Monthly Archives: May 2024

195.908        Payment by Medicare Secondary or Supplemental Plans

195.908        Payment by Medicare Secondary or Supplemental Plans MSSNY will advocate that New York State enact legislation that would mandate that all health plans, compliant with the Rutledge ruling Rutledge v. PCMA, cover Medicare secondary claims regardless of the provider participating in the secondary health plan. MSSNY will advocate that the AMA advocates national legislation

By |2024-05-28T18:57:46+00:00May 28th, 2024|195.000 MEDICARE|Comments Off on 195.908        Payment by Medicare Secondary or Supplemental Plans

235.978           Rollback on Physician Performance Measures

235.978           Rollback on Physician Performance Measures MSSNY will make public statements calling for a removal of any/all unproven outcomes measures and associated mandates placed on physicians, practices, licensed clinics, nursing homes, hospitals and other places of healthcare. MSSNY will seek legislation or regulation removing any/all unproven outcomes measures associated mandates placed on physicians, practices, licensed

By |2024-05-28T18:56:14+00:00May 28th, 2024|235.000 PHYSICIAN CREDENTIALING/RECREDENTIALING|Comments Off on 235.978           Rollback on Physician Performance Measures

155.989           Supporting Independent Practice- Payment Parity

155.989           Supporting Independent Practice- Payment Parity The Medical Society of the State of New York will advocate for payment parity for physicians providing the same services (adjusted for local costs), allowing small independent practices to survive, thus helping to stem the loss of physicians to locum tenens, concierge practice and non-clinical careers, and helping to

By |2024-05-28T20:06:21+00:00May 28th, 2024|155.000 INDEPENDENT PRACTICE OF MEDICINE|Comments Off on 155.989           Supporting Independent Practice- Payment Parity

40.987           Removing Board Certification as a Requirement for Billing for Home Sleep Studies

40.987           Removing Board Certification as a Requirement for Billing for Home Sleep Studies The Medical Society of the State of New York lobby the appropriate bodies in New York State government to remove Sleep Board Certification and facility accreditation as a requirement for the approval of and payment for home sleep studies, simply allowing this

By |2024-05-28T18:52:43+00:00May 28th, 2024|40.000 CLINICAL JUDGMENT|Comments Off on 40.987           Removing Board Certification as a Requirement for Billing for Home Sleep Studies

180.975           United Healthcare Group Abuse of Physicians

180.975           United Healthcare Group Abuse of Physicians The Medical Society of the State of New York (MSSNY) will use all means available, regulatory, legislative, or legal, to force United to cease its demands for excessive records. United Healthcare should also be obligated to allow electronic uploading of medical records. (HOD 2024 – 254)

By |2024-05-28T19:18:09+00:00May 28th, 2024|180.000 MEDICAL DATA|Comments Off on 180.975           United Healthcare Group Abuse of Physicians

165.836                       Making Care Primary–A Capitated Payment Model

165.836                       Making Care Primary–A Capitated Payment Model The Medical Society of the State of New York will remove from its website webinars or other materials advocating participation in MCP, or at a minimum, add a statement informing NYS physicians and patients of the conflicts of interest and the potential risks of participating in a capitated

By |2024-05-28T18:49:59+00:00May 28th, 2024|165.000 MANAGED CARE|Comments Off on 165.836                       Making Care Primary–A Capitated Payment Model

120.877        Full Transparency – Explanation of Benefits

120.877        Full Transparency – Explanation of Benefits MSSNY will advocate legislation and regulations that mandate that explanation of benefits, whether sent to the patient or the physician practice, include the actual CPT codes billed, DRG-codes, CPT descriptions, and optional consumer-friendly descriptions; and EOB must list the actual allowed amount, patient responsibilities (copay, deductible, coinsurance), non-covered

By |2024-05-28T18:48:35+00:00May 28th, 2024|120.000 HEALTH INSURANCE COVERAGE|Comments Off on 120.877        Full Transparency – Explanation of Benefits

120.878        Transparency – Non-Payment for Services to Patients with ACA Exchange Plans with Unpaid Premiums

120.878        Transparency – Non-Payment for Services to Patients with ACA Exchange Plans with Unpaid Premiums MSSNY will advocate for legislation to require that health plans inform healthcare providers whether the plan premium has been paid and whether the account is late on payment as part of benefit verification, whether by phone, fax, or electronic transaction,

By |2024-05-28T18:47:41+00:00May 28th, 2024|120.000 HEALTH INSURANCE COVERAGE|Comments Off on 120.878        Transparency – Non-Payment for Services to Patients with ACA Exchange Plans with Unpaid Premiums

120.879        Mandated Economic Escalators in Insurance Contracts

120.879        Mandated Economic Escalators in Insurance Contracts The Medical Society of the State of New York (MSSNY) will advocate through legislation or regulation for the mandatory insertion of an economic escalator provision in all commercial insurance contracts to account for economic inflation or a decline in Medicare Physician Fee Schedule (PFS). MSSNY shall bring a

By |2024-05-28T18:46:49+00:00May 28th, 2024|120.000 HEALTH INSURANCE COVERAGE|Comments Off on 120.879        Mandated Economic Escalators in Insurance Contracts

120.880        AI In Insurance Claims

120.880        AI In Insurance Claims MSSNY supports:(1) transparency standards which allow for the state agency auditing of AI algorithms used by New York State health insurers to approve and deny claims (2) the modification of New York statute to explicitly preempt the utilization of race and race-based proxies in the algorithmic claims processing of health

By |2024-05-28T18:45:57+00:00May 28th, 2024|120.000 HEALTH INSURANCE COVERAGE|Comments Off on 120.880        AI In Insurance Claims
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