News in brief - Feb. 17, 2003

Medicare tells carriers to change claims payment rates in July - CMS awards contract to upgrade claims-processing technology - Blues assail association health plans - Voters want health reform details from presidential candidates

Medicare tells carriers to change claims payment rates in July

Medicare carriers have been instructed to adjust payments in July for any claims with dates of service in January or February but processed after March 1. Payment rates to physicians are scheduled to be cut 4.4% on March 1.

Claims that are processed before March 1 will be paid at the higher, 2002 levels. Claims processed after March 1 will be paid at the lower, 2003 rates. In July, carriers will have to adjust claims from January and February that they processed during March, April, May and June to the 2002 levels and pay any applicable interest.

Claims from January and February processed after July 1 must be paid at the 2002 rate.

Physicians and other practitioners billing under the fee schedule will not need to take any further action to receive the adjusted payments from carriers.

Legislation before Congress would freeze physician payments at 2002 rates and, and if passed in time, eliminate the need for carriers to later adjust rates.

CMS awards contract to upgrade claims-processing technology

The Centers for Medicare & Medicaid Services awarded a five-year, $50 million contract to deNovis, a developer of transaction-processing technologies, to assist in redesigning a core Medicare processing system. The system modernization is aimed at improving the accuracy, efficiency and simplicity of claims processing.

The initiative is expected to save the program millions of dollars through increased automation, improved accuracy, and enhanced capture of fraud and abuse data. The new system will expand the use of the Internet for self-service functions and will use a simplified approach to reprogramming to ease changes to the system as new regulations are adopted.

"We need to take a quantum leap to improve administrative efficiencies and user-friendliness," said CMS Chief Operating Officer Ruben King-Shaw Jr. "The goal was to find breakthrough technology that could handle Medicaid and Medicare's complex rules, yet be easy to use."

Blues assail association health plans

Federal legislation to allow associations to create health plans could undermine state consumer protections, according to a report by the Blue Cross and Blue Shield Assn. Examples of state laws that could be avoided by such plans include those guaranteeing patients' access to external reviews when claims are denied; mandating certain benefits, such as mental health coverage; and requiring health plans to promptly pay physicians, the BCBSA said.

A copy of the report, in pdf, can be found online bcbshealthissues.com/relatives/20424.pdf (http://bcbshealthissues.com/relatives/20424.pdf).

Voters want health reform details from presidential candidates

Polls released by the managed care community show that an overwhelming majority of likely voters in New Hampshire and Iowa expect 2004 presidential candidates to disclose their health care proposals' cost and impact on the uninsured. The surveys conducted for the American Assn. of Health Plans indicate that voters in these two early primary states are skeptical of candidates who fail to address the issues of health care access, affordability, choice and quality.