265.886 Denying Reimbursement Based on Volume of Procedures Performed: MSSNY is asked to challenge the Department of Health (DOH) on the current lack of quality data as it reflects solely on currently defined low volume threshold; request that the DOH re-examine the policy and reverse its denial of reimbursement based on new quantifiable data gathered
265.885 Out-of-Network Reimbursement MSSNY will support and advocate for legislation and/or regulation that: Requires managed care organizations to use the FAIR Health benchmarks as the basis for reimbursement for out-of-network charges for any policy that provides out-of-network benefits; Prevents health insurance companies from selling policies that purport to but, in fact, fail to adequately cover
265.884 Hospital Readmissions MSSNY will work with the Healthcare Association of New York and the Greater New York Hospital Association to amend state and federal law to exclude know and expected complications from “quality adjustment in DRG payment.” (Denial or reduction in payment when appropriate cause has been provided.) (HOD 2011-64; Reaffirmed HOD 2021)
265.883 Physicians and Evidence-Based Medicine (EBM): MSSNY, in its deliberations and advocacy, will support the development and use of high-quality evidence-based medicine as a guide to treating patients, provided, however, that the ultimate decision for care for each patient must rest with the physician determining the most appropriate care and treatment for their patient based
265.882 Direct Payments to Physicians by Insurance Carriers MSSNY will pursue regulation and/or legislation to compel third party payers to remit insurance payments directly to the non-participating physician when the insurance company is directed by the patient to do so. (HOD 2011-252; Reaffirmed HOD 2021)
265.881 United Health Care Proposed Policy Concerning Overpayment Audits:SUNSET HOD 2023
265.880 Time Limits for Recovery Audit Contractor (RAC) Reviews The Medical Society of the State of New York will petition CMS to limit RAC reviews to less than one year from payment of claims and will send this resolution to the American Medical Association (AMA) at the next AMA House of Delegates (see AMA policy
265.879 Directing Hospital Billing Payments to Physician of Record: SUNSET HOD 2022
265.878 Fair Compensation Mechanism for Changing Medications at Insurance Plan Request The Medical Society of the State of New York will work towards developing a solution that equitably and safely allows medication changes to be made without penalizing the patient while fairly compensating the physician for their work involved in decision-making. (HOD 2012-252; Reaffirmed HOD 2022)
265.877 Clear and Definitive Definitions of Abusive Billing Practices as Stipulated in PHL 3224-b Once a clear understanding of what is considered “abusive billing,” has been established, MSSNY will seek to have all health insurance carriers in the State of New York comply with the following provisions as agreed upon by MSSNY and United Healthcare: The
