CMA-Sponsored Bill Would Allow
Physicians to Sue Health Plans for Fair Payment
Article from California
Physician Online
CMA is sponsoring a key piece of legislation that would strengthen a physician’s right to sue a health plan when the plan fails to make fair and timely payment for care provided to its enrollees. Specifically, the bill would make it easier for a physician to sue health plans that fail to follow the payment and claims-processing provisions of the Knox-Keene Act, which regulates health plans in California. Read the entire article...
AMA to study establishing
coding combinations, modifiers
Article from
AmedNews.com
Standards could help ease the controversy over bundling and downcoding.
Chicago -- The AMA has decided to study the feasibility of developing a national standard for using codes, code combinations and modifiers that could help clarify when it is appropriate to bundle services for coding.
The study, ordered by a resolution adopted by the House of Delegates on June 15 during the AMA's Annual Meeting in Chicago, would examine a national standard that is consistent with CPT guidelines and could be used by all commercial and government payers.
Such a standard could help address the controversy over bundling and downcoding, practices at the heart of major lawsuits brought by physicians against insurers. Though AMA has policies that denounce the practice of unfair bundling and downcoding by payers, it has never formally studied developing a national standard for code combinations. Read the complete article...
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