MSSNY eNews: December 16, 2020 – Surprise Billing is Flat Out Give Away to Insurance Companies


From MSSNY Govt. Affairs: Please Contact Your Legislator!
Congress is at a critical tipping point on a number of issues as they try to finalize a year end spending package in the next 24 hours or so.  Among the proposals in the mix is a terrible federal “surprise bill” fix which would prohibit consideration of physician charge data in its IDR process to resolve insurer-out of network physician disputes, which would tilt the process enormously in favor of insurers and have a significant negative downstream effect on all participating physicians as well.  It appears to not pre-empt New York’s well-regarded law but it would definitely apply to all ERISA claims and create a precedent for New York to change its more balanced law.

We have also developed a customizable grassroots template that focuses on this and other end of the year issues (more stimulus $ for NY, preventing steep Medicare cuts) that your physicians can use:  Urge Congress to Prevent Medicare Cuts, Expand Lifeline Programs and Oppose One-Sided Surprise Bill Proposals (

Join with @MSSNY Join with @MSSNYtweet to urge Congress to prevent Medicare Cuts, expand financial lifeline programs, and oppose one-sided surprise medical bill solutions.

MSSNY Press Release Dec. 14 re Surprise Billing:
Surprise Billing is Flat Out Give Away to Insurance Companies

“Let’s be clear.

The new House-Senate committees’ surprise billing legislative agreement is a flat out give away to already enormously profitable insurance companies at the expense of community physicians on the front lines during the pandemic.  If this proposal were to be enacted, it will reduce patient choice in New York by compelling even more private practice physicians into forced employment arrangements.

We are disappointed that Congress did not look to New York’s well-regarded surprise medical bill law as a model of balance. Instead, they chose a methodology for resolving surprise bills that is designed to tip the scales grossly in favor of insurance companies and empower them to further squeeze patient care physicians at a time when many physicians are also about to absorb huge Medicare cuts.

Indeed, the CBO estimates that most of the so-called savings from this surprise bill proposal would come from cuts insurance companies would impose of network participating physicians, not out of network physicians.  The end result will inevitably be greatly reduced access to care for our patients.

So, as the year-end nears, instead of a thank you to the hundreds of thousands of physicians across the country who have put their own lives and the lives of their families at risk, Congress is giving these physicians a giant lump of coal.  We continue to urge that Congress take action to protect patients from surprise medical bills, but this proposal is way off the mark.

We urge Congress to go back to the drawing board and develop a more balanced proposal. Our health care safety net depends upon it.”

Crain’s: Legislation will Help Insurance Companies at the Expense of Doctors
The House-Senate committees’ legislative agreement on surprise billing will help insurance companies at the expense of community physicians, the Medical Society of the State of New York says. The agreement calls for insurers to make a payment to a provider that is determined either through negotiation between the parties or an independent dispute resolution process. It specifies that there is no minimum payment threshold to enter dispute resolution, and that claims may be batched together to ease administrative burden.

“If this proposal were to be enacted, it will reduce patient choice in New York by compelling even more private practice physicians into forced employment arrangements,” Dr. Bonnie Litvack, president of the medical society, said in a statement released Monday. “We are disappointed that Congress did not look to New York’s well-regarded surprise medical bill law as a model of balance. “Instead,” Litvack continued, Congress “chose a methodology for resolving surprise bills that is designed to tip the scales grossly in favor of insurance companies and empower them to further squeeze patient care physicians at a time when many physicians are also about to absorb huge Medicare cuts.”

Congressional leaders said Friday in announcing the bipartisan agreement that the proposed legislation would protect patients from surprise medical bills and establish a fair framework to resolve payment disputes between providers and insurance companies.

Litvack said the medical society is urging Congress to continue to take action to protect patients, but to “develop a more balanced proposal.” (Crain’s’ Pulse, Dec. 15)”

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NYSDOH COVID-19 Update Tomorrow 2 PM
Please join the NYS Department of Health Thursday, December 17th at 1:00 PM – 2:00 PM for a COVID-19 update for healthcare providers.

To accommodate the large number of participants, find our webinar streaming via YouTube Live (and available for viewing immediately thereafter) on the NYSDOH COVID website for providers:

Audio number and code: 844-512-2950 Access code 6641017#

Gov. Cuomo’s Briefing Highlights, Tuesday, Dec. 15 

  1. Total COVID hospitalizations rose to 5,982. Of the 194,188 tests reported yesterday, 10,353, or 5.33 percent, were positive. There were 1,065 patients in ICU yesterday, up 25 from the previous day. Of them, 580 are intubated. Sadly, we lost 128 New Yorkers to the virus.
  1. New York hospitals continue to receive and administer doses of the COVID vaccine. Among them was Upstate University Hospital in Syracuse, NY, which administered doses that arrived today to the first members of its staff. The doses were administered to Upstate employees Kenzo Mukendi, Caprice Hibbler and Suzanne Buck, by Chief Nursing Officer Nancy Page.
  2. The Finger Lakes region, with 725 hospitalizations, has the highest rate of COVID hospitalization by population. Hospitalizations in the Finger Lakes represent 0.06 percent of the region’s population. Western New York has 520 hospitalizations (0.04 percent of its population); Central New York has 350 hospitalizations (0.05 percent); Mohawk Valley has 192 hospitalizations (0.04 percent); Long Island has 972 hospitalizations (0.03 percent); the Mid-Hudson has 735 hospitalizations (0.03 percent); the Capital Region has 288 hospitalizations (0.03 percent); Southern Tier has 166 hospitalizations (0.03 percent); and New York City has 1,968 hospitalizations (0.02 percent). The North Country, with 56 hospitalizations (0.01 percent), has the lowest rate of hospitalizations due to COVID.

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New York State COVID-19 Vaccination Program Enrollment
The New York State Department of Health (NYSDOH) is now enrolling healthcare provider practices (outside of New York City’s five boroughs) in the NYSDOH COVID-19 Vaccination Program. Practices (outside NYC) interested in administering COVID-19 vaccine when the vaccine becomes available to their group must enroll in the NYSDOH program to be ready to order and receive publicly supplied COVID-19 vaccine and ancillary supplies.

Please review the following attached documentation and complete the online COVID-19 vaccine enrollment application located in the Health Commerce System by Friday, December 18, 2020.

Send questions regarding the NYSDOH enrollment process to:

FDA Verifies Safety, Efficacy Data for Moderna COVID-19 Vaccine Candidate
Ahead of a Dec. 17 meeting of its Vaccines and Related Biological Products Advisory Committee, the Food and Drug Administration released a briefing document confirming Moderna’s data on the safety and efficacy of the mRNA-1273 COVID-19 vaccine candidate. FDA said mRNA-1273 is 94.1% effective in preventing severe COVID-19, with “no specific safety concerns identified that would preclude issuance of an (emergency use authorization).” Like the Pfizer vaccine approved last week, the Moderna candidate requires two doses, albeit 28 days apart, compared with Pfizer’s 21. Once approved for emergency use, Moderna is expected to supply 200 million vaccine doses to the U.S. through the end of 2021. (Dec.15, American Hospital Association)

Updates: COVID-19 Deaths Surpass 300K

  • The nation’s COVID-19 death toll surpassed 300,000 Dec. 14, the same day the first Americans received Pfizer’s vaccine. The U.S. is reporting an average of 2,427 deaths daily, up 300 deaths per day from this spring’s peak, according to data from The COVID Tracking Project.
  • COVID-19 hospitalizations also hit a record 110,549 on Dec. 14, according to COVID Tracking Project data.
  • The average American could receive a COVID-19 vaccine by early April, Anthony Fauci, MD, said in a Dec. 14 interview with MSNBC. The nation’s top infectious disease expert said most Americans could be vaccinated by late spring or early summer. By fall, “the level of infection will be so low in society we can start essentially approaching some form of normality,” Dr. Fauci said.
  • A bipartisan group of lawmakers released a two-part relief plan Dec. 14. The first package contains $748 billion in aid for small businesses, jobless benefits, and healthcare providers. The second $160 billion proposal includes more controversial measures such as state and local aid, as well as liability protections related to COVID-19.
  • The FDA said the Moderna vaccine is highly effective against severe COVID-19, and it is expected to approve the vaccine for use Dec. 18, officials close to the matter told The New York Times. The agency confirmed Moderna’s assessment that its vaccine is 94.1 percent effective, and said potential side effects — including fever, headache, and fatigue — are not dangerous. Moderna’s vaccine would be the second coronavirus vaccine approved for emergency use in the U.S., after Pfizer and BioNTech’s vaccine. (Becker’s Hospital Review, Dec. 16)

COVID-19 Vaccine Codes: Updated Effective Date for Pfizer-BioNTech
On December 11, 2020, the U.S. Food and Drug Administration issued an Emergency Use Authorization (EUA) for the Pfizer-BioNTech COVID‑19 Vaccine for the prevention of COVID-19 for individuals 16 years of age and older. Review Pfizer’s Fact Sheet for Healthcare Providers Administering Vaccine (Vaccination Providers) regarding the limitations of authorized use.

During the COVID-19 Public Health Emergency (PHE), Medicare will cover and pay for the administration of the vaccine (when furnished consistent with the EUA). Review our updated payment and HCPCS Level I CPT code structure for specific COVID-19 vaccine information. Only bill for the vaccine administration codes when you submit claims to Medicare; don’t include the vaccine product codes when vaccines are free.

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55% Of Pediatric Residents Experience Burnout
New survey data reveal that more than half of pediatric residents experience burnout. Researchers surveyed residents training at more than 120 programs in the U.S. between 2016 and 2018, and found that almost 55% of them each year experienced burnout.

There were no clear demographic trends, but the scientists found correlations between burnout and other factors, such as poor mental health, greater stress, and more sleepiness. At the same time, those experiencing burnout were less likely to show mindfulness, self-compassion, and high levels of empathy and resilience. Those who reported better quality of life in 2017 — including more mindfulness — were associated with a lower risk of burnout the following year, according to the data. These links between quality of life and burnout offer opportunities for future interventions, the authors write.

MSSNY has established a confidential helpline phone number (1-844-P2P-PEER) and an email address ( so that physicians may be connected with a peer 24 hours a day/7 days a week. In addition to offering a trained, empathetic ear, peer supporters may provide information on specific resources that can offer further support, provide positive coping skills, or connect physicians to professionals for more focused assistance.

Now More Than Ever, Patients Need Relief from the High Cost of Prescriptions
While COVID-19 has dominated the headlines for months, many New York residents are also dealing with health issues unrelated to the virus that may require medications. In addition, many have lost their jobs and health insurance. The New York Rx Card may be able to help ease the burden of costly prescription medications for your patients. This savings program is designed to help those who may be uninsured, underinsured or who have health insurance coverage with no prescription benefits – but anyone can use it.

Patients (and physicians) can save up to 80% on prescription drugs by using this free card. All they need to do is present the card at a pharmacy when paying for a prescription. In instances in which patients are unable to go to the pharmacy in person, they should call the pharmacy to provide the information and the discount can be applied.

If you are interested in ordering cards for your practice, clinic, hospital or for yourself, please contact Program Director Chez Ciccone or call 800-931-2297.

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