RCMA & CMA Tools
2018 Riverside County New Physician Survival 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.
A Physician's Guide to Covered California: States Health Benefit Exchange CMA has developed this toolkit to educate physicians on the exchange and ensure that they are aware of important issues related to exchange plan contracting.
A Physician's Guide to Implementation of SB 866: The new standardized prescription drug prior authorization formA new law (SB 866–Hernandez, 2011) has taken effect that aims to streamline and standardize the prior authorization process for prescription drugs. The new law requires all insurers,health plans (and their contracting medical groups/IPAs) and providers to use a standardized two-page form (Form 61-211) for prior authorizations on prescription medications. CMA has developed this FAQ for physician members and their staff to address common questions about the new form and process.
Taking Charge: Steps to Evaluating Relationships and Preparing for Negotiations Tool Kit: California Medical Association is pleased to offer our members this guide. Our goal in producing this document is to provide 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.
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 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.
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.
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.
CMA Medi-Cal Survival Guide: This guide contains a summary on many of the changes of Medi-Cal for 2014, important dates, options for physicians and links to important resources.
STEPS Forward: The AMA's STEPS Forward™ collection of practice improvement strategies also offers a variety of education modules to help physicians take steps toward advancing team-based care, implementing electronic health records, improving care and practicing value-based care. Improvement Strategies.
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.
Tools for Overpayment Recovery & Claims Appeals These AMA tools help physicians secure correct claims payment from health plans, navigate the overpayment recovery process and appeal incorrect payments.
Electronic Fund Transfer Toolkit: A free online toolkit from the AMA helps inform about the benefits of EFT to speed up payment and potentially provide savings to your practice.
Electronic Remittance Advice: This toolkit provides in-depth resources about ERA and how it can help expedite your billing process.
Managing Patient Payments: The AMA offers resources to help physicians manage patient payments and maximize efficiencies in the collection process including Point-of-Care Pricing Toolkit, Maximizing Post-visit collections and How to Select a Collection Service.
EFT Fees and HIPAA: AMA has developed this resource detailing the regulatory and technical framework of the HIPAA standard ACH EFT transaction. This resource highlighting restrictions that HIPAA regulations place on health plan usage of fees in ACH EFT.
Know Your Rights and Make ACH EFT Work for your Practice: AMA has developed this resource that details the physician rights and health plan responsibilities created by the new EFT standard. This resource also advises physicians how to avoid the percentage-based fees and auto-debit programs some payment solution vendors are attempting to impose with ACH EFT.