View February Progress Notes Below
Federal Court Blocks Aetna-Humana Merger!
On February 8, the U.S. District Court for the District of Columbia issued a ruling that blocked the proposed merger of the two health insurance giants Anthem and Cigna.
MSMA strongly objected to the merger at both the state and federal level, citing the unhealthy concentration of market power the newly-combined entity would have. MSMA, the AMA, and others loudly warned that the resulting anti-competitive insurance environment would be harmful to the public, with higher premiums, greater out-of-pocket costs, narrow provider networks, and reduced access to care.
The court, siding with the U.S. Department of Justice which filed the lawsuit against the proposal, found that the merger would have worsened an already highly-concentrated market, and likely would have raised prices. The court also found that Anthem did not defend its allegation that “all providers, no matter their size, location, or financial structure, are operating at comfortable margins well above their costs.”
This is an important victory for physicians and their patients, and comes on the heels of an equally significant court ruling in January that blocked a similar merger between Aetna and Humana. Don’t let them tell you organized medicine doesn’t do anything for you.
MSMA Urges Regulatory Scrutiny of Insurance Mergers
MSMA has called on the Missouri Department of Insurance (DoI) to give a rigorous regulatory review of the proposed merger of health insurance giants Anthem and Cigna. Under Missouri law, DoI has the authority to withhold approval of an insurance company acquisition or merger if that action would “substantially lessen competition.”
Citing a recent statistical study conducted by the AMA, MSMA warned that the proposed merger would result in an unhealthy consolidation of market power in Missouri, which would have a deleterious impact on physicians and their patients here.
In a separate but related action, MSMA teamed up with the Missouri Hospital Association and the Missouri Association of Osteopathic Physicians and Surgeons in a letter to the Missouri Attorney General, asking for a thorough review of the individual and cumulative effects of the Anthem-Cigna merger, as well as the proposed Aetna-Humana consolidation (particularly for its impact on Medicare Advantage patients).
Download Letter to Insurance Companies and to Attorney General Koster.
MSMA Fights Proposed Aetna-Humana Merger
In formal comments to the Missouri Department of Insurance (DoI), your MSMA strongly opposed the proposed merger of the two health insurance giants Aetna and Humana.
Citing the unhealthy concentration of market power the newly-combined entity would have in Missouri, MSMA warned that the resulting anti-competitive health insurance environment would be harmful to the public. Higher premiums, greater out-of-pocket costs, narrow provider networks, and reduced access to care follow in the absence of competition, and MSMA asked DoI to exercise its statutory to reject the merger.
DoI held a public hearing on the matter on May 16, in Jefferson City. You can read MSMA’s statement here.
Fees for Medical Records Effective 2/1/17
The new maximum fees for copying medical records will be $24.85 plus $0.57 per page for the cost of labor and supplies for copies provided in paper form, and $23.26 for additional costs if records are maintained off-site. The new maximum fees for copies provided electronically will be $24.85 plus $0.57 per page, or $108.88 total, whichever is less. For more information, go to: http://health.mo.gov/atoz/fees.php.
HIPAA and Fees for Medical Records
Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), a covered entity may only charge an individual or the individual’s personal representative a reasonable cost-based fee. The Office for Civil Rights has posted guidance regarding what a covered entity provider may charge an individual or the individual’s personal representative here.
Medicare Fraud Alert
If you receive a request for a signature on a Certificate of Medical Necessity for a patient not known to you, the physician area already completed, or if you receive a request for medical record documentation for a patient where you did not order the DME item, or that you do not believe is appropriate for the patient, please treat this as a fraud issue.
You can submit the information to OIG Hotline: 800-HHS-TIPS (1-800-447-8477) or online at https://forms.oig.hhs.gov/hotlineoperations/
CMS issues final MACRA Quality Payment Program rule
On October 14, the Department of Health and Human Services issued its final rule to implement the Quality Payment Program (QPP) which was created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to replace the flawed Sustainable Growth Rate formula for updating the Medicare physician fee schedule.
The final rule – a tortuous 2,205-page manifesto and alphabet soup of federal acronyms – sets forth two main options for participating physician practices to consider: The Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APMs)....read more.