date of service partially or fully overlapping a period when a beneficiary was apparently incarcerated based on information CMS receives from the Social Security Administration. As a result, a large number of overpayments were identified and overpayment (demand) letters sent. CMS has since learned that the information related to these periods of incarcerations was, in some cases, incomplete for CMS purposes.
The California Medical Association, American Medical Association and many other state societies sent a joint letter asking CMS to halt recovery efforts until the data has been corrected. CMS updated its Frequently Asked Questions document to indicate it is actively addressing the problem and is working on restoring the original data on the Medicare Enrollment Data Base. Once that occurs, CMS will identify the claims that were denied or assessed overpayments in error. Medicare Administrative Contractors will then reprocess the claims. This process is not expected to be completed until October 2013 at the earliest.
Reminder: Changes to Anthem Blue Cross reimbursement policies and claims software become effective November 1
In late July, Anthem Blue Cross sent physicians a notice advising of upcoming changes to the insurer’s reimbursement policies and claims editing software called ClaimsXten. The changes will go into effect on November 1, 2013. 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 all new, revised and existing reimbursement policies and claims editing rules as well as copies of Anthem’s reimbursement policies.
Changes include: denial of 3D rendering CPT codes 76376 and 76377; assistant surgeon and co-surgeon codes eligible for payment; qualitative drug screen codes eligible for payment; frequency edits on certain codes; denials on invalid match of diagnosis and procedure code; several changes pertaining to durable medical equipment frequency and rental; and denials of attended sleep studies billed with place of service of 21 (home), among others.
Physicians are encouraged to review the claims editing changes as well as the corresponding detailed payment policies and reimbursement rates to understand how the changes will affect their individual practices.
Physicians can also access the information in the mailer via the Blue Cross website. (Select “Reimbursement Policies and McKesson ClaimsXten Rules” under the “What’s New” section.)
Questions about any of the claims editing rules or payment policies can be directed to Blue Cross Provider Care Department at (800) 677-6669.
What will Medicare reimburse for flu vaccine?
The Centers for Medicaid & Medicare Services has released the annual allowance for Influenza vaccines. The new payment rates are effective for dates of service August 1, 2013, to July 31, 2014. Practices can locate more information at www.cms.gov.
FYI: Anthem Blue Cross moving inquiry functions to Availity web portal
Anthem Blue Cross has advised that it will soon be migrating member eligibility, benefits and claim status inquiry functions from its ProviderAccess portal to the Availity Health Information Network web portal. Citing ease of use, broad functionality and breadth of services provided through the Availity portal, Blue Cross will transition these electronic functions exclusively to Availity in the coming months. Blue Cross has not, however, announced a completion date for the transition.
Practices wishing to register for access to the Availity web portal should go to www.availity.com/providers/registration-details/. Or, to view the current Availity free training webinar schedule, go to www.rsvpbook.com/AvailityWest.
Anthem Blue Cross sends “Exchange 101” mailer to physicians in its exchange networks
On September 16, Anthem Blue Cross sent an informational mailer to physicians about the health benefit exchange and Blue Cross’s participation in the exchange. The mailer was sent to physicians who are participating in one or both of Blue Cross’s individual/exchange products.
The notice provides basic information about Blue Cross’s individual/exchange products including product types by region, product names, essential health benefits and what ID cards will look like.
Additional questions can be directed to Blue Cross’s Network Relations staff at (855) 238-0095.
CMS launches new online ICD-10 implementation guide
The Centers for Medicare & Medicaid Services (CMS) recently launched an online ICD-10 implementation guide to help practices of all sizes successfully make the switch to the new ICD-10 coding system, which is used to report medical diagnoses and inpatient procedures. Physicians and payors must begin using the new code sets by October 1, 2014.
ICD-10 is a system of coding created in 1992 as the successor to the previous ICD-9 system. ICD-10 will include new procedures and diagnoses, which the U.S. Department of Health and Human Services HHS hopes will improve the quality of information available for quality improvement and payment purposes.
The differences between ICD-9 and ICD-10 are significant. Physicians and practice management staff need to start educating themselves now about this major change so that they will be able to meet the October 1, 2014, compliance deadline.
The transition to ICD-10 is required for everyone covered by the Health Insurance Portability Accountability Act (HIPAA). Please note, the change to ICD-10 does not affect CPT coding for outpatient procedures and physician services.
CMS's new web-based tool includes a basic overview of ICD-10 as well as step-by-step guidance on how to transition to ICD-10 for small/medium practices, large practices, small hospitals and payors. Users can easily navigate to the information that is most relevant to them – wherever they are in the implementation process. To access the online guide and other CMS resources and tools to help with the ICD-10 transition, visit http://cms.gov/Medicare/Coding/ICD10/ProviderResources.html.
To assist physicians in preparing for the transition to ICD-10, CMA has partnered with AAPC to provide CMA members with a complete suite of ICD-10 educational courses at steeply discounted rates. For more information, click here.
The Coding Corner: Document carefully for same-day preventive, complaint-driven services
CPR’s “Coding Corner” focuses on coding, compliance and documentation issues relating specifically to physician billing. This month’s tip comes from G. John Verhovshek, the managing editor for AAPC, a training and credentialing association for the business side of health care.
Often, a patient who arrives for a “preventive” service (i.e., a well patient exam) will also mention a problem or other health issue that he or she is experiencing. Whether you separately report a problem-focused service – in addition to the preventive service – depends on the nature of the patient’s problem(s), the payer and your documentation.
If the patient has a major complaint or illness, you probably shouldn’t provide the preventive service at the same time because you would be unable to obtain a good “baseline.” In such a case, you’d do better to reschedule the preventive service for another time and focus the current visit on the present patient complaint.
If the patient complaint is relatively minor, but nevertheless requires additional workup beyond that usually associated with the preventive service, you may choose to report a problem-focused visit in addition to the preventive service.
The CPT® codebook instructs, “If an abnormality is encountered or a preexisting problem is addressed in the process of performing this preventive medicine evaluation and management service, and if the problem or abnormality is significant enough to require additional work to perform the key components of a problem-oriented E/M service, then the appropriate Office/Outpatient code 99201-99215 should also be reported.”
Documentation must support both services. If any portion of the history or exam was performed to satisfy the preventive service, that same portion of work may not be used to calculate the additional level of E/M service. A separate history of present illness (HPI) describing the patient’s complaint supports additional work in the history (there’s no HPI for a preventive service). If a portion of the exam performed is not routine for a preventive service, clearly identify that portion.
Remember: When selecting the additional E/M level of service, only the work “above and beyond” what would have been performed during the preventive service may be counted toward the problem-focused visit.
Lastly, when reporting the preventive visit and a problem-focused visit on the same day, you must append modifier 25 Significant, separately identifiable evaluation and management service by the same physician or other qualified healthcare professional on the same day of the procedure or other service to the problem-focused visit code.
For example, a 30-year-old established patient injures her ankle on the morning of a scheduled routine examination. Provider documentation supports a problem-focused history related to the ankle injury, a problem-focused examination of the ankle, and medical straightforward decision-making, as well as a comprehensive preventive medicine service.
The appropriate coding for a commercial payer is 99212-25 Office or other outpatient visit for the evaluation and management of an established patient… with a diagnosis from ICD-9-CM category 845.xx Sprains and strains of ankle. You would also report 99395 Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 18-39 years with V70.0 Routine general medical examination.
Note that commercial payers’ policies vary. Some will not pay for two evaluation and management services on one date of service, or may reduce payment for one of the services. Check with the payer to verify both the coding policy, and the patient’s benefits.
Alert Patients to Costs
When billing Medicare (which specifies its own codes for many preventive services), any additional E/M service must be “carved out” from the preventive service. This portion of the service may be submitted to Medicare for coverage. The Medicare beneficiary may be billed for the difference between the standard fee for the preventive service and the amount that Medicare will cover. Patients may be confused to see two bills for one office visit. Educating patients prior to billing can help to avoid potential confusion and complaints.
CMA advocacy at work
“The CMA saves the day again! Several of our imaging claims were denied incorrectly by a major insurer. We had followed their claims resolution process to no avail, so we turned to the CMA for support. The CMA has assisted us in collecting payment for all claims in question – a task that seemed impossible despite our efforts. Simply put, the CMA comes to the rescue when all else fails.”
April Krogh, Reimbursement Specialist
EPIC CARE – Partners in Cancer Care
CMA members since 1993
Alameda County
Payor updates
AETNA: Aetna has partnered with Citi to provide an online patient health care payment option similar to that offered by several other major payors. Money2 for Health, Aetna’s online payment tool, will allow patients to securely pay for physician services through the Aetna Navigator member website. For those physicians who have signed up to participate in Money2 for Health, patient payments will be electronically transferred into your designated accounts. Similar to other plans offering these products, Aetna advertises no setup fees as part of joining Money2 for Health, but physicians should be cautious as a fee is assessed on each payment issued to the physician.
ANTHEM BLUE CROSS: Effective for dates of service on or after January 1, 2014, Blue Cross has advised that a number of sleep disorder management and treatment guidelines administered through AIM Specialty Health have been updated. Included in these updates is a new precertification/prior authorization requirement for Multiple Sleep Latency Testing (MSLT) and Maintenance of Wakefulness Testing (MWT). This requirement will be effective for members of Blue Cross’s local and individual health plans who participate in the sleep management program managed by AIM. The current and revised guidelines can be accessed at vwww.aimspecialtyhealth.com.
Anthem Blue Cross also announced that it has improved its provider claim escalation process. Visit Provider Claim Escalation Process to read, print, download and share the improved process with your office staff.
UNITED: Beginning the first quarter of 2014, United Healthcare will no longer reimburse CPT codes 80100, 80101 or 80104 for qualitative drug screening. In alignment with the Centers for Medicare & Medicaid Services, United will require the use of HCPCS codes G0431 and G0434 to report drug screening tests. Additional information regarding laboratory services may be found in the newly renamed Laboratory Services Policy located on UnitedHealthcareOnline.com.
Save the date
The California Medical Association (CMA) offers our members free programs to educate physicians and staff on a range of practice management issues. Space is limited, so register soon.
Upcoming CMA webinars
Most webinars are held over the lunch hour, from 12:15 to 1:15 p.m. and are free for CMA members and their staff. See the event calendar for additional details.
10/2: Successful Medi-Cal Provider Enrollment for Physician Providers: Physicians must re-enroll in Medi-Cal as one of the provisions of the Affordable Care Act (ACA). This training will cover basic instructions and guidelines on the proper way to complete a Provider Enrollment Application Package. We will discuss the importance of reviewing and understanding program requirements and how to avoid common mistakes when completing enrollment forms. We will also cover specialized physician enrollments, important changes to the program due to ACA implementation, and where to find additional program information and PED contact information.
10/9: Benefits of Financing your Electronic Medical Records Project: Learn about financing your practice's EMR project. Webinar will cover the benefits of financing, key considerations in financing decisions, maximizing the return on your investment, understanding the financing process, tax advantages and special offers for CMA members.
10/16: Utilizing Technology to Increase Patient Engagement and Meet the Requirements of Meaningful Use: Patient engagement through the use of technology is no longer an option. It’s essential. Technology is changing the way patients manage their own health along with how clinicians interact with their patients. This webinar will define patient engagement, highlight technologies and applications that support engagement efforts and offer some practical advice for incorporating these tools into your practice. Discussion points will include patient portals, personal health records, the blue button initiative and meeting the patient engagement requirements of meaningful use.
10/30: CMS Quality Reporting Programs: What Physicians Need to Know and Do Now to Improve Care and Avoid Penalties: Presented by the Centers for Medicare & Medicaid Services (CMS), webinar attendees will understand the background and rationale for CMS incentives and payment adjustments that affect physicians, including the Physician Quality Reporting System (PQRS), the ePrescribing (eRx) Incentive Program, the Electronic Health Record (EHR) Incentive Program, and the new Value Modifier (VM) program; be able to define what actions they need to take to receive each incentive and avoid payment adjustments; and know where to go to obtain further information about CMS quality programs and stay abreast of future developments.
For more information or to register for CMA webinars, view the CMA event calendar.
Upcoming CMA seminars
CMA experts travel to local county medical societies throughout the state, holding live seminars for members and their staff on a variety of issues.
10/9: Riverside County Medical Association: California’s Changing Insurance Marketplace
10/10: Riverside County Medical Association: Medicare Update 2014
10/16: Riverside County Medical Association: Medicare Update 2014
Contact: CMA’s member help center, (800) 786-4262 or memberservice@cmanet.org.
Problems getting paid?
The California Medical Association’s Center for Economic Services provides direct reimbursement assistance to CMA physician members and their office staff.
Reimbursement Help Line (888/401-5911)
- One-on-one educational and reimbursement assistance to physician members and their staff
Practice Empowerment
- Tools and resources to empower physician practices
- Seminars and toolkits for physicians and their staff
Experienced Staff
- Staffed by practice management experts with a combined experience of over 125 years in medical practice operations
Need help? Contact CMA’s reimbursement experts at (888) 401-5911 or economicservices@cmanet.org.
Health plan provider newsletters
To make sure that you are aware of important news from your contracting health plans, we encourage you to regularly read plans' provider newsletters and bulletins. Follow the links below to access the current issues.
AETNA: www.aetna.com. Click on "Health Care Professionals" in the main menu, then on "News for Providers" in the left sidebar.
CIGNA: www.cigna.com. Click on "Health Professionals" under "Customer Care" in the main menu. Then, scroll down and click on "Newsletters."
ANTHEM BLUE CROSS: www.anthem.com/ca. Click on "Providers" in the main menu, then on "Professional Network Update" under "Spotlight."
BLUE SHIELD: www.blueshieldca.com. Click on "I'm a Provider," then on "Announcements" under "News and Features."
HEALTH NET: www.healthnet.com. Click on "I'm a Provider" and then "California." Enter username and password, and then click "Online News."
MEDI-CAL: www.medi-cal.ca.gov. Click on "Publications" in the main menu, then on "Provider Bulletins."
MEDICARE/PALMETTO GBA: www.palmettogba.com/j1b. Click on "Publications" in the left sidebar, then on "Medicare Advisory."
UNITED HEALTHCARE: www.unitedhealthcareonline.com. Click on "Tools & Resources" in the main menu, then on "Network Bulletin."
CMA RESOURCE: Find up-to-date profiles on each of the major payors in California.
Got questions?
If you have questions related to any of the articles in this issue, please contact CMA's reimbursement help line, (888) 401-5911 or economicservices@cmanet.org. Questions about membership, including technical website issues, should be directed to CMA's member help center, (800) 786-4CMA or memberservice@cmanet.org.
Tell us what you think
Let us know which topics you would like to see addressed in future issues. Contact CMA's Center for Economic Services at (916) 551-2061 or economicservices@cmanet.org.