310.999 Medical Director to be Required for all Third Party Payors: The Medical Society of the State of New York will seek whatever legislative or regulatory action is necessary to insure that all health insurance companies that are licensed in the State of New York and performing utilization review have a physician medical director who
310.998 Third Party Audits of Physicians with Subsequent Billing of Physicians for Tests Deemed Inappropriate: MSSNY will urge the appropriate state and federal regulatory agencies to regulate third party payers’ medical practice audits such that these audits focus on providing education and improving the quality of care, and not be used for financial or punitive activities. MSSNY
310.997 Arbitration in Cases of Third-Party Audits: MSSNY will seek legislation or regulation for the development of an independent arbitration panel to handle requests for refunds by third-party payers arising from audits of physicians’ practices. (HOD 1998-265; Reaffirmed HOD 2014; Reaffirmed HOD 2024)
310.996 Third-Party Payer Use of Unsubstantiated Demand and Refund Letters: MSSNY will seek amendment to the New York State Insurance Law to address the issue of payer demand letters, and to reflect the following provisions: 1) the physician should have the right to due process, should have access to all pertinent carrier documents, and should
310.995 Independent Medical Examiners: MSSNY will legislation to create a pool of physicians in each specialty to act as Independent Medical Examiners (IMEs) for all third party payers doing business in New York State who request such a service in order to determine the need for further or continued medical treatment. MSSNY will urge the
310.994 Use of Binding Arbitration: MSSNY will seek a change to the law to permit binding arbitration clauses in contracts between physicians and patients. (HOD 2006-61; Reaffirmed HOD 2016)
310.993 Low Cost Arbitration: SUNSET HOD 2019
310.992 Utilization Review The Medical Society of the State of New York will seek legislation/regulation that requires insurance companies, peer review organizations, Centers for Medicare and Medicaid Services, and others to use the review criteria that existed at the time that services were provided when making their determinations. This resolution will be forwarded to the
