We're from the government and we are here to help you. The FTC is starting to enforce the Red Flag Rule on May 1, 2009. Hospitals and physician offices are creditors under the rule and are affected. The rule requires all creditors to have written policies and protocols in place to deal with potential identity theft. Red Flags are to identify potential identity theft. For physician offices this may mean for new patients to get and see bona fide government ID to make sure the person is the one you are extending credit to. This includes billing patients later for services rendered. Yes, even if co-pays are deferred and billed. You must have in place written policies on risk factors for your organization, potential sources of Red Flags and the warning signs of Red Flags. Also, the policy must state what you will do if you find a Red Flag and how you will and how often you will re-evaluate your program. Yes, you will spend money to write the program yourself or have someone write it for you. This should help the economy, just not yours.
The AMA continues to argue with the FTC over whether physicians are covered under the Red Flag Rules and is losing. The FTC has stated that the rule is flexible and they do require reasonable things. The smart thing is to build on the already present HIPAA rules.
The White House and the Congress want to fast track healthcare reform, whatever that is, by using reconciliation. The House has passed this short cut but it is not yet passed in the Senate. This would not allow filibuster so the 60 votes would not be necessary, only 51 to pass this legislation. This would be the most partisan bill passed in years with no input from the other side as part of the budget necessary to fund the "reform". The Democrats in the Senate are afraid to use it since it will mean that all other programs will fail to pass the 60 vote margin.
Speaking of budget, in a footnote in Obama's proposed budget is the removal of the Bush zero estate tax in 2010 and replacing it with keeping the 2009 estate tax of 45% of everything over $3.5 million. This is a true sneak attack that was picked up by the Wall Street Journal. The Senate has just passed a bill for a permanent estate tax of 35% for over $10 million in the estate. Reid is not happy.
Obama has officially set up an office for Health Reform in the White House. It is a coordinating agency working with Congress and headed by Nancy-Ann DeParle, the lady with multiple conflicts of interest. The Office is be executive order and as such does not have to report to Congress. Top
UnitedHealth was called before the Senate to defend its use of the infamous Ingenex database. The execs failed to allay Senate concern about the health insurance industry as a whole. This could bode poorly for the industry under any "healthcare reform."
Connecticut has ordered Health Net to pay rebates to its members for failure to conduct a reasonable investigation prior to ruling on claims, paid claims late and without the required interest as well as low balling providers for out of network payments. They have to pay restitution plus pay for consumer education plus pay a large fine to the state.
Connecticut has passed a law not to pay for medical errors on Medicaid patients. The errors include air embolism, foreign objects post op, serious pressure sores, injuries from falls, incompatible blood and catheter associated infections. They expect this to save only $1.7 million per year but will send a message. There are 20 other states that have either passed or are considering passing the same type legislation.
Georgia is now after the insurers and how they pay out of network bills. It appears that each state will have to do this as the insurers are not willing to do the right thing nationally. The mouthpiece for the Georgia Assoc. of Health Plans speaks with forked tongue when he said he doesn't believe that insurers are intentionally underpaying physicians.
CMS has announced the Medicare Advantage payments for this year and the potential for next year. This year the HMOs will get a 0.8% increase this year instead of the usual 4% to 5%. Next year CMS is planning a reduction of 4% to 5%. This takes into account the proposed 20% drop in physician fees for next year which will not occur. This will leave the HMOs short. This means there will by higher co-pays and/or premiums next year so the HMOs can maintain their 5% profit margin. CMS now pays 30 cents more per patient for Advantage members than traditional fee for service.
CMS has announced that they will cover PET scans for all solid tumor diagnosis and follow-up. Can you imagine the socialized countries doing this although it is the best way to follow patients.
California's legislation regarding insurers providing interpreters for their patients went into effect several months ago for HMOs. On April 1, it also went into effect for PPOs. Top
Due to the screw-up by a Las Vegas ASC in not washing their endoscopy instruments correctly the Nevada legislature is again considering raising the cap on med mal claims. The shill that wants the cap states that larger awards would stop a physician from practicing. It would not. The Medical Board has control not the trial lawyers. The people infected with Hepatitis C want the cap raised above the now $350,000 for gross negligence. The other side pointed out to the legislators that they put the cap on six years ago to stop the physicians from leaving the state and it worked. Top
The Medical Board of California is planning on voting to make all physicians with waiting rooms place a sign up with the name and contact information of the Medical Board in case someone wants to make a complaint. The law is the Medical Board is supposed to do it but they are passing the buck to the physicians. Those physicians such as pathologists without waiting rooms will need to send the information in their bills. I am very happy I retired from medicine years ago. Top
DISCLAIMER: Although this
article is updated periodically, it reflects the author's point of view at the
time of publication. Nothing in this article constitutes legal advice. Readers
should consult with their own legal counsel before acting on any of the