PRACTICE NEWS AND RESOURCES

Free to SJMS/CMA Members!

The Office Managers Forum empowers physicians and their medical staff with valuable tools via expert led educations sessions from industry professionals who are committed to delivering quality healthcare.

For the time being, we will be offering Zoom Meetings until we can get back to meeting in person. This monthly forum is normally held on the second Wednesday of each month. Registration is required!

If you don’t receive a monthly invitation via E-Mail, please email Jessica@sjcms.org for the Zoom call info!

July 2021: No Meeting due to facilitating our Decision Medicine Program

August 11th , 2021: 11:30AM-1PM The Modern Workforce Revisited – 5 Ways to Attract and Retain the Next Generation of Workers

Presented by: Jeff Gilbert and Chad Sublet – Verve IT

In our previous presentation, Jeff and Chad advocated for a new way of thinking about the Workplace in order to attract and retain the growing Millennial demographic. Now, here in 2021, more than 50% of the workforce is comprised of Millennials - and not only will this number continue to increase, but Generation Z is hot their heels.

With the impact of COVID, and businesses globally rethinking their work-from-home policies, the Modern Workplace is now no longer a luxury - it is an essential business strategy to compete for the best talent in this new, modern era.

Join us as we revisit our original presentation and update you on the latest trends that will help you continue to attract and retain the next generation of workers.

Jeff Gilbert, CEO– Jeff has been in the Information Technology industry for 20 years, and has served in virtually all aspects of the IT world, getting his start in basic IT work, progressing through software development and architecture, and finally to IT Management. Jeff’s career has led him to provide services for some of the world’s largest firms, including global project management firms, and top 5 national defense firms. Jeff lives in Stockton with his wife Christina and their 4 sons.

Chad Sublet, Partner – Chad’s

background includes 20+ years of customer service and sales. Starting his technical career with electronics repair in the USAF Minute Man program and transitioning those skills to satellite and weapons repair in the civilian world. Eventually growing his skillset to sales, and becoming a partner at Verve in 2008. Chad now has responsibility for the Verve Sales & Account Management team. Chad lives in Stockton with his wife Madeline and their 2 children.

CMA PRACTICE RESOURCES Dignity Health seeks to renew Anthem contract by July 15 deadline; reaches agreement with Aetna

The California Medical Association (CMA) has learned that the contract between Dignity Health California and Anthem Blue Cross is set to terminate for its commercial PPO, Prudent Buyer, HMO, Medicare Advantage, and MediCal HMO lines of business effective July 15, 2021, if both parties are unable to reach a new agreement. According to the Anthem Notice of Termination of Prudent Buyer Plan Participating Physician Agreement sent out to approximately 2,000 Prudent Buyer physicians, as a condition of their contracts they must maintain admitting privileges at an in-network hospital. If Dignity Health and Anthem cannot renegotiate their agreement by July 15, 2021, avoiding termination, and physicians’ admitting privileges are limited to Dignity Health hospitals, they must obtain admitting privileges at another in-network hospital. Failure to do so could result in termination of their Anthem contracts.

CMA has inquired with the California

Department of Managed Health Care (DMHC) to obtain more information regarding the number of Anthem enrollees that would be impacted by the termination and will provide updates as details are available.

This issue comes on the heels of a similar contract renegotiation involving Dignity Health and Aetna. However, CMA was advised that the two parties did reach a three-year agreement that is retroactive to April 1 (with no lapse in the agreements); there is no impact to physician contracts.

In the event of an Anthem-Dignity Health contract termination on July 15, affected patients may be able to continue to see their physicians under California’s continuity of care law. Health plans, at the enrollee’s request, must provide for the completion of covered services as follows:

• For an acute condition • For a serious chronic condition • For the duration of a pregnancy • For the duration of a terminal illness • For the care of children between birth and 36 months For the performance of a surgery or other procedure that has been authorized, may qualify to request continuity of care.

To request continuity of care, patients should call the health plan number on the back of their ID cards.

For more information on continuity of care requirements, see CMA Health Law Library document #7051, “Contract Termination By Physicians and Continuity of Care Provisions.”

Physicians who have additional questions can contact Dignity Health by emailing Debbie Esparza at Debbie.Esparza@DignityHealth. org or Jennifer Kurkjian at Jennifer.Kurkjian@DignityHealth.org.

Physicians can also contact Anthem Blue Cross at CAcontractsupport@anthem.com and Aetna at (888) 632-3862.

Optum Pay Basic increases access to UHC remittances

UnitedHealthcare recently announced that the Optum Pay basic service would restore access to claim payment and reconciliation activities for an unlimited number of users beginning May 22, 2021. As previously reported, the California Medical Association (CMA) had received numerous complaints from physicians regarding the loss of payment remittance advice (PRA) access through the UnitedHealthcare electronic payment platform, Optum Pay. CMA quickly jumped into action and coordinated with the American Medical Association along with many other state and specialty organizations, to escalate these concerns with UnitedHealthcare.

In response to our advocacy, UnitedHealthcare announced that the Optum Pay basic service would restore free access to payment remittances including:

• Providing detailed remittance information (downloadable PDFs), as well as access to 835 files for each payment processed through Optum Pay

• Up to 13 months of payment data

The remaining concern voiced by physicians was the limit of two users per Optum Pay basic account, which proved difficult to manage in large practice groups or where multiple users required access to payment remittances. Effective May 22, 2021, basic accounts will allow an unlimited number of users.

UnitedHealthcare updates telehealth place-ofservice billing requirement

UnitedHealthcare (UHC) is now requiring physicians to bill eligible telehealth services with place of service (POS) 02 for commercial products. Telehealth claims with any other POS will not be considered eligible for reimbursement.

While the policy – announced in United’s October 2020 Reimbursement Policy Update Bulletin – became effective January 1, 2021, UHC advises that an unofficial transition period for payment of claims not billed with POS 02 was in place through midMarch. Effective March 13, 2021, telehealth claims not billed with POS 02 will not be paid and providers will be required to resubmit a corrected claim.

The change implemented by UHC aligns with the California Department of Managed Health Care (DMHC) all plan letter (APL) issued on September 4, 2020, which reminded DMHC-regulated health plans of the continued requirement to reimburse providers at the same rate for telehealth services, including telephonic visits, as they would for services provided in person. This APL clarified that the prior APLs (20009 and 20-013) remain in effect for the duration of California’s declared state of emergency or until further notice from DMHC, whichever is earlier. The APL also clarified that these requirements apply to delegated entities to the extent the health plan delegated the services impacted by these APLs.

On March 30, 2020, the California Department of Insurance (CDI) issued guidance requiring CDI-regulated insurance companies to reimburse providers at the same rate for telehealth services as they would for services provided in person. Insurers were also required to reimburse a service provided telephonically at the same rate as services provided via video. These requirements are in effect throughout the declared COVID-19 state of emergency.

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