MSSNY eNews: November 19, 2021 – 10 Key Provisions of No Surprises Act Implementation in NY
ENEWS WILL NOT BE PUBLISHED NEXT WEEK AND WILL RETURN ON
WEDNESDAY, DECEMBER 1.
MSSNY WISHES ALL OUR MEMBERS AND THEIR FAMILIES
A HAPPY AND HEALTHY THANKSGIVING!
A Grateful Thanksgiving
A National Day of Thanksgiving was proclaimed by President Lincoln in 1863 as our country was torn apart by civil war that threatened our nation’s survival. Next week we will once again celebrate a day of Thanksgiving, with our nation now confronting pandemic and civil strife. Despite all the negative chatter on broadcast and social media, I am optimistic for the future and have an abundance of blessings to be thankful for.
I am thankful for the medical students, residents, fellows, and young physicians who give me faith for the future of medicine.
I am thankful for science, monoclonal antibodies, vaccines, and PPE that give me hope for ending the pandemic.
I am thankful for physician colleagues, nurses, technicians, and therapists and so many support staff who have displayed courage in keeping our medical offices and hospitals open to care for our patients through almost two years of pandemic.
I am thankful for the dedicated MSSNY staff who work hard to support the medical profession and to help us to serve the patients of New York State, particularly during these challenging times.
I am thankful for all the MSSNY physician members and leaders who volunteer their time and talents in service to our communities.
I am thankful for my family and friends who support me, encourage me, and provide gentle correction when I need it.
Happy Thanksgiving to all.
MSSNY Testifies at Joint Assembly Committee Hearing on Impact of COVID-19 Pandemic on Delivery of Healthcare in New York State
Niraj Acharya, MD, Treasurer & Trustee of the Medical Society of County of Kings, Delegate to MSSNY’s House of Delegates (HOD), and a practicing Primary Care physician in Brooklyn, testified on behalf of MSSNY at a joint legislative hearing this week in New York City. The event was hosted by the chairs of the Assembly Health, Higher Education and Labor Committees and centered on how the COVID-19 pandemic has changed the delivery of health care services in New York State and the impact on various health care practitioners. Among the issues Dr. Archarya’s remarks focused on were the impact on the pandemic on physician wellness, promoting expansion of, and access to, care through Telehealth, and MSSNY’s strong concerns with the Governor’s Executive Orders waiving otherwise applicable collaboration and supervision requirements for various non-physician practitioners.
To view Dr. Acharya’s testimony, click here and move to the 46:00 mark.
The Committees’ goals for the hearing were many-fold with a heavy emphasis on examining lessons learned during the pandemic, including the appropriateness of Executive Orders issued by the Governor during the declared emergency period as it relates to access to health care, training requirements of health care workers and the status of the health care workforce, including rates of attrition, worker wellness, training and development programs, and the effect of telehealth on access to care for patients and providers.
MSSNY anticipates that many of the issues raised during the hearing will be part of existing or new legislation, as well as budget proposals for FY 2023 in the coming legislative session and we will continue to work key policymakers and provide updates as things go forward.
Implementation of the No Surprises Act in New York
While MSSNY continues to work with the AMA and the federation of medicine to raise strong concerns with one aspect of the implementation of the federal No Surprises Act (NSA) that relates to criteria to be considered in the surprise medical bill Independent Dispute Resolution proceeding (Nov. 19, 2021: National Advocacy Update | American Medical Association (ama-assn.org), there are many other very important “below the radar” provisions that will also be taking effect in 2022.
Recently, MSSNY staff participated in a meeting convened by various New York state agencies discussing integrating the provisions of the NSA into New York State law. Several key differences between the state and federal law were discussed that will likely need to be reconciled with New York’s law. These provisions include:
- Exempt CPT Codes. Claims for out of network emergency services for patients insured state-regulated plans with CPT codes exempted from New York’s law will likely need to be resolved through the federal IDR process unless these exemptions are deleted from New York’s statute.
- Assignment of Benefits (AOB). Federal law does not require an AOB from the patient to be protected from surprise out of network medical bills, while New York’s law requires an AOB for patient protection from surprise medical bills.
- Facility-Based Providers. Federal law for IDR covers facility-based provider services after an emergency room admission. New York State law only provides coverage for in-patient hospital services, not facility-based providers at those hospitals.
- Patient Cost-Sharing Limits. Federal law limits patient cost-sharing responsibility for surprise medical bills to the qualifying payment amount (QPA). New York does not have a similar provision.
- Continuity of Care-General. Federal law requiring 90-day continuity of care for patient care when a health care provider leaves a network requires that the health care provider to continue to accept the in-network rate. That is not required in the New York state law.
- Continuity of Care-Pregnancy. Federal law requiring 90-day continuity of care for health care providers who leave a network provides for continued coverage through the end of a pregnancy. New York state law requires continued coverage just through the 2d trimester.
- Updated Information for Directories. Federal law requires health care providers to provide necessary information to health insurers to have updated provider directory information. New York state law does not.
- Consequence of Faulty Directories. Federal law requires patients to be “held harmless” for out of network bills for reliance upon “faulty” provider directory information maintained by a health insurer. New York State law does not.
- Detailed Insurance ID Cards. Federal law requires more detailed information on patient insurance ID cards, including applicable deductibles and out of pocket maximums. New York law requires the ID card note whether plan is state-regulated, or ERISA regulated, but not deductible or maximum information.
- Good Faith Estimates. Federal law requires much more detailed information in a Good Faith estimate of anticipated charges to be provided to uninsured/self-pay patients than New York law requires.
Women Physicians Leadership Webinars Now Available Online
MSSNY Educational and Scientific Foundation (MESF) webinar series on leadership for women physicians is now available. Visit the MSSNY CME website to view the following three webinars:
- “Albany, Women Physicians and Their Legislative Impact”
- “How Do CEO’s and Medical Administrators Deal with Women Physicians”
- “Wellness and Women Physicians”
The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The Medical Society of the State of New York designates each enduring activity for a maximum of 3.0 AMA PRA Category 1 credits™. Physician should only claim credit commensurate with the extent of their participation in the activity.
MSSNY Legislator PodCast
Testimony, Medicare Changes & Prior Auth Items
5 Real Estate Considerations for Physicians Nearing Retirement
When retirement looms for physicians, it may be time to consider a reexamination of real estate holdings, depending on the circumstances, the American Medical Association reported Nov. 10.
Many older physicians may have invested in real estate throughout the years, whether in private practice space, a primary residence or a vacation home. Tal Frank, the president of PhysicianLoans, a specialized home loan provider, spoke to the AMA about how to navigate real estate when approaching retirement.
- Consider timing and value.
Mr. Frank advises real estate holders to carefully consider whether their property has reached peak appreciation. He also says that the current market offers an excellent opportunity for sellers.
- Plan ahead.
If physicians are planning to relocate and buy property in another location upon retirement, Mr. Frank recommends meeting with a real estate agent in the area in the three years prior to the move. That way, physicians can be protected from potential surprises.
- Decide whether to keep playing the game.
When winding down, getting cash and increasing investments may not be for everyone. Mr. Frank explains, “You earn it to use it, and many physicians have invested over the years to use their profit for their own benefit or enjoyment.”
- Do you want to keep being a landlord?
If retiring and relocating, consider whether you want to be an out-of-state landlord. Owning a commercial property may require more energy and time than anticipated, so consider selling it. If necessary, physicians can always lease back the property.
- Balance costs.
Mr. Frank recommends reassessing seriously how much money a property would give retiring physicians and balance that against the cost of upkeep and retaining the property.
–Gonzalez, Becker’s Hospital Review
Attention MSSNY Resident and Fellow Members
You were recently sent a survey asking for your input as to how MSSNY CAN HELP YOU…WE NEED YOUR FEEDBACK!
You are a significant part of MSSNY, and your input is important to us! Please check your e-mail and submit your responses. You can also click here to access the survey.
Contact Your Representatives of Congress to Prevent Staggering Medicare Cuts in 2022
With CMS recently announcing its final rule for the 2022 Medicare physician fee schedule, physicians are urged to contact their member of Congress to prevent payment cuts approaching 10%. Tell Congress to cancel Medicare cuts today!
Of significant consequence the 2022 Medicare conversion factor will be reduced by approximately 3.75% as a result of the expiration of an increase to the conversion factor enacted by Congress last December. In addition, there is a 2% cut as a result of the scheduled re-implementation of the previously delayed Medicare sequester provisions, and imposition of a 4% Statutory PAYGO sequester resulting from passage of the American Rescue Plan Act. Should lawmakers fail to act, it will result in a cumulative Medicare payment cut of nearly 10%.
Earlier this fall, Reps. Ami Bera, MD (D-CA) and Larry Bucshon, MD (R-IN) circulated a “Dear Colleague” letter highlighting the financial uncertainty within the Medicare payment system and the dangers facing patient care if Congress fails to enact legislation to prevent this staggering cut. Within a matter of weeks 245 of their colleagues showed their support for fixing the problem of these extreme Medicare cuts by co-signing the letter, including many of the members of the New York Congressional delegation.
The 2022 payment rule also finalized provisions that extend coverage of services that were added to the Medicare telehealth list on an interim basis in response to the COVID-19 public health emergency until the end of 2023 and eliminated geographic barriers, allowing patients in their homes to access telehealth services for diagnosis, evaluation, and treatment of mental health disorders. In addition, CMS announced plans to permanently increase payment for immunization administration, beyond COVID vaccines, and relied on information from the AMA and the RUC in developing the improved payment rates. CMS is also moving forward with the first round of seven MIPS Value Pathways (MVPs) that will be available, beginning with the 2023 performance year.
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For help, information or to place your ad, call Roseann Raia at 516-488-6100 ext. 302
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