June 2001 Bulletin

In Brief

Alabama

Alabama Gov. Don Siegelman signed a prompt pay bill giving insurers up to 45 days to pay physicians for claims provided on paper and 30 days for electronically filed claims or the insurers must notify providers of any problems with those claims within the same time frames.

Alaska

The Alaska Senate approved a bill to allow independent physicians to collectively negotiate fees and patient services with health insurers.

Arkansas

A prompt payment bill was signed into law creating a 12 percent late fee for unpaid claims.

California

Hundreds of physicians from throughout California marched on the state capital in April urging lawmakers to enact legislation that will increase funding to the emergency and trauma system. The California Medical Association (CMA) organized the march of physicians carrying banners warning of "Code Blue" for medical care in California. They also lobbied for bills that would improve patient access to specialists, reduce financial risks to physicians for health care costs that should be borne by health plans and improve access to care for California’s 7 million uninsured.

Florida

The Florida legislature approved a bill requiring that HMO doctors who review cases be licensed in Florida. The Florida House of Representatives also considered a proposal calling for the adverse incidents reports of hospitals and surgical centers to be summarized and posted quarterly on a state web site. The bill would omit the names of the centers where the errors took place and would leave off the names of patients, doctors, nurses and the individuals who reported the incident. Currently, the state requires hospitals to report problems, but keeps the reports confidential. The bill also would give legal liability protection to risk managers who report the incidents. The legislature also approved a bill to ban all products clauses.

Indiana

Both houses of the legislature passed a bill that would require electronically submitted claims to be paid within 30 days and paper claims within 45 days.

Maryland

Maryland lawmakers approved a bill that requires HMOs to reimburse noncontracting physicians for health care services provided at state-designated trauma centers at a minimum of 140 percent of the Medicare fee schedule. The Maryland State Medical Society said it hopes to extend this or a similar formula to all noncontracting physicians in 2002.

New Jersey

More than $1 billion in HMO claims in New Jersey will not be paid fast enough to comply with the state law on prompt payment, according to a survey by the Medical Society of New Jersey. The finding is based on a sample of 1,200 physicians (more than 6 percent of the physician population in New Jersey) serving 1.2 million patients. The society then tracked approximately 17,500 of these physicians’ claims during the week of Jan. 15, 2001, and monitored the claims for 60 days. The managed care firms were Aetna, Amerihealth, Cigna, Horizon, Physicians Health Services and Oxford. The study found that the HMOs, which represent 90 percent of the managed care market, violated the prompt payment law 25 percent of the time. The law demands that HMOs must process electronically filed claims within 30 days and paper claims within 40 days.

New Mexico

A bill signed into law allows for direct payment to providers from Medical Savings Accounts.

New York

A bill was introduced in the legislature allowing physicians and small businesses to jointly negotiate with insurers.

North Carolina

The Senate approved a Patients’ Bill of Rights bill, creating a system of independent external review of treatment denials and permits some patients to select a specialist as their primary care provider.

Oklahoma

A new law requires all clean claims to be reimbursed within 45 days or be subject to 10 percent late interest payments.

Pennsylvania

Physicians in Pennsylvania went to the capital in Harrisburg in April to insist that lawmakers enact insurance-tort reforms and give them relief from soaring malpractice insurance premiums. The doctors, most from the Philadelphia area, say they are so strapped by high malpractice premiums and low reimbursement rates that many of their colleagues—especially orthopaedic surgeons, neurosurgeons and obstetricians—have moved out of Pennsylvania, retired or scaled back their practices.

Texas

The Texas Senate passed a bill to limit information from complaints against physicians that must be disclosed to health care entities for credentialing purposes. When a complaint is closed with no disciplinary or rehabilitative action taken against a physician, the Texas State Board of Medical Examiners would be required to retain a record of the complaint, but to delete the identity of the physician for 10 years from the date when the complaint was closed. The bill would require the Board to provide information to a health care entity regarding the basis and current status of any complaint under active investigation that has been assigned to a person authorized by the board to pursue legal action. The bill also would require that physicians report actual lawsuits and settlements to the board, but not notices of claims.

West Virginia

Gov. Bob Wise signed a bill requiring electronic claims to be paid within 30 days and paper claims within 40 days or face a 10 percent interest penalty. The legislature passed a Patients’ Bill of Rights that outlaws financial incentives to limit care, provides for standing referrals to specialists and requires internal and external review procedures for patients.


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