MSSNY eNews: December 22, 2021
THIS IS THE LAST ENEWS PUBLICATION BEFORE THE HOLIDAY.
WE WILL RETURN ON WEDNESDAY, JANUARY 5.
COVID-Related Stress and Work Intentions in a Sample of U.S. Health Care Workers
A new Mayo Clinic Proceedings article led by the American Medical Association explores the relationship between COVID-related stress and work intentions of U.S. health care workers. The article found that physicians, nurses, and advanced practice providers are at the highest risk of reducing clinical work hours or leaving their practice, with one in five physicians and two in five nurses intending to leave their practice altogether.
Factors associated with a greater intention to reduce work hours or leave a practice include higher levels of burnout, stress, workload, fear of infection, anxiety or depression due to COVID-19, and the number of years in practice. The article concluded that organizations should implement measures to enhance health care workers’ sense of value, create supportive environments, and reduce work overload through better teamwork to reduce stress and prevent turnover.
Federal Law Restricting Patient Surprise Bills Takes Effect January 1:
As reported in recent MSSNY eNews articles, the New York Department of Financial Services has issued a lengthy advisory letter detailing how it intends to reconcile potentially conflicting provisions between the federal No Surprises Act that takes effect January 1, and New York’s surprise bill law provisions. The letter discusses that New York’s law will now:
- Ensure that that the provisions of New York’s surprise bill law will apply to all out of network providers, not just hospitals and physicians;
- Clarify that the “visit” subject to patient protection under New York’s surprise bill law includes: equipment and devices, telemedicine services, imaging services, laboratory services, preoperative and postoperative services, and other such services as HHS may specify;
- Clarify that New York’s surprise bill law applies to all safety net hospitals;
- Clarify that previously exempted CPT codes 99281 – 99285, 99288, 99291 – 99292, 99217 – 99220, 99224 – 99226, and 99234 – 99236 are no longer exempted from NY’s surprise bill law;
- Clarify that the insured’s cost-sharing will be calculated based upon the health insurer’s initial payment amount to the physician, hospital or other care provider
- Clarify that patients cannot be asked to waive protections for both emergency and surprise out of network bills
- Clarify that, even if a patient does not sign an assignment of benefits form, upon receipt of a claim from a provider for a surprise bill or for emergency services, an issuer must send the initial payment or notice of denial of the payment directly to the provider
- Remind health care providers of the federal NSA requirement to post on their website and in their practice location a New York-specific model form advising their insured patients of their legal protections against surprise medical bills.
This is just one of numerous federal patient protections that will become effective on January 1. Litigation has been filed by various medical and hospital associations against one aspect of the federal No Surprises Act relative to the consideration of various data points during an independent dispute resolution between an out of network health care provider and health insurer.
MSSNY’s General Counsel, Garfunkel Wild, P.C., has announced the creation of a Federal Surprise Bill Working Group that has developed a particular level of expertise in addressing client questions about the new Federal No Surprises Act law.
Governor to Sign Legislation to Limit Formulary Adjustments
Governor Hochul will be signing into law legislation (S.4111, Breslin/A.4668, People-Stokes) advocated for by MSSNY and several other patient advocacy groups that will greatly limit the ability of health insurers to implement prescription formulary changes or cost-sharing tier changes for medications during the middle of a policy year. Based upon some technical amendments agreed to by the State Legislature, the law will take effect for policy years that begin January 1, 2023 and after.
We thank the many physicians who took the time to send a letter to Governor Hochul urging her to sign this bill into law. Still pending before Governor Hochul is legislation also supported by MSSNY that would regulate the practices of Pharmaceutical Benefit Managers (PBMs).
Governor Hochul has signed into law another bill (A.1677, Gottfried/S.2008, Jackson) supported by MSSNY that requires health insurers to provide greater details to a physician or hospital when a claim has been partially approved, as opposed to being denied.
UnitedHealthcare Offers New Process to Expedite Claims
UnitedHealthcare is now offering a new process to better serve care providers in a more responsive and efficient way. It will expedite both the handling and accuracy of claims. They now have a dedicated team of individuals that includes claims processors assigned to handle all open claims issues.
With this new process, your unresolved claims issues will be quickly resolved by a dedicated and experienced claims reviewer who will respond with the resolution or a status usually within 2 days. When you have a claims question or dispute that was not resolved to your satisfaction through the service model (e.g., LINK reconsideration, call center or appeal) you now can utilize their dedicated team to handle your escalated issues by sending an email to NewYork_PR_Team@uhc.com. By sending issues as soon as they are identified, your issues will be resolved without further delay.
If you have questions about this or any other insurance concern, contact MSSNY’s Director of Physician Payment and Practice, Heather Lopez, at 518.465.8085 X332 | firstname.lastname@example.org.
Mark Your Calendars: MSSNY’s Virtual Lobby Day is on March 8th
Please plan to put aside Tuesday, March 8th for MSSNY’s Annual Physician Advocacy Day. To view the flyer, click here: MSSNY 2022 Lobby Day. To register, click here: Physician Advocacy Registration
The format will be similar to previous years, where assembled physicians and allies will hear from legislative leaders in the morning (via Zoom), and then have virtual visits with their respective legislators in the afternoon (coordinated by their county medical societies).
With COVID cases on the rise across NYS, we will be advocating for policies that encourage vaccination and support fair payment for telehealth care. We will also advocate for proposals that reduce prior authorization hassles. At the same time, we will voice our opposition to policies that would inappropriately expand the scope of practice for non-physicians and mandate how physicians provide care to their patients.
New CPT Modifier 93: Audio-Only Services
At the September 2021 CPT Editorial Panel Meeting, a new Modifier was accepted to describe real-time telemedicine services between a patient and a physician or other qualified health care professional rendered via audio-only. This new modifier is effective January 1, 2022.
Modifier 93 – Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System:
Synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located away at a distant site from the physician or other qualified health care professional. The totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction.
The official release information can be found on the AMA website.
AMA Updated Specialty Impact Analysis
The American Medical Association’s updated specialty impact analysis factors in the Protecting Medicare & American Farmers from Sequester Cuts Act, which avoided a 4% statutory cut from the PAYGO provisions, extended the moratorium on the 2% Medicare payment sequester, and mitigated the 3.75% Medicare physician payment cut. Note, the analysis is focused on the impact at the beginning of the year.
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