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In a recent ruling, Compliance Dispute Officer Martin Quinn has determined that the pricing policy and associated actions taken by Blue Cross Blue Shield of North Carolina did not violate key provisions in the BCBS Settlement Agreement. In his opinion, Mr. Quinn stated that BCBSNC provided adequate notice of its policy, and provided fee schedules upon request.
The North Carolina Medical Society (NCMS) and numerous physician practices signed affidavits disputing these and other contentions made by BCBSNC. NCMS will likely file a motion for reconsideration.
October 20th, 2009
A report (PDF – 49 pages) commissioned by the Physicians Foundation (PAI), a national health care organization that represents the interests of physicians, raises new questions about the role of socioeconomic determinants as they relate to access, quality, and cost of medical care in the United States. The report, prepared by a team of noted physicians and economists headed by Richard “Buz” Cooper, MD, Professor of Medicine and Senior Fellow at the Leonard Davis Institute of Health Economics, University of Pennsylvania, was sent to the President and Congress today in order to contribute to the national health care debate.”It is essential that in order to pass meaningful health care system reform that the issues be fully debated with factual information,” PAI Treasurer and NCMS EVP, CEO Robert W. Seligson said. “Studies like this help put the debate at the forefront.”
Continue Reading October 20th, 2009
BCBSNC has announced a new policy offering physician practices and others the option to collect an estimated amount of the member’s out-of-pocket expense at the time of service. The new policy requires an established policy, member notification, a method for estimating the contracted amount, and provisions regarding refunds.The current BCBSNC policy is to collect $50 at the time of service.
Physician practices and the North Carolina Medical Society have been advocating for increased payments at the time of service due to the increasing levels of accounts receivables due in part to HSA and HRA products.
October 20th, 2009
Letters have been mailed to North Carolina physicians who have previously seen Humana’s Medicare Advantage patients stating that you will be contracted with the Humana or “ChoiceCare” networks
unless you object in writing within 90 days.Thus, if you fail to notify Humana of your desire not to participate, you will be deemed to be part of the network effective January 1, 2011. The letter states that payment will be calculated at 100% of the Medicare Allowable, and will be subject to terms and conditions listed on
Humana’s website. As of 2009, approximately 20% of North Carolina seniors are enrolled in Medicare Advantage plans. Humana is the largest health plan offering this coverage.
October 20th, 2009
As new and challenging Medicaid initiatives are being announced, physician practices are beginning to respond. The need, usefulness and effect on patient care are of top concern. In response to massive budgetary shortfalls this year, DHHS has been directed to initiate a number of changes, including the following:
Continue Reading October 20th, 2009
The North Carolina Medical Society’s Joint Advisory Group, or “JAG,” was formed as a result of the lawsuit settlement agreement between BCBSNC and North Carolina physicians to discuss issues arising from or related to the relationships and interactions between and among physicians, their patients, and BCBSNC. In July, 2009 the JAG members asked members of the NCMS to submit their issues to the members of the JAG. The list was compiled and categorized, and can be found at www.ncmedsoc.org (PDF). If you have additional issues, please send them to cscheele@ncmedsoc.org. This list has been sent to BCBSNC for their review.
October 20th, 2009
The intense financial pressure of the economic recession is evident in the budget passed by the General Assembly. Provider rates will be trimmed to achieve $76 million in savings during the 2009-10 budget year and $82 million in 2010-11. These reductions are not cumulative. If implemented uniformly across all services, the cuts would be approximately three percent. The Secretary of DHHS is not required to implement the cuts uniformly across all services.
Continue Reading October 20th, 2009
HHS issued regulations requiring health care providers, health plans, and other entities covered by the Health Insurance Portability and Accountability Act (HIPAA) to notify individuals when their health information is breached.
These “breach notification” regulations implement provisions of the Health Information Technology for Economic and Clinical Health (HITECH) Act, passed as part of American Recovery and Reinvestment Act of 2009 (ARRA).
The regulations, developed by OCR, require health care providers and other HIPAA covered entities to promptly notify affected individuals of a breach, as well as the HHS Secretary and the media in cases where a breach affects more than 500 individuals. Breaches affecting fewer than 500 individuals will be reported to the HHS Secretary on an annual basis. The regulations also require business associates of covered entities to notify the covered entity of breaches at or by the business associate.
“This new federal law ensures that covered entities and business associates are accountable to the Department and to individuals for proper safeguarding of the private information entrusted to their care. These protections will be a cornerstone of maintaining consumer trust as we move forward with meaningful use of electronic health records and electronic exchange of health information,” said Robinsue Frohboese, Acting Director and Principal Deputy Director of OCR.
The regulations were developed after considering public comment received in response to an April 2009 request for information and after close consultation with the Federal Trade Commission (FTC), which has issued companion breach notification regulations that apply to vendors of personal health records and certain others not covered by HIPAA.
To determine when information is “unsecured” and notification is required by the HHS and FTC rules, HHS is also issuing in the same document as the regulations an update to its guidance specifying encryption and destruction as the technologies and methodologies that render protected health information unusable, unreadable, or indecipherable to unauthorized individuals. Entities subject to the HHS and FTC regulations that secure health information as specified by the guidance through encryption or destruction are relieved from having to notify in the event of a breach of such information. This guidance will be updated annually.
The HHS interim final regulations are effective 30 days after publication in the Federal Register and include a 60-day public comment period.
View the Breach Notification Interim Final Regulation (74 FR 42740) – August 2009.
View the Press Release.
View the HITECH Breach Notification Guidance and RFI (74 FR 19006) – April 2009.
October 20th, 2009
In accordance with Section 13403(a) of the Health Information Technology for Economic and Clinical Health (HITECH) Act (Title XIII of Division A and Title IV of Division B of the American Recovery and Reinvestment Act of 2009 (Pub. L. 111–5)), the Secretary is to designate an individual in each regional office of HHS to offer guidance and education to covered entities, business associates, and individuals on their rights and responsibilities related to the HIPAA Privacy and Security Rules.
Continue Reading October 20th, 2009
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