265.000 REIMBURSEMENT

265.989           Changes In Reimbursement Rates And Payment Of Benefits Policies Of Insurance Carriers Without Recourse By Participating Physicians: MSSNY will actively seek, through legislation or whatever regulatory means necessary, the establishment of a mechanism whereby HMOs and other health insurers licensed in the State of New York be required to: (a)  include in their annual financial

265.988           Payment Of Balance Of Bills By Secondary Health Insurance Agencies: MSSNY will seek legislative reform in the New York State Insurance Law that would: (a)  require all health insurance plans licensed in this state to include a Coordination of Benefits (COB) clause in their contracts clearly delineating their responsibilities as secondary insurers;  (b)  require

265.987           AMA-CPT Coding MSSNY endorses AMA-CPT as the standard accepted coding system in New York and that proper use of CPT by insurance carriers requires adherence to all of its rules and guidelines; and will recommend that the Insurance Superintendent and the New York State Legislature require health insurance carriers processing claims from New York

265.986           Physician Due Process in Managed Care: Should a physician participant in one plan of an Insurance Company be denied access to other newly evolved plans that Insurance Company offers, the reason for such must be provided in writing and an appeals process be established to review that decision in a timely fashion. (Council 12/18/97;

265.985           Third Party Fee Schedule: MSSNY will seek legislation at both state levels and national levels that would mandate insurers to make available their complete fee schedules, coding policies, and utilization review protocols to physicians prior to signing a participant contract and whenever any changes are made to the foregoing.  (HOD 1998-262; Reaffirmed HOD 2014;

265.984           Amend Managed Care Payment Policy for X-Ray Examinations: SUNSET HOD 2014

265.983           The Prudent Physician Paradigm: It is MSSNY’s position that if a physician excises a clinically suspicious skin lesion, the insurer should be held liable for payment for the surgical procedure regardless of the subsequent pathology report. MSSNY will request legislative or regulatory action that when a physician performs an indicated procedure based on a

265.982           Reimbursement Moratorium on Merged Health Maintenance Organizations: MSSNY will seek appropriate legislation which, in the event of a merger or consolidation of one or more health maintenance organizations, would impose a one-year moratorium after the announcement of a new fee schedule, thereby precluding the lowering of reimbursement to participating physicians for this one-year period. (HOD

265.981           ERISA Plans Should be Held Accountable to the Same Reimbursement Requirements as other Insurance Carriers in the 1997 Prompt Payment Legislation:  The Medical Society of the State of New York supports legislation that would require ERISA plans to pay medical insurance claims in a timely manner as other insurance carriers in New York State are required to do.  (HOD

265.980           Enhancements to HMO Prompt Payment:  MSSNY will petition the Governor of the State of New York to modify the current Prompt Payment Law to provide for the imposition of a penalty of up to 20% of the amount billed, payable directly to the physician by the payor, for any clean claim not paid within