Reimbursement Roundup
Reimbursement Roundup
IL physicians want negotiating power
Rather than wait for Congress to act, Illinois doctors are pushing for a controversial state law exempting them from federal antitrust prohibitions preventing individual physicians from joining to bargain with managed care plans. To date, Texas is the only state that allows collective bargaining between HMOs and individual practices.
"Doctors need to be a part of the negotiating process, not only to talk about fees, but to talk about what kind of services and procedures are covered and what kind of access their patients would have to health care in the future," says Clair Callan, MD, president of the Illinois State Medical Society in Chicago.
Enabling legislation before the Illinois state legislature faces opposition from the Illinois Chamber of Commerce, the Illinois Association of HMOs, and the consumer group Illinois Cam paign for Better Health Care. "We totally understand the doctors’ desire to try to leverage phy - sicians’ collective bargaining power against the insurance industry, but exempting them from antitrust issues would be more like creating a health care cartel like OPEC than a labor union," says Jim Duffett, executive director of the Illinois Campaign for Better Health Care.
Aetna sued over claims
Georgia physicians and the American Medical Association have filed a lawsuit in Atlanta’s Fulton County Superior Court charging against Aetna U.S. Healthcare with routinely and willfully delaying payments of medical claims in order to increase its profit levels.
The Feb. 21 lawsuit asks for compensation for unpaid claims, plus 18% interest on any claims not paid in a timely manner. Physicians also want an injunction preventing Aetna from continuing to delay clean claim payments. "It’s time to expose Aetna’s harmful practices," says Paul Shanor, executive director of the Medical Association of Georgia. "Through this lawsuit, we hope Aetna and other insurance companies understand that physicians are no longer willing to accept harmful business practices."
Under Georgia’s prompt-payment law, insurers must pay a medical claim within 15 working days of receipt or notify providers why it has not been paid.
OH ponders faster-pay law
Backed by the Ohio State Medical Association (OMA), legislation has been introduced in the Ohio house that would force health plans to reconcile and pay medical claims more quickly.
The OMA says 42% of health plan claims are not paid within the 24-day period mandated by state law. HMOs also fail about half the time to notify physicians about claims problems within the 24-day time period. Insurers counter that the main reason claims do not get paid faster is that practices often fail to file fully completed forms. Plans also contend that more doctors would get paid faster if they filed claims electronically. Overall, only about 40% of physicians in heavily populated northern and central Ohio submit claims electronically. Of those, the OMA’s study shows 85% of the electronic claims are paid within 30 days.
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