Monday Rx | October 22nd, 2018 | L.A. Care and Prop 56 Payment Updates
When members and even non-members ask about the value of membership, I usually share the three key areas of support: practice, personal and strategic (organizational). In other words, the LACMA value proposition is not a “one size fits all”scenario. Independent physician practices have unique needs. Health systems, IPAs andmedical groups have distinctive goals, objectives and blind spots. Today’s LACMA can help every organization thanks, in part, to the strong relationship with CMA. Learn more here.
In recent months, some members reached out with a particular problem: Earlier this year, L.A. Care issued a large number of over paymentrequests to physicians. According to L.A. Care, it was requesting refunds on overpaid Medi-Medi claims. However, some of the requests were for very old claims, dating back to 2012. CMA raised concerns with L.A. Care about the timeliness of some of the refund requests, as California’s Knox Keene act limits plans’ ability to request refunds to 365 days from the date of payment, except in cases of fraud or misrepresentation.
After review, L.A. Care rescinded the over paymentrequests on claims that were non-compliant with the 365-day time frame. L.A. Care is also refunding payments already made by physicians or payments that were automatically recouped by L.A. Care on claims older than 365 days. Any physician appeals contesting the 365-day time frame will be closed.
However, for claims paid within 365 days from the date of the over paymentrequest, L.A. Care still expects reimbursement. In letters sent to doctors, L.A. Care states it will provide physicians with an updated list of claims it is pursuing forrecoupment within the 365-day time period within the next 45 calendar days. Physicians will have 60 calendar days from the date of the re-issued over paymentnotices to refund L.A. Care. Failure to do so will result in automatic recoupments.
Some Medi-Cal Managed Care Plans Slow to Distribute Prop 56 Funds
Since the passage of Proposition 56, California Health Care, Research and Prevention Tobacco Tax Act of 2016, I’ve been sharing updates from time to time on where the funds are, CPT Code updates and key dates to be aware of.
In May, the California Department of Health Care Services (DHCS) distributed the Proposition 56 supplemental funds for FY 2017-2018 to the Medi-Cal managed care plans. At CMA’s request, DHCS specified that plans must distribute the funds to providers within 90 days. However, the 90-day window ended August 31 and CMA hasreceived complaints from physicians that some plans still have not issued supplemental payments.
The supplemental payments are a result of Prop 56 which created new revenues dedicated to the Medi-Cal program. Physicians receive supplemental payments in both fee-for-service and Medi-Cal managed care when providing Medi-Cal services under certain CPT codes. The supplemental payments bring Medi-Cal reimbursement rates for these codes up to about 65 percent of Medicare rates.
Practices that believe they have not received their supplemental payments are strongly encouraged to reach out to the plan contactfor Proposition 56 directly, or you can always reach out to meand I will assist any way possible. CPT codes and Supplemental Payments are on the CMA website.
The 2018 Los Angeles Healthcare Awards is on November 30th!
Members of the Los Angeles County medical community are invited to join the Los Angeles County Medical Association (LACMA) and our Patient Care Foundation for the Annual Los Angeles Healthcare Awards for an extraordinary celebration of individuals and institutions who have positively impacted healthcare delivery in their local communities.
The funds raised will benefit crucial medical student programs at the Charles R. Drew University of Medicine and Science. I hope you can join us.
To learn more and purchase tickets, please click here.
Chief Executive Officer
Los Angeles County Medical Association
“If it matters to our LACMA members, it matters to me.”
SOUTHERN CALIFORNIA WOMEN IN MEDICINENovember 9, 2018
A one day conference with a vision to unite, empower,and educate California’s female physicians through leadership, advocacy, business knowledge, and wellness and balance.
Presented through the Orange County Medical Association
SUSAN BLUMENTHAL, M.D.
SENIOR FELLOW IN HEALTH POLICY, NEW AMERICA
CLINICAL PROFESSOR, TUFTS AND GEORGETOWN UNIVERSITY SCHOOLS OF MEDICINE
FORMER ASSISTANT SURGEON GENERAL AND HEALTH EXPERT
FIRST DEPUTY ASSISTANT SECRETARY FOR WOMEN’S HEALTH
5TH ANNUAL GAYLE BRINKENHOFF BREAST CANCER SYPOSIUM
WHEN: October 23, 2018
WHERE: Argyros Auditorium, City of Hope
1500 E. Duarte Road
Duarte, CA 91010
TIME: 8:00 AM -4:00 PM
This program will bridge the gap ofcurrent practice to include recent developments in disease classification, molecular biology, diagnostic algorithms, testing modalities andtherapeutic advances.
NEOPLASTIC HEMATOPATHOLOGY UPDATE
WHEN: November 8 to 10, 2018
WHERE: The Waterfront Beach Resort, A Hilton Hotel
21100 Pacific Coast Highway
Huntington Beach, CA 92648
Click herefor more information.
Join experts for this exclusive interactive conference. This is a unique opportunity for up-close learning and discussion with experts in the treatment of neoplastic hematopathology.
HOW THE EXPERTS TREAT HEMATOLOGIC MALIGNANCIES
WHEN: March 21 to 23, 2019
WHERE: Waldorf Astoria, Las Vegas
3752 S. Las Vegas Blvd.
Las Vegas, NV 89109
Click herefor more information.
This two-and-a-half-day symposium has been designed by experts in the field of hematologic malignancies and affords the conference attendee specialized educational tracks for both physicians and nurses, providing an opportunity to learn about the most recent advances in the treatment of bone marrow transplant, multiple myeloma, lymphoma andleukemia.
For questions contact: email@example.com or 626-218-5622.