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

For years, patients in California have been unable to rely on information provided by health insurers andplans about which physicians they contract with, and if so, whether a physician is taking new p...

Many physicians across the state are being approached by hospital systems and other lay entities to joinnew entities for purposes of ...

Physicians face various tax obligations in the course of doing business as retailers and consumers of health-related products. The following is a discussion of California’s sales and use tax law...

Some physicians have responded to the economic pressures created by the managed care environment by offering patients the ability to pay a fixed fee in exchange for “concierge care” or &ld...

The Health Insurance Portability and Accountability Act (HIPAA) Transaction and Code Set Standards govern transactions involving claims and encounter information, payment and remittance advice, claims...

For some time, the California Office of Statewide Health Planning and Development (OSHPD) has published hospital specific risk-adjusted outcome reports for various procedures and conditions. For detai...

The following is a discussion of California and federal laws that require access to primary care physicians (PCP), including OB/GYNs, and specialists for health plan enrollees, including laws governin...

Physicians throughout California are considering whether to sell their practices to and join or affiliate with an “integrated delivery system” (IDS). IDSs, which are generally hospital-spo...

The purpose of this Sample Consultant Agreement and RFP is to provide physicians with information concerning issues commonly presented by consultant arrangements. These samples are not designed to be ...

Medicine is undergoing dramatic changes. Physicians do not have to undergo these changes without help from professionals. However, hiring the right professional is not always easy. Common questions re...

Physician complaints about the policies and practices of their own organizations appear to be increasing. The following discusses practical steps physicians can take to attempt to resolve problems, pr...

Penalties (e.g., monetary fines, payment reductions, contract termination, etc.) are increasingly being imposed on physicians by managed care organizations (MCOs) and Independent Practice Associations...

This document discusses the potential shortcoming of utilization profiling, and how it may be properly conducted. California law related to profiling is also discussed. The California Medical Associat...

Physicians often ask about the obligations of medical directors. Some of these obligations are discussed below....

As part of their legislative mandate to “ensure” access to quality care, the Department of Managed Health Care (DMHC) and the California Department of Insurance (CDI) (collectively, &ldquo...

The following discusses the California Newborns’ and Mothers’ Health Act of 1997, the State law requiring minimum hospital stays for mothers and their newborns. Also discussed below are la...

This document discusses prospective or concurrent denials of authorization for medically necessary services by managed care plans. For a discussion of retroactive denials of payment, see...

The adoption of the federal health care reform legislation, enacted through the Patient Protection and Affordable Care Act (ACA), further incentivized the development of healthcare payment and deliver...

California regulates “disease management organizations.” The phrase “disease management” refers to the concept of reducing health care costs and/or improving the quality of lif...