Monday, December 11, 2017

OCMA Blog

Physician Advocate Mid-Year Report: 127,000 Reasons to be Member

127,000 REASONS TO BE A MEMBER


The California Medical Association's (CMA) Center for Economic Services' (CES) reimbursement specialists have recouped $127,168 on behalf of physician members of OCMA since the beginning of 2014!

Mitzi Young is OCMA's Physician Advocate from CMA's CES team. Since the start of 2014, Mitzi has met with over 43 physician practices to assist with practice management needs and perform complimentary practice assessments. 

Your Personal Physician Advocate
Meet Mitzi Young, staff member and CMA Center for Economic Services (CES) Physician Advocate for the OCMA. Mitzi is dedicated to handling your practice management issues and is only a phone call away!

Mitzi brings 21 years of practice management experience and expertise in the health care industry. She has worked in numerous health care settings including county organized health programs, surgery centers and specialty health care practices. 
 
Mitzi understands the needs of physicians and their staff, the challenges that face medical practices, and is very passionate about advocating on behalf of doctors in the ever-changing healthcare environment.

 

When do you call Mitzi?

  • When you have questions about Covered California
  • When your claims are not being paid in a timely manner
  • When you are not being paid according to your contract
  • When your claims are being denied after obtaining prior authorization or verifying eligibility
  • When you receive unreasonable requests for medical records or untimely requests for refunds
  • When you are having difficulty obtaining fee schedules and/or payment rules
  • When your claims are denied despite timely filing
  • When you've been presented with a managed care contract and you're not sure if the terms are consistent with California law
  • When you've done everything you can to resolve an issue with a payor and have been unsuccessful
  • When you need help evaluating your practice
  • When you need ANY practice management guidance

Would you like a FREE Practice Assessment?

Find opportunities to increase revenue through the billing process, accounts receivable and collections. Increase efficiency with patient scheduling, appointments and check-in process and discuss all of your practice-related concerns. Contact Mitzi to schedule your member-only practice assessment.
 
Receiving practice management guidance from Mitzi Young 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

Not a member?

Join today!  
Contact Mark Morones, Director of Membership:
(949) 398-8103
mmorones@ocma.org


Physician Advocate Tip of the Month: Give your patients the answers they need about Covered CA

June Tip:

Give your patients the answers they need about the Covered California networks and more.

Download "Frequently Asked Patient Questions about Covered California."

With the recent launch of California's health benefit exchange, Covered California, millions of Californians are now eligible to obtain insurance through this new online marketplace. Understandably, patients have many questions. Download this document to provide answers to the most common patient questions.

Receiving practice management guidance from Mitzi Young 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


Physician Advocate Tip of the Month: Be aware of the off-exchange products that utilize Covered CA plan networks

April Tip:

Be aware of the off-exchange products that utilize Covered CA plan networks.

1. Every plan offered in Covered CA must also be offered outside of Covered CA, using the same network.  If you see these product names on the ID card, it indicates the patient only has access to the Covered CA network. For more information, download "Surviving the Second Month of Covered CA" at www.cmanet.org/ces.

2. To physicians who are currently participating in the Anthem Blue Cross Individual / Covered CA network: Anthem Blue Cross recently notified over 11,000 practices of a contract addendum that will become effective July 1, 2014. For more information, click here.

Receiving practice management guidance from Mitzi Young 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


Physician Advocate Tip of the Month: Verifying your patients' eligibility and benefits

March Tip:

Verifying your patients' eligibility and benefits in 2014 may save your practice thousands of dollars

The beginning of a new year means calendar year deductibles and visit frequency limitations start over. Remember, with open enrollment there may be changes to patients' benefit plans, or they may even be insured through a new payor. Physicians are urged at this time of the year to be diligent in verifying patients' eligibility and benefits to ensure that you will be paid for services rendered.
 
And don't forget that under the ACA, patients receiving premium assistance through federal tax subsidies are given a 90-day grace period in which to pay their portion of the premium. During the first 30 days of the grace period, the plans must pay for services incurred. However, during days 31-90 of the grace period, plans are allowed to suspend the patient's coverage
 
Don't get stuck with unnecessary denials or an upset patient. Do your homework before the patient arrives by obtaining updated insurance information at the time of scheduling, if possible, and making copies of the insurance card at the time of the visit. 

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


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


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


Physician Advocate Tip of the Month - Don't miss out on your ACA Medi-Cal Payment Increase!

December Tip

Don't miss out on your ACA Medi-Cal Payment Increase!

Attesting is easy, so visit www.medi-cal.ca.gov and complete the ACA Self Attestation Form before 12/31/2013. Physicians must attest individually. Checks are currently being distributed to those who have attested!

Medi-Cal Resource:

Over the past year, there have been a number of changes for Medi-Cal patients and for the physicians who treat them with more to come in 2014. Be sure to review CMA's new Medi-Cal Survival Toolkit available for free at www.cmanet.org/ces (members only).

BONUS TIP:

The deadline to avoid a 1.5% fee schedule penalty in 2015 is fast approaching. There is still time to report at least one valid individual measure via claims for dates of service in 2013. There are many measures that only need to be reported once per reporting period (January 1 through December 31, 2013) that meet the requirement.  
 
The 2013 Physician Quality Reporting System (PQRS) Implementation Guide is a good place to start to identify any measure that might pertain to your practice. The 2013 PQRS Individual Claims Registry Measure Specification Supporting Documents provides the specifications that must be met in order to report the measure (frequency of reporting, procedure codes, diagnosis codes, and reporting measure code(s)). Remember, you cannot go back and add a measure code to claims already submitted.

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


ALERT: You May have Automatically been Contracted into an Exchange Plan

Open enrollment began October 1st for Covered California (California's Health Benefits Exchange). The OCMA has received many calls from members confused as to whether they are contracted to see these patients. 
  

Many doctors were automatically put into contracts, and are unaware that they are on the plan directory for exchange plans with payers. These physicians have to opt out of that part of their contract if they do not wish to participate in the Exchange. The easiest way to confirm your participation is by calling the provider relationship department of the three plans in Orange County who are contracted to see Exchange patients.  

  • Anthem Blue Cross:  (855) 238-0095
  • Blue Shield Of California:  (800) 258-3091
  • HealthNet:  (800) 641-7761

For additional questions about Covered California or any practice management issue, OCMA / CMA members may call OCMA Physician Advocate Mitzi Young directly at (888) 236-0267 or myoung@cmanet.org.


May Tip of the Month from OCMA Physician Advocate, Mitzi Young

May Tip:

"The Health Exchange is coming...get ready now!  With the implementation of the Patient Protection and Affordable Care Act (ACA), two thirds of California's uninsured will be covered by private insurance through a health insurance exchange purchasing pool. The exchange's goal is to start pre-enrollment in October 2013.

We have developed a toolkit 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 OCMA /CMA members only at www.cmanet.org/exchange."

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

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


Practice Management Tip of the Month from OCMA Physician Advocate, Mitzi Young

April Tip:


"A reminder that as of April 1, 2013, Medicare reimbursement for physicians will be cut by 2 percent.

With no solution on the horizon to the budgetary woes in Congress, physicians should be prepared for the 2 percent reduction in reimbursement from the Medicare program. The 2 percent Medicare cuts are part of the $1.2 trillion in cuts required by the Sequestration Transparency Act. Medicaid is exempt from the cuts."

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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