Updating Provider Demographic Information with Payors It is important that physicians update their practice demographic information with contracted payors to ensure payment and other vital notices are received and to reduce the potential for delayed or denied payments. CMA surveyed the major payors in California on their process for updating provider demographic information. The information is compiled in this document. Taking Charge: Steps to Evaluating Relationships and Preparing for Negotiations Payor contract negotiations can be difficult. This guide is designed to guide physicians and their office staff through the contract evaluation and negotiation/ renegotiation process. A Physician’s Guide to Implementation of SB 866: The new standardized prescription drug prior authorization form A new law has taken effect that aims to streamline and standardize the prior authorization process for prescription drugs. It requires all insurers, health plans (and their contracting medical groups/ IPAs) and providers to use a standardized two-page form for prior authorizations on prescription medications. CMA has developed this FAQ to address common questions about the new form and process. Know Your Rights Series CMA has created a series of one-page documents that summarize California’s prompt pay legislation and educate practices on their rights under the law. Best Practices – A guide for improving the efficiency and quality of your practice This toolkit offers a series of proven steps that solo and small-group practices can take to improve many facets of their practice, including the delivery of betterquality medical care.
PQRS and Value-Based Modifier Getting Started Guide The Medicare Physician Quality Reporting System (PQRS) has used a combination of incentive payments and payment reductions to promote reporting of quality information by eligible professionals. PQRS is closely tied to another congressionally enacted program known as the valuebased modifier (VM). Successful reporting of PQRS will provide quality data for determining tiering calculations for VM payment incentives or penalties. Medicare Incentive and Penalty Programs: What physicians need to know Over the past few years Congress has created a number of programs that call for payment incentives and reductions that impact physicians and their practices. At their inception, most of these programs offered an incentive to participate. However, most of the programs are entering their penalty phases, with complex and potentially conflicting requirements and implementation processes. This document provides an overview of these programs. Cal MediConnect Physician FAQ In an effort to save money and better coordinate care for the state’s low-income seniors and persons with disabilities, the 2012 California state budget authorized a three-year demonstration project, the Coordinated Care Initiative (CCI). CCI contains two main components (1) Cal MediConnect, which transitions individuals who are eligible for both Medicare and Medi-Cal (dual eligibles) away from feefor-service and into a single managed care and (2) integration of long term supports and services into managed care. This FAQ provides what you need to know about keeping your patients and billing for the dual eligible population.
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participating in their exchange networks, often without their express consent or knowledge—making “do you take my insurance” not always an easy question to answer.
Financial Impact Worksheet It is important that physicians understand how a fee schedule can affect their practice’s bottom line so that they can make informed decisions about participation in a payor’s network before contracts are signed. CMA has developed a simple worksheet to help physicians
CMA: Tools and Resources to Empower Physician Practices
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