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Medical Legal Guidelines
LSMS Member Services
SETTLEMENT UPDATES - 8.17.07
An
update from AMA's Private Sector Advocacy online.
File by
Oct 19th- BCBS
As a part of the Settlement, the Blue Cross Blue Shield Settling Parties
have agreed to make a settlement payment of $131,209,507. Be sure to
submit a completed claim form by October 19, 2007. Questions about the
settlement may be addressed to the Settlement Administrator through email
submissions at
www.hmosettlements.com or by telephone at 1-877-893-2643.
Health
Net and Humana settlements have been mailed to physicians
Disbursements in the Health Net and Humana settlements have been
mailed to physicians. The Health Net settlement disbursements were
sent on August 6, 2007, and Humana settlement disbursement checks were
distributed on August 10, 2007.
For more information on HMO
settlements, including Aetna, Cigna
and Blue Cross Blue Shield,
visit HMO settlements.com
AMA Practice Tips for Physicians
AMA ALERT—Be
Wary Of Unsolicited Faxes Requesting Your Practice Information
At the end of the year, physician
practices typically receive an increased number of fax requests for a
copy of the practice or physician’s W-9, National Provider Identifier
or other information that allow a payer to process your claims or
update its physician roster. While these fax requests may be
legitimate, other unsolicited requests may only be masquerading as a
proper request for information and may in fact, bind you unknowingly
to a contract with a provider network or other entity. Be sure to
instruct your staff to read all faxes carefully. The physician or
legal representative should carefully review and understand any
agreement or contract before signing.
If your practice receives an unsolicited fax request from an unknown
party, please forward the information to the AMA Practice Management
Center at
practicemanagementcenter@ama-assn.org.
Protecting Your Practice From Inappropriate Discounts
Multiple payers could be
taking advantage of your lowest contracted payment rate through the
use of a rental network preferred provider organization (PPO). The AMA
developed the booklet “Read your contracts: Is your practice losing
revenue through rental network PPOs?” to educate physicians about how
to identify and protect their practices from inappropriate discounts.
Visit the
AMA Practice Management
Center Web site to access the educational resource “Read your
contracts: Is your practice losing revenue through rental network PPOs?”
AMA members can download this informative educational resource as a
member benefit.
Connecting With Your Patients
Online medical consultations, also known as e-visits, present
opportunities for growth and increased efficiency in the physician
practice. To learn more about this new patient convenience and if it
is right for your practice, visit the AMA's Practice Management Center
Web site at
www.ama-assn.org/go/psatools to access the educational resource
“Online medical consultations: connecting physicians with patients.”
Filing A Complaint
Physicians and practice
staff—alert the AMA of problems you may be experiencing with health
insurers and payers by visiting
www.ama-assn.org/go/clickandcomplain and completing the AMA Health
Plan and HIPAA Complaint Forms. These forms gather sophisticated data
on the types and severity of administrative “hassles” that the
physician practice experiences on a day-to-day basis in the managed
care environment.
While the AMA may pursue
compliance activities with health insurers or payers where a pattern
of administrative hassles are shown, the information provided will be
used primarily to shape the AMA’s agenda. The AMA does not directly
respond to these complaints, as the forms are anonymous. If an AMA
member wishes, they may contact the AMA Practice Management Center
unit at (800) 262-3211.
Legal Information for Physicians
Louisiana State Board of Medical Examiners Official Statement of
Position regarding Referrals for Imaging Services and the Louisiana
Anti-Kickback Law
AMA Drug
Substitution Q & A HIPAA Compliance Center
HIPAA Conference - Monday, November 18, Baton Rouge
Sheraton
HIPAA
Transactions and Code Sets Requirements
HIPAA
Privacy
HIPAA
Compliance Package
Definition of
Dispensing Physician
Medical Review Panel Process
Responding to Subpoenas
Medical-Legal Interprofessional Code
Closing a Medical Practice
Terminating a
Physician-Patient Relationship
AMA Policy/Opinion and Links
AMA Challenging Network
Placement with Insurers
This flyer, created by AMA Physician
Practice Advocacy, offers physicians eight steps to handling
problems with these types of programs, i.e., the use of claims data,
inadequate risk adjustment, lack of an appeal mechanism and invalid
ratings.
AMA Model
Managed Care Contract
AMA Opinion on billing
for No-Show Appointments
AMA
Opinion on
Gifts to Physicians from Industry
AMA
Opinion on Handling of Medical Records
The
LSMS Department of Legal Affairs provides
guidance and assistance to LSMS physicians and component societies on
a number of Medical-Legal issues affecting physician practices and
organized medicine. Department of Legal
Affairs Staff
Director
~
Amy W. Phillips,
JD
Phone: 800.375.9508
Fax: 225.763.2335
Email:
legalaffairs@lsms.org |
