Anthem Blue Cross recently notified over 11,000 practices who are currently participating in its individual/exchange network of a contract addendum that will become effective July 1, 2014. The amendment only applies to physicians who are currently participating in the Anthem Blue Cross individual/exchange network.
According to the notice, the addendum contains new regulatory requirements. While many provisions are requirements of Covered California, SFMS/CMA has concerns with certain provisions that appear to be beyond the scope of regulatory requirements, including:
Physicians have the right to opt out of the Anthem exchange product without affecting the underlying Prudent Buyer PPO contract if Anthem receives notice before the effective date of the addendum, July 1, 2014. If you do not wish to participate in the individual/exchange product, you can opt out by providing 90 days written notice, which should be sent via certified mail with return receipt, to Anthem Blue Cross Prudent Buyer Plan Contract Processing, Attn: Individual/Exchange Contract Processing, Mail Station 8A, P.O. Box 4330, Woodland Hills, CA, 91365-4330. The notice must be received by Anthem by June 30.
Please cc CMA on any opt-out notices submitted to Anthem at the following address:
California Medical Association
Center for Economic Services
1201 J Street, STE 200
Sacramento, CA 95814
Physicians are as always urged to carefully review and assess the impact any contract changes or addendums will have on their practices. Questions and concerns about the Anthem exchange addendum should be directed to the Anthem Blue Cross Network Relations at (855) 238-0095 or email@example.com.
Physicians in small to mid-sized practices can conduct their own risk assessments using a free tool newly available from the U.S. Department of Health and Human Services.
The security risk assessment (SRA) tool is designed to help practices conduct and document a risk assessment to evaluate potential security risks in their organizations under the Health Insurance Portability and Accountability Act (HIPAA) Security Rule. Conducting an SRA also is a core requirement for physicians seeking payment through the federal meaningful use program for electronic health records.
Physicians can watch a tutorial and other videos about risk analysis and contingency planning to provide further context. The assessment tool is available through the Apple App Store (search for “HHS SRA tool”) for use on iPads, and can be downloaded onto computers running Windows operating systems.
HIPAA regulations were updated last year in what were called the “most sweeping changes” since the law was implemented.
Click here for additional resources from the AMA to help physicians ensure their practices are HIPAA-compliant, including a new HIPAA toolkit and an associated continuing medical education activity.
Last night, the Centers for Medicare and Medicaid Services (CMS) publicly released Medicare physician payment data, which identifies 38 of the top-paid doctors practice in California. The spreadsheet files show each physician’s NPI, name and address, average charge and Medicare payment amounts, unique beneficiary counts, and other information for the various Medicare services they provide. Although both federal officials and advocacy groups say the information will increase transparency, they also caution against misinterpreting the data.
CMS explained their decision to release the data in a letter to the American Medical Association (AMA). They cited that because of a recent court decision to reverse an injunction that previously prevented CMS from making the data available to the public, the agency received a large wave of Freedom of Information Act (FOIA) requests for data in which CMS felt could not be handled on a case-by-case basis. Given the broad interest in viewing the data, the agency determined that it should be made public and accessible to all. Similar information has been available for several years on Medicare hospital payments.
Unfortunately, the data posted by CMS is not subject to safeguards that protect physicians and patients from misuse of inaccurate or misleading data. Physicians were not given the opportunity to review their data for accuracy prior to their publication, and users of the data are not required to disclose the methodology they use in manipulating it. Furthermore, the posted data has significant limitations.
A fact sheet is being circulated by the AMA to help promote responsible use of the data.
The AMA is in the process of examining the data to identify any additional issues and is exploring opportunities to help physicians respond as individuals to inquiries they may receive about their personal data.
Click here for AMA's most recent press statement on the data release.
California is currently seeing increased cases of this highly infectious viral illness. Between January 1, 2014 and March 28, 2014, 49 cases of measles were reported to the California Department of Public Health, as compared with only 4 cases during the same period in 2013.
As of April 4, San Francisco has had no confirmed 2014 measles cases, though recent cases have occurred in several Bay Area counties. The majority of the 2014 cases have occurred among returning international travelers and their contacts; the majority have also occurred in unvaccinated individuals. A current measles outbreak in the Philippines has led to imported cases, but measles is currently circulating in many countries outside of North and South America.
SFMS/CMA surveyed the major payors in California to learn about each payor’s requirement for submitting the new CMS 1500 (2/12 version) for submission after April 1, 2014.
With ICD-10 implementation delayed until October 2015, SFMS/CMA is awaiting additional information from CMS on whether there will be any changes to the new CMS-1500 form. Until that time, we recommend that providers continue to follow the previous guidance issued and implement as required.
*Information current as of March 19, 2014.
**May be delayed until October 1, 2015 with new ICD-10 postponement. Please confirm with payor.