265.897 Inappropriately Constrained Provider Reimbursement, Increasing Health Insurance Premiums and Increased Patient Cost-Sharing: (Council 3/30/08; SUNSET HOD 2018)
265.896 Legal Flexibility to Offer Uninsured Patients Structured Pre-Payment Options: MSSNY will support innovative strategies and physician initiatives that allow or enhance universal access to medical care, including permitting physicians legal flexibility to offer otherwise uninsured patients structured pre-payment options for accessing care in their office. (HOD 2009-65; Reaffirmed HOD 2019))
265.895 United Health Group Policy Change: MSSNY will contact the United Health Group immediately demanding that it halt and reverse its policy change of deletion of the use of UCR for determining reimbursement and replacement with the terminology of allowed charge and that it abide by the letter, spirit and intent of the Attorney General’s
265.894 Recovery of Damages Resulting from the Use of Flawed UCR Data: MSSNY will support efforts to recover damages due participating physicians that resulted from the use of the flawed Usual Customary & Reasonable (UCR) (Ingenix) database. (Council 6/25/09; Reaffirmed HOD 2019)
265.893 Assist Physician Practices to Move Toward Electronic Billing: SUNSET HOD 2019
265.892 Medical Home Model: MSSNY will study the medical home model through an existing committee or by establishing a Task Force on Medical Home Models with these directives: define medical home, including payment models, after considering American Medical Association Policy H-160.919; research successful medical home pilot projects; monitor the progress of medical home pilot projects
265.891 Adjustments Made to Relative Value Scale to Include Increased Paperwork for Physicians: MSSNY will seek reconsideration of Work Relative Value Units for all AMA-CPT codes from the Relative Value Update Committee (RUC) to capture the additional work forced upon physicians by voluminous documentation requirements resulting from regulatory mandates when reimbursement rates are calculated and to
265.889 Claims Denial Although Accurately Coded: MSSNY will seek legislation that (1) would mandate the health care provider discuss denials based on policy, utilization or medical necessity with a physician of the insurance company rather than a non-physician representative and (2) the discussion between the health care provider and the Medical Director of the insurance
265.888 Denial of Reimbursement Based on Volume of Procedures Peformed: MSSNY will communicate its concern to the New York State Commissioner of Health, as well as to the Governor and State Legislature, regarding a newly implemented health department policy whereby payment for procedures or treatments performed at certain hospitals will be discontinued based on the
265.887 Re-evaluation of Evaluation and Management Codes: SUNSET HOD 2020
