The most current
edition of California Physician Magazine, an online resource for
California healthcare professionals, provides an informative report on common
HMO payment denial schemes. The feature story not only provides the specifics of
the most frequent responses used to deny payments to California doctors, but it
also outlines methods and procedures for pursuing successful appeals.
Unfortunately, the article indicated that “[s] ome physicians report that they
don’t bother to appeal claim denials because they believe the effort and costs
are not justified by the outcome.” The good news for California physicians,
according to the writer is that “[m]any claims, however, are denied unlawfully
and can be effectively appealed.” The keys to successful appeal include both
education and persistence, and unfortunately more and more of the healthcare
professional’s precious time. For the complete story, please go to www.calphys.org. The California
Physician Magazine is a publication of the California Medical Association at
www.cmanet.org. 
Physician
delegates from around the country meet in Chicago this week to discuss the many
important issues facing the Association and its members. Agenda items for this
important week of debate and decisions include many managed care issues such as
prompt payment requirements, the Health Insurance Portability and Accountability
Act (“HIPAA”), Medicare reimbursement and others. The election of Donald J.
Palmisano, MD, a general and vascular surgeon from New Orleans, to
president-elect by the AMA House of Delegates was also announced. For additional
details and updates on the weeks activities please go to www.ama-assn.org.