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Member Resource

The California Health Care, Research and Prevention Tobacco Tax Act of 2016 (Prop. 56) 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 California Department of Health Care Services (DHCS), will …

This enduring material has been approved for 1 AMA PRA Category 1 Credit™. This webinar is presented by the Southern California Public Health Association, California Baptist University and the Los Angeles County Department of Public Health. Original release date: May 1, 2018. Review date: May 1, 2019. Termination date: May 1, …

On August 28, the Centers for Medicare and Medicaid Services (CMS) published an update to the Initial Preventive Physician Examination and Annual Wellness Visit benefits, highlighting that a review of patient opioid use is now a component of medical and social history assessments. Per CMS, the review of opioid use during these annual preventative exams will help physicians identify …

In January 2018, the California Department of Health Care Services (DHCS) began requiring that all Medi-Cal managed care providers be enrolled through the Medi-Cal program. Medi-Cal managed care plans have the option to develop and implement a managed care physician screening and enrollment process that meets federal requirements, or they …

Effective July 1, 2018, physicians and licensed independent practitioners are now required to report cases of Parkinson’s disease to the California Department of Public Health (CDPH). Licensed independent practitioners holding the following credentials who diagnose or treat Parkinson’s disease patients are required to report: Doctor of Medicine (M.D.), Doctor of …

Participation in capitated reimbursement contracts (financial arrangements where physicians are paid a fixed amount for each patient assigned to them) can offer physicians a routine and sustained source of monthly income for their practice. Capitation, however, can be a complicated process. It is essential that physicians monitor their monthly capitation …

MEDICARE: For prroviders who participated in the Merit-based Incentive Payment System (MIPS) in 2017, the MIPS final score and performance feedback is available for review on the Quality Payment Program (QPP) website. For more information on understanding the MIPS performance feedback, the Centers for Medicare and Medicaid Services (CMS) has prepared a …

The American Medical Association (AMA) has urged regulators to block the proposed acquisition of health insurer Aetna by retail pharmacy and pharmacy benefit manager CVS Health. After conducting an exhaustive analysis, AMA found evidence of the merger’s likely anticompetitive effects on Medicare Part D, pharmacy benefit management services, health insurance, …

In March, the California Medical Association (CMA) asked the Department of Managed Health Care (DMHC) to investigate Anthem Blue Cross’ systematic failure to publish effective dates for its 241 different medical and clinical utilization management policies. Without clearly posted effective dates, the published policies cause confusion and misinform physicians and …

The California Medical Association has learned that two health plans, Inland Empire Health Plan (IEHP) and Molina Healthcare are terminating their contracts with Vantage Medical Group. Two other plans, Blue Shield of California and Care1st Health Plan, have issued notices of material breach with an intent to terminate.  The plans …