Practice News and Resources

Free to SJMS/CMA Members!

The Office Managers Forum empowers physicians and their practice manager staff with valuable tools via expert led educations sessions from industry professionals who are committed to delivering quality healthcare. This quarterly forum is normally held on the second Wednesday of March, June, September and December at Papapavlo's.

Registration is required!

If you don’t receive an invitation via E-Mail, please email Jessica@sjcms.org

March 8th, 2023: 11:00AM to 1:00PM

“2023 Employment Law Updates”

Jamie Bossuat, a shareholder and employment lawyer at Kroloff will present an update on the most pressing issues in employment law and will offer practical suggestions for reducing liability. Issues will include recent changes in wage and hour requirements, updates to leave of absence laws, and current litigation trends.

June 14th, 2023: 11:00AM to 1:00PM

“Customer Service: Improving the Patient Experience by Seeing it Through Their Eyes”

This presentation focuses on how to improve patient experience, which begins with understanding the difference between patient satisfaction and patient experience. Presented by one of CMA’s practice management experts, Mitzi will discuss what has happened to service in a medical practice, how to improve the patient experience, having transparency with your patients, and effectively communicating, connecting, and building trust with patients and their family members.

Speaker: Mitzi Young is the Associate Director, Practice Strategy for the California Medical Association, Center for Economic Services. Mitzi brings over 29 years of experience in the health care industry. In Mitzi’s current role, her focus is Practice Management and Operations. She focuses on the day-to-day operations of CMA’s member practices. Mitzi recommends areas of improvement within a physician practice to achieve financial health, education, staff morale, and development of new internal systems. Mitzi presents seminars on practice management and health care regulations.

Mitzi started her career working for a third-party administrator as a claim and eligibility processor for San Bernardino County hospital’s medically indigent adult program. She went on to further her education and worked as an operations and business manager for specialty practices and for ambulatory surgery centers overseeing all personnel and business operations. She brings with her a vast knowledge of medical billing and collections, contracting, accreditation, and personnel and business management. She understands the needs of physicians and their staff, the challenges that face medical practices, and is very passionate about advocating on behalf of providers on succeeding in the ever-changing challenges of the healthcare landscape.

Cma Practice Resources

MEDI-CAL TO REQUIRE SUBMITTERS TO VALIDATE CONTACT INFORMATION ON LOGIN

UHC delays Designated Diagnostic Provider program in CA until Jan. 1, 2022

Beginning on January 27, 2023, organizations that submit information to, or look up information in, the Medi-Cal provider portal will be required complete a one-time validation of their contact information.

After that date, the first time you log into Medi-Cal provider website’s Transaction Services using a submitter ID, a one-time web form will pop up that must be filled out to continue. Submitters will be required to validate their address, phone number and organization’s authorized contact person.

Once this is complete, access will be granted to Transaction Services as usual. This updated information will be used to mail an organization token to all submitters, allowing them to register for access to the new Medi-Cal Provider Portal.

Physicians should be aware that once this form is submitted, you will not be able to access the web form again. If for some reason it was input incorrectly, you will need to call the Medi-Cal service center at (800) 5415555 to update your information.

DHCS TO REINSTATE PRIOR AUTH FOR REMAINING DRUG CLASSES ON FEB.24

The California Department of Health Care Services (DHCS) recently announced the list of drugs that will require prior-authorization (PA) under Phase II Wave 2 of the Medi-Cal Rx transition, which is scheduled to start on February 24, 2023.

Phase II, Wave 2 will reinstate PA requirements for 46 additional standard therapeutic classes, including medical supplies, for new start prescriptions for beneficiaries 22 years of age and older. “New starts” are defined as new therapies or medications not previously prescribed to the beneficiary during the 15-month lookback period.

Phase II, Wave 2 will complete the reinstatement of PA requirements for new start prescriptions for beneficiaries 22 years of age and older. Medi-Cal Rx will continue to utilize PA and claims data to allow for grandfathering of previously approved PAs until Phase III of Reinstatement, as announced in the alert.

New start prescriptions for pediatric patients 21 years of age and under continue to be excluded to prevent additional administrative obligations for providers of specialty pediatric services who have been significantly impacted by the transition to Medi-Cal Rx.

For an overview of the remaining phases of the MediCal Rx transition plan, see the DHCS Medi-Cal Rx Reinstatement Spotlight.

DHCS will also be holding Phase II reinstatement webinars via Zoom every Friday at 12 p.m. No registration is required. This month’s webinar will provide information specific to Phase II, Wave 2, including reinstatement of PA requirements for beneficiaries 22 years of age and older and submission of PAs in advance of the retirement of the transition policy.

To receive the latest news, alerts and bulletins on MediCal Rx, including the Reinstatement Spotlight published each Friday, sign up for the subscription service.

For questions, please contact the Medi-Cal Rx Customer Service Center at (800) 977-2273, available 24 hours a day, 365 days a year, or email MediCalRxEducationOutreach@magellanhealth.com.

For More Information

• 30-Day Countdown – Reinstatement of Prior Authorization Requirements for 39 Drug Classes; https://medi-calrx.dhcs.ca.gov/cms/medicalrx/staticassets/documents/provider/bulletins/2022.12_A_PA_ Reinstatement_39_STCs_30-Day_Countdown.pdf

• Medi-Cal Rx Reinstatement of Prior Authorizations and Retirement of the Transition Policy: Phases II, III, and IV presentation; https://medi-calrx.dhcs.ca.gov/ cms/medicalrx/static-assets/documents/educationand-outreach/Slidedeck_PA_Reinstatement_and_ Transition_Policy_Retirement_Phases_II_III_IV.pdf

• Medi-Cal Rx: Transitioning Medi-Cal Pharmacy Services from Managed Care to Fee-for-Service

Frequently Asked Questions; https://medi-calrx.dhcs. ca.gov/cms/medicalrx/static-assets/documents/faq/ Medi-Cal_Rx_Transitioning_Medi-Cal_Pharmacy_ Services_from_Managed_Care_to_FFS_FAQs.pdf

Congress Extends Advanced Alternative Payment Model Bonus For One Additional Year

As part of its year-end omnibus budget deal, Congress extended the Advanced Alternative Payment Model (APM) incentive payment for one additional year.

Advanced APMs are one track of the Center for Medicare and Medicaid Services (CMS) Quality Payment Program, which offers incentives for meeting participation thresholds based on levels of payments or patients through Advanced APMs.

The California Medical Association (CMA) had advocated for this extension as part of the negotiations around the omnibus legislation. CMA also continues to advocate for a greater variety of and improvement to voluntary APMs and Accountable Care Organizations so more physicians have the opportunity to participate.

The extended availability of the Advanced APM incentive payment will allow eligible clinicians who are Qualifying APM Participants (QPs) for the 2023 QP performance period to receive a 3.5% (down from 5%) APM incentive payment in the 2025 payment year. Without this change, there would have been a one-year gap with no statutory incentives for participating in the program in the 2025 payment year.

In addition, the participation threshold for becoming a QP will remain frozen: Clinicians must receive at least 50% of Medicare Part B payments or see at least 35% of Medicare patients through an Advanced APM Entity during the QP performance period.

Clinicians who are QPs for 2023 performance period will not need to do anything to receive their payments in 2025, unless the Center for Medicare & Medicaid Services (CMS) is unable to verify their Medicare billing information. QPs who do not receive their payments after initial disbursements are made will be able to check a public notice to see if they need to verify their Medicare billing information.

To learn more about the Advanced APM, visit qpp.cms. gov/apms/advanced-apms.