Saturday, December 16, 2017

OCMA Blog

DHCS Releases Online UCR Attestation Form for ACA Primary Care Rate Increase

The federal Affordable Care Act (ACA) included an increase in reimbursement to eligible primary care physicians for specified services provided from January 1, 2013 through December 31, 2014. Payments for services rendered to Medi-Cal patients will be reimbursed at Medicare rates for the two-year period.
 
However, according to DHCS and CMS policy, total payment for services rendered may not exceed a provider's billed charges. Due to system limitations at the DHCS, providers may be restricted from billing their usual and customary rates on the PM-160 billing form. In most cases, providers have adapted to this restriction by billing at the expected Medi-Cal reimbursement rate for services provided to Child Health and Disability Prevention Program (CHDP) participants. This has created a problem for physicians anticipating the higher reimbursements, as according to DHCS and CMS policy, the providers have been paid at billed charges and are not owed additional ACA reimbursement.  As a result, millions of dollars in payments to California physicians have not been released.
 
CalOptima and other California managed care plans have been working with the DHCS for several months to develop a solution that wouldn't require physicians to re-bill all eligible CHDP claims in order to obtain the increase. At the urging of physician advocacy groups such as CMA, OCMA and other stakeholders, the DHCS has agreed to a workaround that would allow these practices to be paid at the higher rate without the inconvenience of rebilling each claim. 
 
DHCS recently released an online form where providers may attest to their usual and customary rates for CHDP services, allowing the practice to receive the higher reimbursement intended by the ACA rate increase. This attestation must be completed by November 28, 2014. The form may be found online at: http://files.medi-cal.ca.gov/pubsdoco/ACA/articles/acanews_23115_1.asp
 
DHCS recently announced it intends to make an interim payment on CHDP claims in December, with a true up to occur in 2015.

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


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


CMA Develops Simple Tool to Identify Physician Participation Status in Exchange Plans

January 23, 2014

On January 1, 2014, Covered California began providing health coverage to more than 500,000 patients statewide. With that figure expected to grow by the end of the 2014 open enrollment period, it is critical that physicians and their staff have a clear understanding of their exchange plan participation status so that they can communicate this information to patients before scheduling. It’s equally as important that practices understand the reimbursement rates and other terms associated with the plans with which they are contracted.

Even if you did not intentionally contract with any exchange plans, the California Medical Association (CMA) urges physicians to check their participation status. It is very possible that physicians may have been unknowingly opted into an exchange plan network due to the way that major insurance plans have structured their provider agreements.

If you've attempted to look up your exchange plan participation status on the Covered California website, you know that it's not a straightforward process. Because it is critical that physicians know what plans they are contracted with, CMA has created a quick and easy tool to look up your exchange plan participation status in just a few clicks.

The tool, available to members only, requires simply your first and last name and middle initial and it will tell you which plans list you as a contracting physician (as of September 2013, the most recent data released by Covered California). To access the tool, visit http://www.cmanet.org/exchange-lookup.

Please note: You will be required to login with a member account. If you have not already activated your web account, visit http://www.cmanet.org/activate. If you need assistance activating your account, contact CMA's member service center at (800) 786-4262 or memberservice@cmanet.org.

For more information on Covered California, visit CMA’s exchange resource center at www.cmanet.org/exchange. Physician members and their staff also have free access to CMA’s practice management experts at (888) 401-5911 or economicservices@cmanet.org.


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