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CMS Publishes 2014 Medicare Fee Schedule

From CMA's December 16, 2013, CMA Alert On November 27, the Centers for Medicare and Medicaid Services (CMS) released the 1,369-page 2014 Medicare Physician Fee Schedule final rule, which was published in the December 10 Federal Register. Most provisions take effect January 1, 2014, although a few issues are open for public comment by January 27, 2014. The American Medical Association (AMA) has published a summary of the final rule. Below are a few key points: Although the final rule contains the 23.7 percent physician payment cut ...

Voluntary Submission of the New CMS 1500 Claim Form Begins in January

From CMA's December 16, 2013, CMA Alert The White House Office of Management and Budget (OMB) approved the revised Centers for Medicare & Medicaid Services (CMS) 1500 claim form, version 02/12, OMB control number 0938-1197. The CMS 1500 claim form is the required format for submitting paper claims to Medicare. The revised form, among other changes, adds the following functionality: Indicators for differentiating between ICD-9 and ICD-10 diagnosis codes. Expansion of the number of possible diagnosis codes to 12. Qualifiers to identify ...

CMS Delays Stage 3 Reporting Requirements for Meaningful Use Until 2017

From CMA's December 16, 2013, CMA Alert Late last week, the Centers for Medicare & Medicaid Services (CMS) announced proposed updates to the electronic health records (EHR) incentive program timeline that extends stage 2 meaningful use for an additional year through 2016. That means that providers participating in the program will now not be required to start stage 3 until January 2017 at the earliest. The goal of this change is two-fold: first, to allow CMS to focus efforts on the successful implementation of the enhanced patient engagement, interoperability and health ...

CMA Updates Exchange Toolkit to Reflect Key Developments

From CMA's December 16, 2013, CMA Alert In February, CMA published a comprehensive toolkit on Covered California: "CMA’s Got You Covered: A Physician’s Guide to Covered California, the State’s Health Benefit Exchange." The guide has been updated to reflect key developments in the exchange including the grace period, how plans are building their exchange networks, how to check physician participation status on the Covered California website, and steps physicians can take if they disagree with their participation status in the exchange plans. The toolkit is available free to members only at ...

New Workers' Compensation RBRVS Physician Fee Schedule Effective January 1, 2014

From CMA's December 16, 2013, CMA Alert As part of the reforms instituted by SB 863, the Division of Workers’ Compensation (DWC) will begin utilizing a new fee schedule based on the resource-based relative value scale (RBRVS) effective January 1, 2014. The new RBRVS-based physician fee schedule will apply to services rendered on or after January 1, 2014, and will replace the current Official Medical Fee Schedule, which has not been updated to reflect new procedure codes and relative value units (RVU) since 1999. This newly adopted physician fee schedule will ...

Low Income Health Plan Transition Begins January 1

From CMA's December 16, 2013, CMA Alert As part of a multi-faceted Medi-Cal expansion, the California Department of Health Care Services (DHCS) will be transitioning roughly 600,000 enrollees with incomes at or below 133 percent of the federal poverty level from the Low Income Health Program (LIHP) to Medi-Cal managed care effective January 1, 2014. LIHP is a county-based program established under California’s “Bridge to Reform” SS1115 Medicaid Demonstration Waiver, and was created to prepare for health coverage options authorized through the Affordable Care Act of 2010 (ACA). The program provides ...

CMA Medi-Cal Survival Guide Takes the Guesswork out of understanding Numerous Program Changes

From CMA's December 16, 2013, CMA Alert Over the past year, there have been a number of changes for Medi-Cal patients and for the physicians who treat them. There will be more changes in 2014 as well. To help physicians understand the impact these changes will have on their practices, the California Medical Association (CMA) has published a Medi-Cal Survival Toolkit. The toolkit contains a summary of many of the changes, important dates, options for physicians and links to important resources. The toolkit is available to free to members in CMA's online ...

Democrats' Budget Framework Includes the Restoration of Medi-Cal Cuts

From CMA's December 16, 2013, CMA Alert With California looking at a budget surplus for the first time in years, the Assembly Democrats released their 2014 budget blueprint yesterday, which includes raising the state's reimbursement rate for doctors who treat patients through the Medi-Cal program. The Assembly Democratic budget plan doesn't specify how much money it would restore to the program, saying it would be a "phase in" of higher provider rates. Currently, those rates are among the lowest in the nation and were the focus of intense Capitol debate this ...

DHCS Pays $65 Million to Primary Care Physicians in Initial Retroactive Medi-Cal Rate Increase Payment; Second Payment Expected Soon

From CMA's December 16, 2013, CMA Alert The California Department of Health Care Services (DHCS) is expected next week to make its second round of retroactive interim payments to primary care physicians who have attested to their eligibility for the rate increases called for under the Affordable Care Act (ACA). These primary care payment increases have been put in place by the federal government in an effort to recruit more primary care physicians to treat low-income patients who will be newly eligible for health coverage in 2014. Although under the ACA ...

CMA Applauds Historic Movement of Medicare SGR Payment Reform Legislation

Urges a Stable Fix in 2014 The California Medical Association (CMA) is pleased that legislation aimed at repealing the Medicare sustainable growth rate (SGR) was approved in the Senate Finance Committee and the House Ways and Means Committee today. This is good news for California physicians, who have been working with both committees to revise the initial draft of the legislation since it was introduced in October. For more than a decade, Medicare’s flawed SGR formula has plagued policymakers and physicians, alike, often calling for reductions in payments to physicians despite ...