Emergency Transfer
Medicare and Medi-Cal | 14 pages
Providing Care to Medi-Cal Enrollees
In California, more than one third of state’s population receives health care through the Medi-Cal program. The Department of Health Care Services (DHCS), which administers Medi-Cal, both contra...
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End of Life Issues | 17 pages
The California End of Life Option Act
On October 5, 2015, California became the fifth state in the nation to allow physicians to prescribeterminally ill patients medication to end their lives. ABX2-15, the ...
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Ancillary Services | 17 pages
Clinical Trials
Advances in medicine depend on clinical trials conducted by public and private institutions. Physicians considering referring patients or participating in such clinical research studies should take st...
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eMedicine | 9 pages
Reimbursement: From Private & Public Payors | 11 pages
Reimbursement: From Private & Public Payors | 19 pages
Payment Denials by Managed Care Plans and IPAs
Following is a discussion of the laws relating to private payors’ (non–Medicare/Medi-Cal) denials ofpayment for physician claims, including retrospective payment denials based on lack of m...
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Reimbursement: From Private & Public Payors | 28 pages
Silent PPO (Unfair Discounting) Action Guide
Some physicians’ bills are being discounted when the physicians believe they never agreed to a discount. This occurs because either: 1) the physician unknowingly authorized a PPO, IPA, health pl...
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Reimbursement: From Private & Public Payors | 10 pages
Reimbursement: From Private & Public Payors | 3 pages
Health Plan Special Claims Review
The following is some general information concerning the ability of a health plan to place physicians special claims review and seek copies of the physician’s medical records for the purposes of...
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Reimbursement: From Private & Public Payors | 10 pages
Plan Requests for Refunds from Physicians
Physicians often contact CMA because managed care plans ask them to return monies allegedly overpaid on their claims. We understand that thousands of physicians have been unfairly asked to return paym...
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Reimbursement: From Private & Public Payors | 30 pages
Non-Contracting Physicians
This document addresses reimbursement issues that may arise when an out-of-network physician treats a patient with commercial health care coverage. The following also includes an analysis of Assembly ...
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Outpatient Facilities | 6 pages
Reimbursement: From Private & Public Payors | 12 pages
Reimbursement: From Private & Public Payors | 17 pages
Bankruptcy of IPAs or Health Plans
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...
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Reimbursement: From Private & Public Payors | 4 pages
Reimbursement: From Private & Public Payors | 18 pages
Authorization and Payment for Emergency Services
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 ...
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Reimbursement: From Private & Public Payors | 11 pages
Late Payment
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...
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Reimbursement: From Private & Public Payors | 5 pages
Coordination of Benefits
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...
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Reimbursement: From Private & Public Payors | 7 pages
Assignment of Benefits
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...
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