Wednesday, June 22, 2011

Mid-week update

The American Medical Association which is holding its annual meeting this week issued it fourth annual National Insurer scorecard. It's no surprise that the report card bashes insurers.
According to the AMA’s latest findings, commercial health insurers have an average claims-processing error rate of 19.3 percent, an increase of two percent compared last year.
That is an absurd finding. Medpage Today reports AHIP's response:
"Health plans are doing their part by collaborating [via e.g., the CAQH CORE program] with providers and investing in new technologies to improve the process for submitting claims electronically and receiving payments quickly," said Robert Zirkelbach, a spokesman for AHIP. "At the same time, more work needs to be done to reduce the number of claims submitted to health plans that are duplicative, inaccurate, or delayed."
In other words, the AMA should be taking the log out its eye first.

The FEHBlog jumped the gun with its concern about the House Energy and Commerce hearing on Medicare coordination of benefits today. From looking at the testimony which is now online the hearing is focusing on liability settlements. The FEHBlog recently attended a legal ethics seminar at which a speaker warned plaintiffs' tort bar members about the importance of looping in Medicare before settling any negligence case involving a Medicare beneficiary as the plaintiff. The process is slow. The House Committee is interested in getting Medicare to be more responsive to the plaintiff's bar.

Last year, the Walgreen's pharmacy chain picked a fight with CVS Caremark. This year, Walgreen's is fighting with another prescription benefits manager Express Scripts, Inc. The New York Times reports that
The Walgreen Company said on Tuesday that it was willing to walk away from more than $5 billion in annual revenue because the pharmacy benefits manager Express Scripts did not pay it enough to fill prescriptions.
The break would occur in January 1, 2012. A negotiated settlement is expected before then.

The AMA News reports that Senator Orrin Hatch (R UT) and Rep. Erik Paulsen (R Minn) have introduced
The Family and Retirement Health Investment Act of 2011 [which] would reduce or remove several limits on health savings accounts and flexible spending arrangements. The proposed changes include allowing:
  • HSAs and FSAs to be used to purchase over-the-counter drugs without a prescription.
  • HSAs and FSAs to be used to pay fees for retainer health care provided by primary care physicians, physician assistants and nurse practitioners.
  • Medicare beneficiaries with hospital coverage to continue to contribute to HSAs.
  • Individuals with FSAs to carry over up to $500 in the accounts to the following year.
  • States to bring back Medicaid health opportunity accounts, in which states contribute to HSAs to be used for some medical services.

The FEHBlog bets that the OTC drug prescription requirement will be the next Affordable Care Act provision to be repealed.

No comments: