The national class-action settlement agreements require that reason codes be on EOBs. The Horizon agreement is in effect and failure to provide the reason code violates the agreement. Members are urged to inform MSNJ of any Horizon plan EOBs that do not contain reason codes. Please write to firstname.lastname@example.org and put “Horizon: EOB Compliance Dispute” in the subject line. Please indicate the plan name and for how long the EOBs have been missing this information. If the EOBs contain inaccurate information, particularly about patient responsibility, please provide that information, too. We have learned that some of Aetna’s EOBs are dropping the reason code. It is not clear if this is an isolated situation. Please write to email@example.com if you receive EOBs that are missing the reason code. Please put: “Aetna: EOB remittance advice” in the subject line.
In early January, the US Secretary of Health & Senior Services offered her Department’s assistance to the state of California concerning Blue Shield’s significant premium increases. In a news release, she stated that:
The practice of insurers imposing these kinds of rate increases without public scrutiny would be the wave of the future without the Affordable Care Act. If the law were repealed, we would be left with few tools to protect consumers against these kinds of rate increases. Insurers would be able to spend more on profits, marketing, and CEO bonuses, instead of care. Families and small businesses would lose their ability to negotiate more competitive rates in the Exchanges, and insurers would again be able to deny coverage to children based on their pre-existing health conditions. [News Release, U.S. Department of Health & Human Services (January 6, 2011)].
Independent Payment Advisory Board
The Congressional Research Service (CRS), a non-partisan entity, has issued a report raising questions about the legal authority of the Independent Payment Advisory Board (IPAB) established under the Affordable Care Act. The IPAB was created to “reduce the per capita rate of growth in Medicare spending.” Board members are appointed by the President. The report takes the position that the IPAB is open to legal challenge because it shifts “the balance of power to the executive branch and away from Congress.” MSNJ objected to the IPAB for the same reason. Read the report in its entirety.
Physician Compare Website
The Physician Compare website is now live. The website was required by the healthcare reform law and is being implemented by CMS. While the physician directory is only for those who treat Medicare patients, the website is available to the public at large. Currently, the website includes information on physicians such as contact and address information, medical specialty, degree credentials, gender and languages spoken.
A second phase, schedule for later this year, will indicate whether physicians are prescribing electronically. In 2013 the website will include data on quality of care. MSNJ has expressed concern to CMS about how the quality of care information will be presented. MSNJ urges members to access the website to confirm the accuracy of the information provided.
The MSNJ Policy & Strategy Panel is seeking interested members who would be willing to serve on a task force to advise MSNJ regarding the development of a truly physician driven Accountable Care Organization (ACO).
The task force membership will be appointed by the President of MSNJ. The task force will convene in late January for an initial orientation meeting. The task force will convene by webinar or teleconference about every other month over the course of 2011 (in the evenings).
Please send an email stating your interest and a copy of your CV to firstname.lastname@example.org.
The New Jersey General Assembly passed A-3378, the so-called Out of Network reform bill, along party lines earlier this week. While many legislators continued to express concerns over the legislation’s impact on providers, its sponsors, Assemblyman Gary Schaer (D – Passaic) and Assemblywoman Grace Spenser (D – Essex), were able to prevail upon their caucus to get the minimum 41 votes needed for final passage.
The bill, as it stands today, would prohibit the waiver of copays and deductibles with some exceptions, require physicians to discuss their network status and charges with patients prior to the delivery of care, and require insurers to provide information about benefits on their websites. MSNJ, while agreeing that transparency will ultimately be beneficial to healthcare consumers, is committed to addressing the legislation’s many imperfections as the process moves forward. The bill has been received in the Senate and referred to the Commerce Committee, which is also considering its Senate counterpart, S-2372 (Vitale, D – Middlesex).
Click here for the latest version of A-3378.
The Medical Society of New Jersey has launched its new campaign entitled “Leaders in healthcare, leaders in life.” It tells the stories of MSNJ physician-members who are leaders in their community as well as their profession. What’s your story?