MSSNY eNews: September 10, 2021 – MSSNY Calls on Administration to Simplify COVID-19 Vaccination Process for Physicians
Join us for MSSNY’s Virtual HOD next Saturday, September 18
I am looking forward to vigorous debate with my physician colleagues from every corner of our state at MSSNY’s 2021 House of Delegates virtual meeting on September 18—just a week away!
While only credentialed Delegates can participate in the actual discussions, I hope you’ll join us on YouTube to watch the proceedings live as we engage in what promises to be robust debate on issues ranging from increasing the physician workforce in New York State to eliminating health disparities in New York City, and from hospital closures in vulnerable neighborhoods to requiring physician participation in the planning and development of Accredited Continuing Education for Physicians. See the article below in eNews or click here for a full listing of the 2021 HOD resolutions.
Visit the www.mssny.org home page and click on the YouTube link at any time during the proceedings on Saturday September 18 from 8 am-6 pm.
And remember to register for our virtual CME events that will take place on Friday, September 17:
And, finally, I want to again thank our HOD Speaker Dr. Bill Latreille, Vice Speaker Dr. Maria Basile, and our MSSNY staff for their hard work in putting together the HOD and transitioning to a virtual meeting.
Joseph Sellers, MD, FAAP, FACP
MSSNY Calls on Biden Administration to Simplify COVID-19 Vaccination Process for Physicians
The following statement was sent to the press on September 10:
Statement Attributable to:
Joseph R. Sellers, MD, FAAP, FACP
President, Medical Society of the State of New York
“MSSNY fully supports and encourages the significant efforts laid out by President Biden to get the COVID-19 pandemic under control. As the spread of the Delta variant increases and the number of related hospitalizations and deaths rise, we need aggressive measures to stop the spread.
“We are especially encouraged by President Biden’s acknowledgement of the important role physicians play in the effort to convince their unvaccinated patients to get the shot. At the same time, we urge the Administration to engage in efforts to help make it easier for physicians to give the shots in their offices, including facilitating the availability of smaller dose vials, encouraging state governments to reduce excessive reporting requirements, and other steps that will further enable community-based physicians to vaccinate their patients during their visits.”
State of Politics Covers MSSNY Statement on Administration’s COVID-19 Plan
Today, NY State of Politics featured an article on MSSNY’s statement regarding President Biden’s COVID-19 plan:
A New York doctors organization on Friday applauded the expanded efforts to increase the vaccination rate by President Joe Biden’s administration.
But at the same time, the Medical Society of the State of New York (MSSNY) also called on the federal government to make it easier for individual physicians to administer COVID-19 vaccinations in their offices.
The effort to expand vaccinations around the country and in New York comes after a summertime spike in COVID-19 cases and a rise in hospitalizations, the vast majority of which were among unvaccinated people. In New York, serious COVID-19 cases that require hospitalizations account for only 0.04% of the vaccinated population, Gov. Kathy Hochul said this week.
“MSSNY fully supports and encourages the significant efforts laid out by President Biden to get the COVID-19 pandemic under control. As the spread of the Delta variant increases and the number of related hospitalizations and deaths rise, we need aggressive measures to stop the spread,” said the group’s president, Joseph Sellers.
Biden’s administration is requiring all federal workers to be vaccinated and is calling on companies with more than 100 workers to require vaccinations as well. Still, Sellers said more can be done to encourage vaccinations, including provisions that would enable doctors in private practice to administer the vaccine.
“We are especially encouraged by President Biden’s acknowledgement of the important role physicians play in the effort to convince their unvaccinated patients to get the shot,” Sellers said. “At the same time, we urge the Administration to engage in efforts to help make it easier for physicians to give the shots in their offices, including facilitating the availability of smaller dose vials, encouraging state governments to reduce excessive reporting requirements, and other steps that will further enable community-based physicians to vaccinate their patients during their visits.”
United Agrees to Give Physicians ERISA Rights in Connection with Repayment Demands
The AMA sent a note to state medical societies across the country regarding a recent class action settlement that gives all out-of-network (“ONET”) physicians important – and often overlooked – rights under the Employee Retirement Income Security Act of 1974 (“ERISA”) in connection with repayment demands.
After paying claims submitted by ONET physicians, United sometimes determined that it overpaid a claim and sent the physician a repayment demand (“Repayment Demand”). Plaintiffs alleged that United failed to provide notice and appeal rights required by ERISA in connection with Repayment Demands. The class did not seek the payment of any money but sought to require United to provide ERISA notice and appeal rights to ONET physicians (and allied health care professionals) in connection with past and future Repayment Demands.
The class, made up of about 50,000 ONET physicians, includes those that: (1) received a Repayment Demand any time after January 24, 2005; and (2) where one such Repayment Demand was not fully resolved by payment, offset, or otherwise, as of June 2, 2021.
How does the settlement benefit Federation of Medicine members?
- For Repayment Demands issued in the 12 months prior to June 2, 2021, United is required to: (a) provide a spreadsheet to each class member containing information about each of those demands; and (b) automatically treat such class member as their patients’ Authorized Representative under ERISA for purposes of those demands.
- For New Repayment Demands issued by United’s UNET claim processing system, United is required to treat an ONET provider as an Authorized Representative under ERISA so long as the provider gives United: (a) an executed Authorized Representative Designation form (United’s website contains such a form) or (b) an executed Assignment of Benefits form that purports to “assign,” “convey,” or “transfer” to a provider any “right,” “claim,” “cause of action,” or “chose in action” with respect to the plan beneficiary’s or plan participants’ plan or insurance policy (regardless of whether that form is an effective assignment of benefits).
- If an ONET provider submits either of these forms to United in connection with a New Repayment Demand issued by the UNET system, United must give that provider ERISA rights as an Authorized Representative.
Why is this important to Federation of Medicine members?
ERISA provides insured patients with a powerful set of legal rights to protect them from errors and other misconduct by those that administer their healthcare plan (in this case, United). What is often overlooked is that a physician can also take advantage of many of these rights if the physician is designated as their patient’s Authorized Representative under ERISA. An Authorized Representative is a person entitled to act on behalf of a plan participant for purposes of ERISA.
This settlement makes it much easier for a physician who receives a Repayment Demand to be deemed by United to be an Authorized Representative, which means that the physician can “step into the shoes” of the patient and exercise the patient’s legal rights under ERISA. This includes the right to obtain detailed information about the written plan terms that purportedly support the Repayment Demand and United’s rationale, as well as the right to pursue an appeal to further understand and challenge that determination. These rights are designed to put the burden on United to show why, under the written terms of the patient’s plan, a Repayment Demand is reasonable. Although United allows ONET providers to file “Claim Reconsideration Requests” or “Appeals,” those procedures are not subject to ERISA’s requirements. As a result, even physicians who take these steps often lack the information necessary to determine if a Repayment Demand is reasonable. With this settlement, physicians have a much clearer path to obtaining the substantive information that ERISA promises, which will make their appeals more informed and effective.
In other words, if one of your members wants to know what to do if United sends them a New Repayment Demand, and the member’s patient executed an Authorized Representative Designation or an assignment, the member has the option of responding in effect – “I dispute your claim. If you intend to pursue this further, I insist that you give me all of my patient’s rights ERISA and prove it in an ERISA hearing.”
Have questions or looking for more information?
For more information or questions related to the above, please contact Diana Huang (firstname.lastname@example.org).
 Integrated Orthopedics v. UnitedHealth Group, No. 11-425 (D.N.J)
HHS Announces Additional Funding for Lost Revenue Arising from Pandemic
Today, the US Department of Health and Human Services (HHS) announced $25.5 billion in new COVID-19 provider funding. The funding includes $8.5 billion in American Rescue Plan (ARP) resources for providers who serve rural Medicaid, Children’s Health Insurance Program (CHIP), or Medicare patients, and an additional $17 billion for Provider Relief Fund (PRF) Phase 4 for a broad range of providers who can document revenue loss and expenses associated with the pandemic.
HHS Secretary Xavier Becerra stated, “The funding will be distributed with an eye towards equity, to ensure providers who serve our most vulnerable communities will receive the support they need.” HHS stated that “consistent with the requirements included in the Coronavirus Response and Relief Supplemental Appropriations Act of 2020, PRF Phase 4 payments will be based on providers’ lost revenues and expenditures between July 1, 2020, and March 31, 2021.”
HHS has released payment calculation methodology for Provider Relief Fund Phase 3 that can be found here. HHS also announced today a final 60-day grace period to help providers come into compliance with their PRF Reporting requirements if they fail to meet the deadline on September 30, 2021, for the first PRF Reporting Time Period.
Please Urge Governor to Veto Multiple Pro-Trial Lawyer Tactical Bills
Physicians are urged to contact Governor Hochul’s office to urge her to veto multiple problematic pro-trial lawyer bills passed at the end of the Legislative Session. If signed, these bills could have the effect of significantly disadvantaging defendants generally in litigation in New York State (including physicians and hospitals) defending against malpractice claims. While these bills do not have the same gargantuan premium impact as other legislation sought by the trial bar that would expand lawsuits and awards against physicians, they would continue to make New York’s already dysfunctional medical liability adjudication system even more unbalanced and add to New York’s notorious outlier status with regard to medical liability payouts. These bills include:
- A2199/S473 – Expanding the time period for the imposition of New York’s excessive 9% judgment interest in cases where a plaintiff’s request for summary judgment was not initially granted, but then overturned on appeal.
- A8040/S7093 – Changing a long-standing rule that heretofore excluded a “hearsay” statement made by a defendant’s employee.
- A8041/S7052 – Imposing excessive insurance disclosure requirements on defendants during litigation.
2021 House of Delegates Resolutions
Following is a complete list of the 2021 House of Delegates Resolutions:
50 Physician-driven Medical Assistant Specialty Training in the Office Setting
51 Uniform Standard of Care in Liability Cases
52 Hospital Closures in Vulnerable Neighborhoods in NYS
53 Patient Protection from Insurance Company Contract Disputes
54 Site of Service Availability
55 Enforcement of Administrative Simplification Requirements
56 We’re Mad as Hell and We’re Not Going to Take it Any More
57 Prioritizing People First – Upholding our Oath & Code of Conduct by Endorsing the Improved and Enhanced Medicare for All Act
58 Prioritizing People First -Upholding our Oath & Code of Conduct by Endorsing the NY Health Act
101 Fifteen Month Lab Standing Orders
102 Increasing the Physician Workforce in New York State
103 Optimizing the Online SNAP to Advance Health Equity
104 COVID-Related Mental Health Coverage
105 Reciprocal Telehealth Agreements
106 Medicare Advantage Plan Mandate
150 Electric Scooters
151 Requiring Physician Participation in the Planning and Development of Accredited Continuing Education for Physicians
152 Fifteen Month Prescribing
153 Require Methadone Dispensers to report to I STOP – PMP
154 Nursing Home Medical Directors Registry
155 Physician Burnout
156 Eliminating Health Disparities in New York City
157 Support Physicians Providing Gender Affirming Care for Youth
200 September 11 as a National Holiday
201 UN International Radionuclide Therapy Day Recognition
202 IMG Membership
203 Physician-Scientist Committee
204 Promotional Period for Membership (“18 months for 12 months”)
205 MSSNY Membership Dues Multiyear Discount Program and Other Innovative Membership Levels
250 Insurance Coverage for Cooling – Cold Cap – Therapy
251 Prohibition of Insurer Processing Fee on Claims
252 Third-Party Insurer Abuse of Modifier 25 Policy
253 Compensation for Appealing Denials to Insurance Companies
254 CPT Denials- Service- Preauthorization Denials
255 Prior Authorization – CPT Codes for Fair Compensation
256 Improving Workman Compensation MTG Compliance by Insurers
Interested in Learning How to Become a Political Strategist? Register for AMPAC Campaign School
Recognized as one of the top training programs in the country, AMPAC Campaign School will mold you into a winning political strategist and help you elect friends of medicine. The Campaign School is renowned for its use of a simulated campaign for the U.S. House of Representatives, complete with demographics, voting statistics and candidate biographies and much more.
To provide the same high-quality content of the in-person program, the Virtual Campaign School will be conducted over the course of two consecutive weekends: December 4-5 and 11-12, 2021.
Both weekends are part of the full program and must be attended by participants. This includes a two-hour virtual welcome reception tentatively scheduled for the evening of Wednesday, December 1 and each Saturday and Sunday session will run from 10:00 am – 4:00 pm ET.
To help participants prepare for the virtual program in December, AMPAC has developed a set of online tools, to be completed before the main program begins. These include the Campaign School simulation and workbooks which you will receive shortly after you register. This “pre-school” work will require 8-10 hours of online study over the course of the two months leading up to the program.
Virtual attendees may include physicians, spouses of physicians, residents, medical students and state medical society staff interested in becoming more involved in politics. Past participants ranged from those attracted to grassroots efforts to those considering becoming a candidate for public office. No matter where you are in the process, you will develop a new understanding of how campaigns are run. As a graduate of the AMPAC program, candidates will rely on you to give them advice on strategy, message and campaign plans.
Note: Registration fee is $350 for AMA Member/$1000 for non-AMA members. This fee is waived for AMA residents and students; however, space is limited and the AMPAC Board will review and select four participants from the pool of qualified resident and student applicants.
Registration for the Virtual Campaign School is now open. Space is limited and deadline to register is October 13, 2021.
For questions or more information please contact: email@example.com.
Calling All Physician New York Yankees Fans!
Join your fellow healthcare professionals and the New York Yankees for a fun-filled night at Yankee Stadium for the October 1st game as the Yankees take on the Tampa Bay Rays. The first 1,000 healthcare professionals who purchase through this link will receive a special New York Yankees scrub top. Scrub sizes are not guaranteed and are first come, first served.
Offer expires: September 30, 2021
Once inside the Stadium and prior to the start of the 4th inning, please head over to the scrub redemption table located on the Field Level (100 level) next to Gate 2.
Offer valid for select, non-premium seating areas. Offer is for a limited time only, subject to availability, has no cash value, is not valid on previously purchased tickets, and is not good in conjunction with any other promotional offer.
Please note that all sales are final and there are no refunds or cancellations.
When purchasing tickets or ticket plans on yankees.com and associated websites, you are limited to a specified number of tickets or ticket plans for each event (also known as a “ticket limit”). The Yankees reserve the right to cancel any or all orders and tickets/ticket plans without notice to you if you exceed the posted limits. This includes orders associated with the same name, e-mail address, billing address, credit card number or other information.
Physicians’ search services • allied medical placements • locum tenens • practice valuation • practice brokerage • practice consulting • real estate
FOR SALE: Established Concierge Internal Medicine Practice. Southern Florida
Opportunity available at an established rheumatology practice in Great Neck, NY. Looking for a dedicated physician to join, share or merge practices. Fully equipped office with onsite parking and proximity to mass transit. Contact 516-972-2986 for more info.
Health Research, Inc. (HRI) has a job opening within the AIDS Institute’s Office of the Medical Director for a Public Health Physician II. Please distribute this announcement widely through your networks. Interested individuals can apply for this position through the HRI website.
79th St near Lexington / Park. 750 sq Ft beautiful, street entrance, medical office for sale with a 25 + yr internal medical practice for sale. Office is in move in condition. Physician retiring. Waiting room. Secretarial area for 3. 1 Consult room. 2 exam Rooms 2 Toilets. Please contact: 917-770-8700 / email firstname.lastname@example.org