The California Health Benefit Exchange (hereafter ...

The following questions and answers apply to physicians faced with the bankruptcy of a health plan, independent practice association (IPA), physician practice management (PPM), or other entity that co...

For years, CMA has received numerous complaints from physicians and patients that managed care organizations that pay secondary to Medicare (in applying coordination of benefits provisions) are failin...

The discussion below sets forth answers to some frequently asked questions about obtaining authorization for emergency services and how physicians are to be paid for emergency services. Also included ...

Depending on the type of payor, physicians may be entitled to certain protections when payors fail to pay claims on time. The following provides guidance to deal with late payments by payors. For info...

The following discusses the general rules applicable to coordination of benefit (COB) provisions in private health plans between a physician and a payor. These provisions apply when the physician trea...

An “assignment of benefits” enables a physician who has provided services to an insured or managed care patient but has no contractual agreement with the payor to legally obligate the payo...

Physicians increasingly ask whether there is any law that prohibits them from having more than one fee schedule. The answer to this question depends on what contracts the physician has signed and what...

This document explains what ERISA plans are and how they work. It is designed to assist physicians in dealing with an ERISA plan and understanding ERISA plans’ general payment obligations. For a...

On April 16, 2015, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signed into law. (Pub.L.No. 114-10). This law repealed the Medicare Sustainable Growth Rate (SGR) formula, reaut...

Federal regulations and California law impose broad notification requirements for physicians and others to notify patients when there has been a breach of security involving their medical information....

In 1994, the Legislature passed A.B. 595 regulating certain “outpatient settings.” (Business & ProfessionsCode §§2215 et seq., Health & Safety Code §§1248 et se...

In 2017, approximately 2.3 million (40%) Medicare members in California opted to enroll in Medicare Advantage plans, instead of receiving their Medicare benefits through Medicare fee for service (orig...

The Institute for Medical Quality (IMQ) is a subsidiary of the California Medical Association and is dedicated to improving the quality of care provided to patients across the continuum of health care...

The following discusses the importance of effective communication between physicians and their patients....

As is summarized below, federal and state laws contain strict licensure and registration requirementsfor facilities that perform mammography and use x-ray machines. In addition, effective January 1,20...

Although the law permits certain uses or disclosures of patient health information, patients have the right to request restrictions on the disclosure or use of their protected health information. Pati...

This document discusses a patient’s right to receive an accounting of disclosures of protected health information made by the physician pursuant to the privacy regulations enacted pursuant to th...

The California Department of Health Care Services (DHCS), the state agency responsible for administering the Medi-Cal program, routinely audits its payments to physicians and other providers. Physicia...

You have asked for information concerning Medicare and/or Medi-Cal billing practices. Below is contact information concerning these programs which should be helpful to you....