From:  AMC/NOMA Staff

SUBJECT:  AMC/NOMA Notables

 

Date:  January 22, 2002

 

AMC/NOMA provides print materials through fax blasts, our magazine – The Cleveland Physician, fact sheets, mailers and through our Web site at www.amcnoma.org.  Periodically the physician members with email addresses will receive the AMC/NOMA Notables.

Joint negotiations bill update – AMC/NOMA to testify on legislation

     House Bill 325, which would allow health-care providers to jointly negotiate with health plans and third-parties over provider contracts is currently hearing testimony.  The House Insurance Committee heard testimony from the bill's sponsor, Rep. James Trakas (R-Independence).  Rep. Trakas stated that the bill would serve consumers by allowing negotiations over health-care coverage to be conducted by experts in medical care rather than allowing health insurers to dictate what coverage is included in an insurance contract.   The House Insurance Committee is due to meet again during January, and the AMC/NOMA will be testifying on the bill.

ODH legislation may expand state's power during public health emergencies

     The Ohio Department of Health may soon introduce legislation that would give them additional authority in the event of public health emergencies.   If introduced the legislation would be drafted from the Model State Emergency Health Powers Act, developed by the U.S. Centers for Disease Control. This proposal would allow the governor to appoint a council to advise administration on coordinating government offices' responses to emergencies, train medical personnel to treat infections diseases, evacuate residents and appoint emergency judges to execute quarantine orders.  The legislation would also allow hospitals and nursing homes be used for treatment and vaccination centers and grant access to some patient medical files.

United HealthCare to expand managed care coverage to beneficiaries in Cleveland

     The Centers for Medicare and Medicaid Services recently approved a request by United HealthCare Insurance Co. to expand managed care coverage to Medicare beneficiaries in Cleveland and Akron.  Beginning February 1, 2002, United HealthCare, based in Minneapolis, Minn. will start serving coverage.  The plan will give Cleveland and Akron beneficiaries another health care option.  Two Medicare managed care plans, Kaiser Permanente and Anthem Senior Advantage currently serve these areas.  QualChoice Medicare Prime and United HealthCare Medicare Complete are in Cuyahoga County, while SummaCare Secure and HomeTown SecureCare operate in Summit County.

AMA calls for halt to Medicare physician payment cut

     The American Medical Association called for an immediate legislative halt to the 5.4 percent Medicare physician payment cut that went into effect January 1 with a letter sent to all U.S. senators and representatives January 17.  The AMA is urging physicians to contact their legislators and demand that action on this matter not be deferred for consideration as part of a broader Medicare package.

     During the last congressional session, the "Medicare Physician Payment Fairness Act of 2001," a bill designed to tackle the Medicare physician payment update problem, was advanced by lead co-sponsors Sense. Jeffords, Breaux and Kyl (S. 1701) and Reps. Bilirakis and Brown (H.R. 3351).  These bills obtained a super-majority in both houses, with 65 co-sponsors in the Senate and 287 in the House.  Because no action was taken, physicians are experiencing the largest across-the-board payment cut since the Medicare fee schedule was developed ten years ago.

     Physicians and other practitioners may be forced to lay off staff and/or unable to accept new Medicare patients as a result of the Medicare cut.  The update problem also is likely to increase the number of health care practitioners retiring early or reducing their participation in the Medicare program.  Physicians are encouraged to join in the fight by calling (800) 833-6354 and telling their legislators to halt the payment cut.

FRAUD ALERT FROM MEDICARE

Individuals, under the guise of performing HIPAA compliance audits, are contacting physicians and requesting access to computers and databases.  The individuals do not produce identification or documentation.  Physicians and their staff should remember to never allow any individuals access to their computers, billing information or medical records who are unknown to them.  It has been suggested that if a physician’s office is contacted by suspicious individuals attempting to conducting HIPAA compliance audits, that the contact the Medicare Fraud Hotline at 888-619-5316.

Note:  “AMC/NOMA Notables” includes links that provide direct access to Internet sites other than the AMC/NOMA site, the AMC/NOMA takes no responsibility for the content or information obtained on those other web sites, and we do not have any editorial or other control over those web sites.  Additional information on these topics may be available on our web site at www.amcnoma.org.