Tuesday, January 25, 2011

Tuesday Tidbits

The AMA News salivates over the prospect that the non-profit company FAIR Health will increase rates for out of network doctors in the fee schedule which FAIR Health is developing to replace the long standing Ingenix fee schedule. United Healthcare which owns Ingenix settled a New York Attorney General investigation and an AMA lawsuit about two years ago by agreeing to turn over its "usual reasonable and customary" data bases to a non-profit and to pay $300 million into a settlement fund.  Health plans and insurers use these schedules to set a ceiling on payments to doctors who do not participate in their PPO networks. The article notes that the FAIR Health database under development faces competition from a number of sources, including the Medicare Part B resource based relative value schedule which is well known to physicians.

HHS Secretary Sebelius announced today record recoveries in healthcare fraud cases obtained during the last federal government fiscal year. She also announced new final regulations to tighten Medicare and Medicaid controls designed to prevent fraudulent payments. It strikes the FEHBlog that most of the new controls already are in use by private sector health plans.

The House Ways and Means Committee is holding an Affordable Care Act hearing tomorrow at 9 am. "The hearing will examine the economic and regulatory burdens imposed by the enactment and implementation."

Business Insurance reports that the Senate leadership will be introducing a bill to repeal the Affordable Care Act's expanded Form 1099 tax reporting requirements and that a bipartisan group of House members has introduced a bill (H.R. 5) to cap damages and limit contingent attorrney's fees in medical malpractice cases.

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