MSSNY eNews: February 9, 2022 – Empire Plan Drastically Cutting Some Payments

NYS Empire Plan Drastically Cutting Some Payments
MSSNY has received very concerning reports from some practices (primarily anesthesiologists) regarding the New York State Empire Plan drastically cutting payments since January 1 for out-of-network care delivered to state employee patients at in-network hospitals.

This is likely the result of a health plan taking advantage of the implementation of the federal No Surprises Act enacted by Congress that took effect 1/1/22.  Of further concern is that we have been advised that in some cases practices are being informed they must wait 30 days to seek relief through New York’s Independent Dispute Resolution (IDR) process to appeal these low payments.  Staff at the New York Department of Financial Services (DFS) has confirmed that statement is incorrect, in that New York law enables a physician to immediately bring a payment dispute with a health plan to IDR.

Bring a dispute to New York’s IDR process here.

Physicians should continue to provide examples of these tactics to MSSNY staff, which will assist in our advocacy efforts with various government officials.  MSSNY has raised concerns to DFS that this tactic being used by the Empire Plan is going to result in unnecessary delays to the IDR process.

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 | hlopez@mssny.org

The Physicians Foundation’s Fellowship Program Announces Call for Applicants
The Physicians Foundation today opened a Call for Applicants for its Fellowship Program, which advances physicians’ leadership skills to strengthen the physician-patient relationship, support medical practices’ sustainability and navigate the changing health care system. The Fellowship Program is open to physicians who are new or mid-career in their practice, and have experience with or interest in addressing social drivers of health (SDOH), improving physician wellbeing and lifting physician perspectives in health policy discussions. Applications are due Friday, March 25, 2022.

The Fellowship Program provides physician participants with the tools and knowledge necessary to improve practice environments and fulfillment within the profession. The Program offers physicians the opportunity to:

• Expand leadership skills to be equipped to address barriers to physician wellbeing, improve practice environments and build understanding of SDOH implications for patients and physicians;
• Contribute to the research, education and innovative grant making happening nationally that seeks to shape the future of health care;
• Connect and learn from SDOH experts and leaders through mentorship opportunities;
• Share perspectives in the ongoing media and policy discourse on how to improve health care delivery; and
• Advance research on the SDOH and their impact on all aspects of the health care environment.

The Fellowship Program will last for 12-months beginning July 1, 2022 through June 30, 2023, and participating fellows will receive a stipend of $24,000 as well as reimbursement for program related travel and lodging expenses. This fellowship requires approximately 10 to 15 hours monthly for project development and implementation, along with external thought leadership activities. Interested physicians must submit an application with a current resume/CV, two letters of recommendation, one of which is recommended to be from their state or county medical society, and a statement of intent that briefly describes how participation in the Fellowship Program will prepare you to make positive, constructive contributions to the medical profession.

The Decline of Independent Practice: Wall Street Journal Publishes Opinion Piece by MSSNY Member
In an opinion piece in the Wall Street Journal, MSSNY member Dr. Michael Goldstein writes the following:

Federal No Surprises Act – One Month In: What Have We Learned? What Questions Remain?
Garfunkel Wild’s February 1, 2022 webinar, “Federal No Surprises Act – One Month In: What Have We Learned? What Questions Remain?” is now available for those that were unable to attend the live webinar. The presentation to available to download here. You can also listen to and view the full webinar on Garfunkel Wild’s YouTube channel here.

For more information, access the detailed CMS explanation of how the QPA is to be calculated and access the Federal IDR Initiation Form.

Updated Return-to-Work Protocols for Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2
The NYS Department of Health (NYSDOH) released updated guidance on return-to-work protocols for healthcare personnel, which supersedes the January 4, 2022 return-to-work guidance. Updated CDC guidance will be reviewed by NYSDOH as it is released and additional requirements may be added.

OnBoard Update from WC Board
Last week, we reported details regarding OnBoard, the Workers’ Compensation Board’s new online business information system. It will eventually replace the Board’s legacy paper-based claims systems and the eCase system with a single, web-based platform, providing stakeholders with increased accuracy, paperless transactions and a user-friendly interface for interacting with the Board.

The GovDelivery notification provides additional OnBoard information, training webpages and webinar training links. As a reminder, OnBoard: Limited Release, the first phase of OnBoard, will be implemented on March 7, 2022.

For more details, please visit the OnBoard project website and refer to the frequently asked questions and project resources, which includes stakeholder-specific fact sheets, FAQs, and recorded webinars. To have project updates and webinar information sent directly to you, please subscribe for emailed updates.

Classified Ads Available for:

Physicians’ search services • allied medical placements • locum tenens • practice valuation • practice brokerage • practice consulting • real estate

For help, information or to place your ad, call Roseann Raia at 516-488-6100
ext. 302

For the MSSNY 2022 Ad Rate Sheet, please click here.