News in brief - Oct. 13, 2003

Health plans weigh in on HIPAA compliance - AAHP, HIAA may unify - FTC files complaint against Texas doctor group

Health plans weigh in on HIPAA compliance

A recent letter from the American Assn. of Health Plans explains that the group recognizes that there will be physicians and others who are not ready for the Oct. 16 switch to new electronic transaction standards mandated by the Health Insurance Portability and Accountability Act.

However, the group stated that managed care companies will not be taking a uniform approach to dealing with noncompliance.

Several physician groups have suggested that payers should continue to accept the electronic claims they are now receiving until practices can complete the process of adapting to the standard. That is one option, AAHP President Karen Ignagni acknowledged in her letter.

"I would also point out that, in many cases, a health plan may have several different 'contingency plans' that are dependent on the specific needs of a particular business partner, and it may not be appropriate to share such information publicly," she wrote.

AAHP, HIAA may unify

The American Assn. of Health Plans and the Health Insurance Assn. of America are expected to merge this month after their member plans vote on the arrangement.

The boards of directors of the two advocacy groups voted to pool their 1,400 members and $9.3 million lobbying budgets. The groups' members provide coverage to more than 200 million Americans.

The unified organization would be called AAHP/HIAA until the new board could come up with another name.

The new group's agenda is not expected to change much from the current focus of both groups on maintaining the role of managed care in Medicare, promoting access initiatives for the uninsured and opposing state coverage mandates.

"In unison, we can make a greater contribution to the nation's efforts to improve quality, moderate costs, promote access, and offer choice in health care," said AAHP Chair William T. McCallum.

FTC files complaint against Texas doctor group

The Federal Trade Commission in September issued an administrative complaint against a 551-physician group in Texas, alleging that the doctors were involved in price-fixing while negotiating health plan contracts.

The FTC alleges that North Texas Specialty Physicians negotiated agreements among its participating physicians on price and other terms, refused to deal with payers except on collectively agreed-upon terms and refused to submit payer offers to participating physicians unless the terms met the group's minimum-fee standards.

NTSP says that its physicians' reimbursement rates have not been increased since the group formed in 1997. In a statement, the group stated that it regrets the FTC's decision to go forward with a complaint.

"We must defend our right to refuse being a party to someone else's contract," the physician group said. "Specifically, we cannot agree to be a party to an HMO or health insurance contract that we believe may not be compliant with Texas patient protection laws passed by the Texas Legislature in the mid and late 1990s. ... Our patients, doctors and others would be ill-served if we departed from the position we have taken."