Practice Tools
RCMA/CMA Tools
Riverside County New Physician Tool Kit: This packet includes information on where to obtain general information on the City and County itself, along with many resources to consult for assistance in setting up your practice.
EHR Desk Reference: Physicians in California are in different stages of EHR implementation. This reference is intended to help you at any stage of the implementation process.
HIPAA Compliance ToolKit: CMA/PrivaPlan are now offering a HIPAA Compliance ToolKit CD-ROM. Your complete resource for HIPAA and California law – covers privacy, security, and transactions.
Managed Care Contracting Toolkit: Physicians face a significant challenge in understanding and negotiating the complex and confusing provisions contained in the third party payor contracts with which they are confronted. CMA is pleased to offer our members this Toolkit as an educational resource to help members thoughtfully consider whether and when to enter into agreements with payors and how to prepare for negotiations when a payor relationship is desired.
Balance Billing Toolkit: Many physicians and other healthcare providers have questions in the wake of recent balance billing regulation and the Prospect legal decision that prohibits "balance billing" patients for the unpaid portion of bills only partially paid by Knox Keene plans for noncontracted emergency services. The California Medical Association has prepared this toolkit to answer questions and provide options to physicians and their billing agents who can no longer "balance bill."
Best Practices: "A guide for improving the efficiency and quality of your practice": This toolkit offers a series of proven steps that solo and small-group practices can take to improve many facets of their practice, including the delivery of better-quality medical care. It is based on an important premise: that in order to provide quality medical care, a physician practice must be efficient and well run.
Medicare Part B 2012 Important Changes: What They Mean to Your Practice: The Centers for Medicare & Medicaid Services (CMS) issued a final rule on November 1, 2011, that updates payment policies and Medicare payment rates for physicians’ services furnished in 2012. To assist physician offices in planning for billing changes, CMA has developed this guide to highlight changes that may impact physician billing.
Medicare Electronic Prescribing Overview: Payment Incentives and Payment Reductions: Medicare introduced an e-prescribing program in 2009 that encourages physicians to electronically transmit their prescriptions. The e-prescribing program provides incentive payments for physicians who e-prescribe and payment penalties for physicians who do not. Starting in 2012, Medicare will begin a 1 percent payment reduction penalty on all Medicare allowed charges for eligible professionals who do not electronically transmit their prescriptions. The penalty increases to 1.5 percent in 2013 and 2 percent in 2014.
Preparing for the New HIPAA 5010 Standards: A Guide for Physicians: Physician practices may need to make adjustments to the patient data they collect and report in order to comply with a new Health Insurance Portability and Accountability Act (HIPAA) requirement that takes effect January 1, 2012. The new "HIPAA 5010 regulations" impact all health care providers who conduct administrative transactions electronically (including submitting claims, checking eligibility and claims status, or obtaining remittance advice and referral authorizations). The California Medical Association (CMA) is advising members to familiarize themselves with these regulations and be proactive about making the needed changes to comply.
Are you ready for the transition to HIPAA Version 5010?: Beginning January 1, 2012, physicians and others in the health care industry will be required to use the updated 5010 version of the Health Insurance Portability and Accountability Act (HIPAA) transactions standards to conduct electronic administrative transactions, such as claims submissions, checking eligibility, claims status, remittance advice, and referral authorizations. The updated 5010 transactions will include clearer instructions, reduced ambiguity among common data elements, and elimination of redundant and unnecessary data elements.
5010 Quick Reference Guide: CMA surveyed the major payors in California to find out which of them will allow for an extension on the 5010 enforcement deadline. Results, where available, are below. This guide will be updated regularly as new information becomes available.
Medicare Enrollment Guide for Individual Physicians: Medicare enrollment processes have changed considerably over the years, and even more so with the introduction of national provider identifiers. The enrollment application process for individuals can be complex and burdensome. CMA has developed this document to guide new physicians through the enrollment process, and to assist enrolled physicians who are making changes or who must revalidate their enrollment.
2010 Guide for Medicare Consultation Code Reporting: 6-page billing guide that includes a CPT code crosswalk for reporting consult codes to Medicare.
CMA Managed Care Consultation Code Quick Reference Guide: CMA surveyed the major payors in California to find out which of them plan to follow Medicare’s lead and eliminate consults. This chart will be updated regularly as new information becomes available.
AMA Tools
Practice Management Alerts: Position your practice to save time and money. Sign up for timely e-mail alerts, which help you stay up to date on unfair payer practices, ways to counter these practices, and practice management resources and tools.
AMA-Path-AMA‐Path: A Groundbreaking Analytical Tool For Physician Practices designed to help physicians prepare for billing and payment audits by health insurers and federal contractors.
Virtual Mentor-Virtual Mentor: Your Practical Guide To Resolving Ethical Dilemma. Virtually every clinical decision is an ethical decision—whether it's prescribing a brand versus generic drug, or determining the correct care regimen. Virtual Mentor can help physicians and medical students with these sometimes thorny dilemmas. Every issue of the online ethics journal contains original articles and commentary on a given theme—such as access to care, quality‐of‐life considerations in clinical decision‐making and conflict of values in the clinic.
AMA Medicare Participation Toolkit: The AMA has developed the “Know your options: Medicare participation guide” to help physicians evaluate their options and choose the direction that is right for their practice. The kit contains a detailed explanation of the three options, a helpful calculator and various sample materials to help physicians share information with current, new and prospective patients.
New Payment Resources Toolkit: This video and upcoming webinar explore how physicians can lead and find success with new payment and delivery models, such as accountable care organizations and episode-of-care bundled payments presented in the Affordable Care Act.
