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Hot issues
NCOIL model act paves the way for favorable state regulation of the rental network PPO market
In most states, physicians have little control over how their managed care contracts are marketed, leaving them vulnerable to illegitimate discounts in payments for their services. As a result of the AMA's Advocacy Resource Center efforts, that could all change.
As part of an ongoing advocacy campaign to promote fair physician contracting and payment practices, the AMA has been encouraging the National Conference of Insurance Legislators (NCOIL), which consists of lead state legislators who handle insurance issues, to adopt model legislation to regulate the rental network PPO market. After three years of advocacy, on November 23, NCOIL adopted the Rental Network Contract Arrangements Model Act. This model act will enable physicians to identify illegitimate discounts and will authorize them to deny their discounts to noncomplying entities.
The AMA successfully argued that all entities engaged in leasing physician discounts in the commercial health insurance market must be held accountable to the act, despite the American Association of Preferred Provider Organizations and America’s Health Insurance Plans’ lobbying for exemption of certain key entities.
Ohio, Colorado, Connecticut, Indiana and Florida adopted laws to regulate the rental network PPO market in 2007 and 2008, and several other states are presently considering legislation in this area. NCOIL’s adoption of this model act should increase the likelihood that additional states will be receptive to legislative initiatives to increase the transparency and fairness of rental network PPO activity.
Visit NCOIL's Web site at www.ncoil.org to view its statement on the model act.
BCBS settlement facilitator named
On September 8, 2008, the appointment of Deborah J. Winegard as the Class Compliance Dispute Facilitator (CDF) for the Blue Cross Blue Shield (BCBS) settlement was announced. Find out how to file a compliance dispute.
Payer Web sites: Contracted fees and payer payment policies
Visit payer Web sites to access payment polices, contracted fee schedules and claim edits available to physicians.
Alert: The Aetna settlement expired June 2, 2008. Read Aetna's press release regarding the expiration and its Guiding Principles for Physician Relations.
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New AMA resource: Save money with credit card payments—shop around
One of the best ways to ensure receipt of your patients’ payment responsibility is to offer the option of credit and debit card transactions. Learn how to maximize the benefits of accepting credit and debit card payments by contracting with a payment processor that suits your practice’s specific needs and by recognizing how you can save on fees with your current processor. The AMA's Practice Management Center has developed the educational resource, “Shopping for a credit or debit card merchant agreement: Guidelines for physicians,” (PDF, 107KB) to help you improve your practice’s bottom line.
Defensible Fee Schedule Toolkit
Blue Cross Blue Shield (BCBS) Settlement
Find out how the BCBS Settlement helps your practice and find out which BCBS plans and subsidiaries in your state have settled.
Join the campaign
November is Heal that claim month. Review and reconcile your claims, and join physician practices around the country in the AMA's campaign to cure the claims process. Keep checking back as we will have continous updates.
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