Monday, December 18, 2017

OCMA Blog

Physician Advocate Tip of the Month: How To Collect Deductibles On Covered CA Health Plans

September Tip:

How To Collect Deductibles On Covered California Health Plans

There are four plan types (Bronze, Silver, Gold and Platinum) and not all plans and benefits are subject to deductibles. To prevent patient confusion and frustration, OCMA recommends all front office staff:

1.   Download the Covered CA Standard Benefits Summary for 2014 here.
 
2.   Be familiar with which plans have a deductible and which benefits are subject to the deductible.
 
3.   Learn how to confirm whether the patient has met their deductible through their plan's website.

 
For more information, see the Covered CA Standard Benefit Plan Designs.


Physician Advocate Tip of the Month: Identify Covered California patients who are in months two and three of the Grace Period

July Tip:

Identify Covered California patients who are in months two and three of the Grace Period using the following verification codes:

Plan Name 

Eligibility Code

 Anthem Blue Cross  "Inactive pending investigation"  
 Blue Shield of California   "Pended" 
 Health Net  "Eligibility suspended"

 

What are your options if a patient presents with inactive coverage? Download "Surviving Covered California: Tip Sheet #4" (a member-only resource) at www.cmanet.org/exchange.

Would you like a FREE Practice Assessment?

Find opportunities to increase revenue with the billing process, accounts receivable and collections and discuss all of your concerns. Increase efficiency with patient scheduling, appointments and check-in process. Contact Mitzi to schedule your member-only practice assessment.
 
Receiving practice management guidance from Mitzi Young is a FREE OCMA member benefit!
Mitzi Young
Physician Advocate, CMA Center for Economic Services
888.236.0267
myoung@cmanet.org


Physician Advocate Tip of the Month: Request your FREE Covered CA Contract Analysis

May Tip:

Request your FREE in-depth, paragraph-by-paragraph contract analysis of the four insurance payors participating in Covered California!

OCMA contracted with our business partner Tredway Lumsdaine & Doyle, LLP, to do an in-depth analysis of the contracts of the three insurance payors (Blue Cross, Blue Shield and Health Net) that are offering plans through Covered California. OCMA members can receive a FREE copy of this paragraph-by-paragraph analysis to help aid your understanding of these health plan contracts.
 
Contact Mitzi Young at:
888.236.0267
myoung@cmanet.org


Member Resource: Surviving the Third Month of Covered CA

As of February 15, Covered California reports that more than 828,000 individuals have enrolled in exchange plans, which surpasses its original target. 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 third tip sheet to help physicians survive the third month of Covered California.

Additionally, CMA has just published a document physicians can provide to their patients to address the most common patient questions. The document is available free for members in CMA's exchange resource center at www.cmanet.org/exchange. If you would like patient materials delivered to your office or patient training for your office staff, please fill out a Covered CA Information Request form and fax or email it back to OCMA. 
 
Still have questions?
Visit CMA's exchange resource center at www.cmanet.org/exchange. There you will find all of CMA's exchange resources, including CMA's comprehensive exchange toolkit, "CMA's Got You Covered: A Physician's Guide to Covered California, the state's health benefit exchange." OCMA members and their staff also have FREE access to your Physician Advocate, Mitzi Young for reimbursement assistance and questions about the exchange. Members can contact Mitzi at (888) 236-0267 or myoung@cmanet.org.


CMA Resource: 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 a second tip sheet as a members-only benefit to help physicians survive the second month of Covered California. To access the full Covered CA tip sheet, click here or visit  http://www.cmanet.org/resource-library/detail/?item=surviving-the-second-month-of-covered.


Physician Advocate Tip of the Month - What you need to know about "the grace period"

February Tip:
What You Need to Know About "The Grace Period"

 Federal law allows Covered CA enrollees who receive financial subsidies to keep their health insurance for three months, even if they have stopped paying their premiums. This is known as the "grace period."

CMA made significant progress through their advocacy efforts to help ensure that physicians are not on the hook for unpaid claims in months two and three of the three-month grace period. Instead, coverage will be suspended during those two months. CMA has prepared an easy-to-understand fact sheet to help physicians and their staff understand what the grace period means for their practices and their patients. Click here to download a copy of the grace period fact sheet.

 Upcoming: OCMA Exchange Seminar  

Mitzi Young, OCMA/CMA Physician Advocate, will be hosting an exchange seminar at OCMA on Thursday, February 27. The seminar will focus on how the California health benefit exchange will affect physician practices. Attendance for this seminar is free for OCMA members. For more information and to RSVP, visit https://caexchange.eventbrite.com.


Receiving practice management guidance from Mitzi is a FREE OCMA member benefit!


Contact Mitzi to schedule a one-on-one consultation to discuss your practice management needs:

Mitzi Young
Physician Advocate, CMA Center for Economic Services
888.236.0267
myoung@cmanet.org


Orange County Public Healthcare Update: OC In+Care Newsletter


OC In+Care: A newsletter for providers serving people living with HIV/AIDS in Orange County


How does ACA affect patients? 

 
There are three ways in which ACA may affect people living with HIV/AIDS (PLWH/A). 
 
1) ACA will not impact your patient if they:

  • Would like to keep their current private insurance plan
  • Have employer-based insurance
  • Are receiving Ryan White medical care and ineligible for ACA
  • Are CalOptima (Medi-Cal in Orange County) or Medicare patients

2) ACA offers an opportunity for Individuals living with HIV/AIDS to quality for CalOptima coverage based on Federal Poverty Level (FPL) which is about $15,000 per year for one person.

  • Individuals who are legal residents with income below 138% FPL.
  • Patients who are currently on Medical Services Initiative (MSI) will be automatically enrolled into CalOptima for individuals below 138% FPL.

3) ACA requires that your patient purchase insurance and enroll in the health insurance exchange through Covered California if the individual is above 138% of the FPL. Depending on the individual, financial assistance such as: subsidies, health insurance premium payment, and/or waivers may be available. 

For patients who do not qualify for private health insurance, Medi-Cal, or will receive services not covered by their current coverage, they may be eligible for the federally-funded Ryan White program. This program offers medical, supportive services, and medication assistance for individuals who have no other source of paying for care services.

Covered California Enrollment Locations- Orange County
 
AIDS Services Foundation- (949) 809-5781 -Sky Park Circle, Irvine
 
AltaMed- (877) 462-2582 - S. Bristol Ave., Santa Ana 
 
APAIT Health Center- (714) 636-1349 - Garden Grove Blvd, Garden Grove 
 
Delhi Community Center- (714) 481-9600 - E. Central Ave., Santa Ana 
 
The Center OC- (714) 953-5428 ext. 336- N. Spurgeon St., Santa Ana

Covered California
 
For patients who are interested in health insurance options other than their current plan, or their income puts them above the 138% FPL, they will have to apply through the health insurance exchange. In California, this is called Covered California.

Multiple locations in Orange County have enrollment workers who can help patients enroll in appropriate health coverage; whether it is into private insurance or Medi-Cal. Individuals can also visit the Covered California website at www.coveredca.com..

Subsidies may be available to patients who have enrolled in a Covered California approved plan.

Office of AIDS-Health Insurance Premium Payment (OA-HIPP)

OA-HIPP is a program for individuals living with HIV/AIDS and need assistance in payments for health insurance premiums. Individuals above 138% FPL who qualify for AIDS Drugs Assistance Program (ADAP), may also qualify to receive assistance with premiums. For more information on OA-HIPP, visit: www.cdph.ca.gov/programs/aids/Pages/tOAHIPPindiv.aspx

Important Reminders 

  • If the patient currently has ADAP or Ryan White coverage, s/he will be screened at their eligibility appointment for all programs s/he may be eligible. 
  • Patients should be reminded to attend their eligibility appointment.
  • If the patient has a case manager or a care coordinator, they can assist the patient in addressing questions regarding ACA.
  • Enrollment varies depending on coverage.
  • If patient is eligible for Medi-Cal, enrollment began October 1, 2013. Coverage will begin January 1, 2014, but patients can apply at any time.
  • If the patient is above 138% FPL and is eligible for a Qualified Health Plan through Covered California, enrollment began October 1, 2013 and ends March 31, 2014. Open enrollment is between October through December thereafter.
  • Remind clients to open and read their mail as important information regarding health coverage is being disseminated via mail.


Covered California Affordable Care Act Resources


Health Care Reform and YOU!

 
HIV Health Reform: www.hivhealthreform.org/ 
 
Greater Than AIDS 
www.greaterthan.org/campaign/obamacare/ 
 
Please visit Orange County Health Care Agency's website for important up-to-date resources on the Affordable Care Act: www.ochealthinfo.com/phs/about/dcepi/hiv/libehiv/aca


OC In+Care is a project of the Orange County HIV Quality Management Committee. The HIV Quality Management Committee works to increase the quality of Ryan White services. For more information about the committee, please call (714) 834-8711.
 
If you have feedback or topic suggestions for future newsletters, please contact Mindy He at Mhe@ochca.com

Physician Advocate Tip of the Month - Surviving the first month of Covered California

January Tip:


On January 1, 2014, California's health benefit exchange, Covered California, began providing health coverage to more than 400,000 patients statewide. It is critical that physicians and their staff know what to expect. 

In an effort to proactively arm physician practices with important information during the first month of the exchange, the California Medical Association has prepared the resource "Surviving the first month of the exchange" tip sheet. 



Receiving practice management guidance from Mitzi is a FREE OCMA member benefit!

Contact Mitzi to schedule a one-on-one consultation to discuss your practice management needs: 

Mitzi Young
Physician Advocate, CMA Center for Economic Services
888.236.0267
myoung@cmanet.org


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