265.000 REIMBURSEMENT

265.959           Insurance Companies Should Reimburse Physicians for Telephone Time with Pharmacies: MSSNY will seek regulatory or legislative action to (a) require health care plans doing business in New York State to recognize, as a separate service, through the existing AMA-CPT coding nomenclature, telephone calls communicating with family members, medical entities, pharmacies, benefit management companies, case managers, and

265.958           Authorized Assignment of Benefits: MSSNY will seek legislation or regulation to: (a) ensure that third-party payers be required to issue payment directly to providers when the patient has signed an authorization for the assignment of benefits; (b) mandate that health plans notify physicians when claim payments are issued to the insured rather than the

265.957           Recognition of “Incident To” Services: SUNSET HOD 2013

265.956           Unfair Claims Filing by HMOs: MSSNY will seek legislative action to prevent any Third Party Payer doing business in New York State from seeking repayment or refund through withholding of claim payments relating to treatment of other patients (offset).  (HOD 2000-265; Reaffirmed HOD 2010-259; Reaffirmed HOD 2020)

265.955           Managed Care Organizations Should Disclose Their UCR Calculation Methodology: SUNSET HOD 2014

265.954           Implementation of Carrier Advisory Committee (CAC) Functions by Third-Party Insurers: MSSNY will seek legislative or regulatory relief to require all third-party payers to implement a Carrier Advisory Committee (CAC) function, in order that carriers’ medical/surgical claims processing policies may be codified with the input of the specialty societies in New York State.  (HOD 2000-269; Reaffirmed

265.953           Reimbursement for Baclofen Pump: SUNSET HOD 2024

265.952           HCFA Evaluation and Management Codes – Modifier 25:  SUNSET HOD 2014

265.951           Cost of Living Adjustment to Compensate for Rising Overhead Medical Expenses MSSNY supported a resolution to the American Medical Association House of Delegates requesting passage of federal legislation requiring that insurance reimbursement have an annual cost of living adjustment to compensate for rising overhead expenses.  (HOD 2001-58; Reaffirmed HOD 2011; Reaffirmed HOD 2021)

265.950           Insurance Company/Managed Care Plan Acceptance of Physicians Submitted Claims: Sunset HOD 2011