265.917 Pay for Performance: MSSNY recommend that all Pay for Performance (PFP) programs pay physicians a per-member-per-month fee for data collection for all lives covered in the program; that this policy be consistently articulated by all MSSNY representatives at any meeting regarding PFP; that MSSNY neither endorse any PFP programs nor encourage its members to
265.916 NYS DOH Review of Provider Contracts: That MSSNY seek legislation, regulation or other appropriate means to assure that the Department of Health review health plan standard provider contracts to assure that the contract terms contained are fair to physicians and patients in those situations where the health plan holds a 10% market share in
265.915 Insurance Companies and Publicizing the Hassle Factor Form: That MSSNY monitor unfair business practices of health plans through the use of the new MSSNY Hassle Factor Form (HFF), creating or joining with a coalition of stakeholders (to include physician groups and leaders of industry and business who bear the burden of health care costs)
265.914 Electronic Payment or Funds Transfer Systems: MSSNY will: (1) urge insurance companies initiating electronic payment or funds transfer systems to allow physicians with fewer than 10 Full-Time Equivalent (FTE) Employees to claim an exemption to mandatory electronic payment or funds transfer system; (2) seek to assure that physician practices of all sizes have the
265.913 Managed Care and Medicare “Carve-Out” Services: In those instances where an insurance company has “carved out” specific services, and has contracted with an outside party to arrange and pay for these services, and then denies reimbursement on the basis that such payment is no longer their responsibility, MSSNY to (1) advocate for a physician’s
265.912 Reimbursement for Participation: MSSNY adopts the American Medical Association’s Principles for Pay-for-Performance and Guidelines for Pay-for-Performance, H-450.947: PRINCIPLES FOR PAY-FOR-PERFORMANCE PROGRAMS Physician pay-for-performance (PFP) programs that are designed primarily to improve the effectiveness and safety of patient care may serve as a positive force in our health care system. Fair and ethical PFP programs
265.911 ERISA Plans and the United States Department of Labor: MSSNY will seek the support of the American Medical Association in proposing an amendment to federal legislation that would modify ERISA law to incorporate a clause that addresses timely payment of medical claims of health care practitioners who provide treatment in good faith to the
265.910 Publicizing the Hassle Factor Form: Deleted (HOD 2007-264, Combined with 265.915 as single policy, HOD 2017)
265.909 HMOs Decreasing Reimbursement & Patient Co-Payments: MSSNY will continue to advocate to the Legislature, the Governor, the Department of Health and other relevant policymakers to address the problem facing physicians, businesses and patients regarding inappropriately constrained provider reimbursement, rapidly increasing health insurance premiums and increased patient cost-sharing at the same time that health plans
265.908 Impediments Imposed by Health Insurance Companies to Obtaining Pre-Authorization: MSSNY will take appropriate steps including, if necessary, seeking the enactment of legislation and regulation, to eliminate unnecessary impediments imposed by health insurance companies to obtaining pre-authorization, including reducing the need and time for obtaining pre-authorizations. (Council 3/3/08; Reaffirmed HOD 2008-50; Reaffirmed HOD 2016-262)
