AMA Offers Physicians Help Claiming Damages From UnitedHealth Settlement

The American Medical Association (AMA) today launched a new online resource that will help thousands of physicians file claims in the record-breaking settlement reached in the AMA legal victory against UnitedHealth Group—the nation’s largest health insurer. More than $350 million is available to compensate physicians and their patients for 15 years of artificially low payments for out-of-network services.

The UnitedHealth settlement is governed by a series of court-imposed deadlines that physicians must follow. The current settlement deadlines include the following key dates:

July 27 – Deadline for filing objections to the settlement or for opting out of the settlement.

September 13 – Date for the final settlement hearing to consider any filed objections.

October 5 – Deadline for filing a claim to share in the settlement fund.

AMA Supports Senate Health Reform Bill

After carefully evaluating the changes contained in the manager's amendment filed by Senate Majority Leader Harry Reid (D-Nev.), the AMA Board of Trustees voted to support passage of H.R. 3590. In a letter of support to Sen. Reid, the AMA noted the need for additional changes in the final conference committee agreement that reconciles the differences between the House and Senate bills.

The AMA Board's decision to support passage of the amended version of H.R. 3590 is consistent with the recommendation from the AMA Council on Legislation that the AMA support H.R. 3590 while seeking additional changes in the House-Senate conference committee agreement. Check the AMA website for more detailed analysis.

HIPAA 5010 Resources for January 2012

Are you preparing for the compliance deadlines for the Health Insurance Portability and Accountability Act (HIPAA) 5010 standard transactions, the next version of HIPAA? Beginning Jan. 1, 2012, physicians will be required to use only the 5010 standard transactions when conducting them electronically. The AMA has prepared several educational resources to assist physicians with implementing the 5010 standard transactions.

House Repeals SGR

The AMA Bulletin below provides a good summary of the bill and House actions that led to passage.

By a vote of 243-183 today, the U.S. House of Representatives passed H.R. 3961, a bill that repeals the current Medicare physician payment formula, known as the sustainable growth rate (SGR), and replaces it with a new framework. Michael Burgess, MD, (R-Texas), a former AMA alternate delegate was the sole Republican to vote for final passage.

This legislation would replace the SGR with a new formula that creates two updates: GDP +2 for Evaluation and Management services and GDP + 1 for other services. Additional technical changes will avoid the accumulation or compounding of debt that occurred with the SGR formula.

House Speaker Nancy Pelosi (D-Calif.), House Majority Leader Steny Hoyer (D-Md.), House Committee on Ways and Means Chairman Charles Rangel (D-N.Y.), House Ways and Means Health Subcommittee Chairman Pete Stark (D-Calif.), House Committee on Energy and Commerce Chairman Henry Waxman (D-Calif.), Rep. Frank Pallone (D-N.J.), the bill's sponsor Rep. John Dingell (D-Mich.), and the Obama Administration were strong advocates for passage of H.R. 3961.

House Republican leadership offered a last-minute alternative that would have provided for 2 percent updates over the next four years, reverting back to the SGR and steep cuts. Also, it would have offset the cost with medical liability reforms modeled after California and Texas laws. The AMA opposed the motion to recommit because we do not support any temporary "patches" for the SGR. A permanent repeal is long overdue. The motion to recommit with medical liability reform provisions was ruled non-germane. A second GOP alternative providing for a two-year "patch" was defeated by a vote of 177-253.

The battle now shifts back to the Senate. While action to permanently repeal the SGR was blocked in the Senate last month, the Obama Administration and several senators support a permanent replacement of the SGR formula. The health system reform bill released by Senate Majority Leader Harry Reid (D-Nev.) provides for a one-year reprieve with a steeper cut in 2011. The AMA does not support temporary patches that further grow the problem.

No one expects Congress to allow the 21 percent cut scheduled for Jan. 1 to occur. We regret that Congress has deferred action until the "eleventh hour." The AMA will redouble our efforts in the Senate and with the Obama Administration to achieve a permanent solution.

AMA House of Delegates Committed to Health System Reform

As the House of Representatives passed a health reform bill this weekend, the AMA House of Delegates is holding its Interim Meeting in Houston. Delegates have introduced a number of resolutions related to health system reform. Some are supportive of current bills and measures, while others are critical. After lengthy testimony regarding health reform in reference committee hearings on Sunday, the HOD voted on Monday to reaffirm its committment to existing health reform policies in Substitute Resolution 203, maintaining support for H.R. 3962. View resources that show exactly which proposals are supported and opposed. 

AMA President J. James Rohack, MD noted, "H.R. 3962 is not the perfect bill, and we will continue to advocate for changes that help make the system better for patients and physicians as the legislative process continues." The AMA will continue to support H.R. 3961 to repair the broken Medicare SGR formula and keep pushing for liability reforms that will reduce the costs of defensive medicine.

FTC Delays Red Flag Rules 3rd Time

The Federal Trade Commission recently announced its third delay in implementation of the Red Flags Rule. Implementation of the rules has been delayed until June 1, 2010. The AMA has been urging the FTC and Congress that physicians are not "creditors" and should not be subject to the rule. View the FTC's release for more information on the delay.

The AANEM encourages its members to be cognizant of these rules and will continue to report on anticipated implementation and the work of the AMA on this issue. The AMA has developed resources for implementation of these rules.

Vote on SGR

Wednesday's vote to limit debate and proceed to consideration of legislation (S. 1776) to repeal the SGR, erase the existing debt, and freeze physician payments at current rates for 10 years failed. This was a disappointing blow to physicians and supporters. A majority of senators from both parties agree the formula is flawed. The vote seems to have failed because (1) moderate senators who agree the SGR is a problem could not overlook the deficit implications and (2) Senate Republican leadership portrayed this as a test vote on Democrats' health reform legislation.

Unfortunately, temporary fixes that override the formula simply make the problem worse. In 2005 it would have cost $48 billion over 10 years to repeal the formula. Physicians that year faced cuts of 3.3%. Today it would cost $245 billion and the 2010 scheduled cut to physicians is 21.5%. Visit the Health System Reform website to stay current on this and other reform issues.

New H1N1 Resources

The AMA has put together new, free H1N1 patient management tools. The website includes information for both patients and providers, including a unique online practice management system and self-assessment tools from AMA and CDC. Additional H1N1 resources are also available from the AMA.

Medicare Physicians Fairness Act of 2009

Contact your senators in support of S. 1776. With the introduction in the U.S. Senate of S. 1776, the "Medicare Physicians Fairness Act of 2009," earlier this week, the AMA urges all physicians to contact their senators and tell them to support this critical piece of legislation that would eliminate Medicare's sustainable growth rate (SGR) formula.

S. 1776 will be the subject of a cloture vote in the coming days. The Senate needs 60 votes to invoke cloture to allow formal consideration of the bill. A vote on final passage is expected to occur late next week, either on Oct. 22 or 23. Senate Majority Leader Harry Reid (D-Nev.), Senate Finance Committee chairman Max Baucus (D-Mont.), and Sen. Chris Dodd (D-Conn.), along with President Barack Obama, are all strongly supporting passage of S. 1776.

Send an e-mail to your senator, or call the AMA grassroots hotline at (800) 833-6354 and be connected directly to your senators' offices. Learn more about S. 1776 in the latest edition of the AMA's Health System Reform Bulletin.

H1N1 CPT Code

With both seasonal influenza and H1N1 influenza circulating this flu season, the AMA announced this week it has expedited the publication of a new code specific to vaccine administration and revised existing code 90663 to include the H1N1 vaccine. The new Current Procedural Terminology (CPT®) code issued by the AMA will streamline the reporting and reimbursement procedure for physicians and health care providers who are expected to administer nearly 200 million doses of the H1N1 vaccine in the United States. In consultation with the U.S. Department of Health and Human Services, the AMA CPT® Editorial Panel created code 90470 to report H1N1 immunization administration and counseling. Code 90663 was revised by the CPT® Editorial Panel to refer specifically to the H1N1 vaccine product. Both are effective immediately.

HIPAA Breach Notification Rule

New regulations effective September 23, 2009 require all physicians who are covered by HIPAA to notify patients if there are breaches of security involving their medical information. The linked guidance from the AMA summarizes the new requirements. These requirements apply in addition to any notification obligations imposed by state law. These requirements also supplement the obligations imposed by the HIPAA Privacy and Security Rules.