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Medical Malpractice Liability Insurance Premium
Assistance Fund (MMLIPA)
New Jersey Division of Consumer Affairs November 30, 2004
The New Jersey Medical Care Access and Responsibility and Patients First Act (Act), P.L. 2004, c.17 was signed into law on June 7, 2004. The Act creates the Medical Malpractice Liability Insurance Premium Assistance Fund; the Health Care Subsidy Fund; a student loan reimbursement program for obstetrician/gynecologists; and an annual allocation to the Division of Medical Assistance and Health Services. The Medical Malpractice Liability Insurance Premium Assistance Fund is to be administered by the Department of Banking and Insurance (see N.J.S.A. 17:30D-28 et seq.).
The Medical Malpractice Liability Insurance Premium Assistance Fund (Fund) was created for the purpose of preserving access to quality medical care for New Jersey patients by providing direct relief towards the payment of medical malpractice liability insurance premiums to certain health care providers in New Jersey, who are finding it difficult to remain in practice due to escalating medical malpractice liability insurance premium rates.
Revenue for the Fund is being collected from the following sources:
An annual surcharge of $3 per employee for all employers who are subject to the New Jersey "unemployment compensation law," collected by the comptroller for the New Jersey Unemployment Compensation Fund and paid over to the State Treasurer for deposit in the Fund annually, as provided by the commissioner, which surcharge may, at the option of the employer, be treated as a payroll deduction to each covered employee;
An annual charge of $75 to be imposed by the State Board of Medical Examiners on every physician and podiatrist licensed by the board pursuant to the provisions of R.S.45:9-1 et seq., collected by the board and remitted to the State Treasurer for deposit into the Fund;
An annual charge of $75 to be imposed by the State Board of Chiropractic Examiners on every chiropractor licensed by the board pursuant to the provisions of P.L.1989, c. 153 (C.45:9-41.17 et seq.), collected by the board and remitted to the State Treasurer for deposit into the Fund;
An annual charge of $75 to be imposed by the New Jersey State Board of Dentistry on every dentist licensed pursuant to the provisions of R.S.45:6-1 et seq., collected by the board and remitted to the State Treasurer for deposit into the Fund;
An annual charge of $75 to be imposed by the New Jersey State Board of Optometrists on every optometrist licensed by the board pursuant to the provisions of R.S.45:12-1 et seq., collected by the board and remitted to the State Treasurer for deposit into the Fund; and
An annual fee of $75 to be assessed by the State Treasurer and payable by each person licensed to practice law in this State, for deposit into the Fund.
Four health care boards within the New Jersey Division of Consumer Affairs have been given the responsibility to assess and collect an annual fee of $75 over the next three years from the following licensees: physicians (M.D.s and D.O.s), podiatrists, optometrists, dentists and chiropractors. Certain licensees are automatically exempt if they:
Have been licensed for less than one year;
Are barred from practicing by any disciplinary order of the Board or because their license has expired; and
Are completely retired from practice of their profession and have elected to place their licenses in an inactive status.
For the purposes of this section, "completely retired" means a licensure status established by a licensee's affirmative election of an inactive status at the time of license renewal pursuant to N.J.S.A. 45:1-7.3, or through a submission of other written notice, where authorized by the professional practice act to obtain a certificate of retirement. During the time that a licensee is "completely retired," no practice of the profession, within the meaning of this definition, is authorized, including but not limited to, the prescribing of medications, if authorized within the scope of practice. Physicians who are 65 years old or older, without hospital or health maintenance organization affiliation, and who hold a reduced fee license, issued pursuant to N.J.S.A. 45:9-19.16, shall be deemed active licensees and shall not be deemed "completely retired.
All other licensees will be receiving a mailing by the end of November, with an invoice requiring payment within 30 days. Some additional licensees may be exempt from having to make payment to this Fund. In order to claim an exemption, a licensee will have to complete, sign and return the coupon/invoice attesting that they:
Are currently on full-time duty with any branch of the armed forces, VISTA or the Peace Corps and are not required to maintain a New Jersey license to perform their duties, if they are serving within New Jersey; or
Do not maintain a bona fide office or other practice location at which they engage in or provide services for which a license is required by statute or by virtue of the job description, specifications or qualifications.
For the purposes of this section, "bona fide office" means a practice location at which a licensee engages in any activity or provides any service for which possession of a license is statutorily required or otherwise mandated by virtue of the job description, specifications or qualifications. A "bona fide office" shall include a private practice setting, at a hospital, educational institution, research facility, governmental agency or a business. The accessibility of a licensee at the practice location to members of the public in person or by telephone shall not be a determinative factor.
If a licensee fails to pay the required fee or claim an exemption, enforcement and/or collection actions may be pursued. Furthermore, failure to remit payment by the due date will result in the licensee being ineligible for a subsidy from this Fund.
Although the Division of Consumer Affairs is collecting the funds from its licensees, the Department of Banking and Insurance will administer the fund monies.
Please call the Society office with any questions.
PROVIDER ISSUES
PUBLIC ISSUES
INFLUENZA VACCINE SHORTAGE
Oct. 6, 2004
1. Where can I go to get vaccinated?
The private sector may have already received some or all of their supply from another manufacturer. If you are in one of the priority groups, you should first contact your health care provider. If they do not have any vaccine, try www.findaflushot.com which can be searched by zip code. Be sure to call the clinic provider to make sure that the clinic is still being held.
2. What are the priority groups?
All children aged 6-23 months
Adults aged 65 years and older
Persons aged 2-64 years with underlying chronic medical conditions
All women who will be pregnant during the influenza season
Residents of nursing homes and long-term care facilities
Children aged 6 months-18 years on chronic aspirin therapy
Health-care workers involved in direct patient care
Out-of-home caregivers and household contacts of children aged <6 months.
3. What happened to the vaccine supply?
The US supply comes from two manufacturers (Aventis and Chiron), with about half from each company. One of the companies, Chiron, located in England, had its license to manufacture influenza vaccine suspended for three months.
4. Why can’t more vaccine be made available by another manufacturer?
The FDA (Food and Drug Administration) approval process for all drugs is complex. Influenza vaccine requires tests for many things related safety and effectiveness. In addition, currently available influenza vaccines are produced by growing influenza viruses in embryonated chicken eggs taking between 6 to 9 months to prepare.
5. Why doesn’t the US make its own vaccine?
Sorry, I don’t have any information on that.
6. What about that new nasal vaccine?
FluMist is available in limited supply.
We encourage FluMist for those healthy adults under 50 years of age who are health-care workers involved in direct patient care provided they:
are not pregnant
do not care for severely immunocompromised patients in special care units
do not care for children under 6 months of age
refrain from contact with severely immunosuppressed patients for 7 days after vaccine receipt.
7. What about the use of antivirals?
It is too early in the flu season to know exactly which strains of flu will be occurring this year and whether antivirals will be effective. We will know more as the season progresses.
8. Meanwhile, what can I do to protect myself?
Practice Universal Respiratory Precautions (URP):
Cover your mouth and nose with a tissue when coughing or sneezing; promptly dispose of the tissue and wash hands thoroughly with soap and warm water (20 seconds)
If no tissue is available, cover your mouth and nose with hands; promptly wash hands thoroughly with soap and warm water
When soap and water are not available, use alcohol-based disposable hand wipes or gel sanitizers
Keep hands away from eyes, nose, and mouth
Stay away from people who are sick; wear a surgical mask when caring for sick people
Stay home when you are sick so as not to expose others
30 million of the 54 million doses that will be available in the US from Aventis have already been distributed. The distribution of the remaining 24 million is on hold while CDC, FDA and other federal agencies discuss how to best utilize this supply.
We are asking large employers who usually vaccinate their entire workforce to limit vaccine to the CDC’s priority groups and share the rest with the public health sector.
2. Is there somewhere else I can refer my patients for vaccine?
They then should call the provider to find out if the clinic is still being held.
3. What about vaccine for high risk children?
If they are eligible for the Vaccines for Children Program (Medicaid, KidCare Plans A-D, uninsured, American Indians, Alaskan Natives, and underinsured), they may be able to obtain vaccine at a Federally Qualified Health Center. Contact the Vaccine Preventable Disease Program for eligibility requirements (609-588-7500).
Certain children under age 9 may require 2 doses of vaccine if they have not previously been vaccinated. If vaccine is available, they should be given a first dose. Do not hold doses in reserve to ensure a second dose. Instead, available vaccine should be used to vaccinate persons in priority groups on a first-come, first-serve basis.
4. Is FluMist available?
There are 1.1 million doses available in the US.
We encourage FluMist for those healthy adults under 50 years of age who are health-care workers involved in direct patient care provided they:
are not pregnant
do not care for severely immunocompromised patients in special care units
do not care for children under 6 months of age.
Health-care workers and hospital visitors who receive FluMist should refrain from contact with severely immunosuppressed patients for 7 days after vaccine receipt.
5. What about the use of antivirals?
It is too early in the flu season to know exactly which strains of flu will be occurring this year and whether antivirals will be effective.
Stay tuned for updates as the season progresses.
6. Meanwhile, what can I do to protect my patients and my staff?
Practice Universal Respiratory Precautions (URP):
Cover your mouth and nose with a tissue when coughing or sneezing; promptly dispose of the tissue and wash hands thoroughly with soap and warm water (20 seconds)
If no tissue is available, cover your mouth and nose with hands; promptly wash hands thoroughly with soap and warm water
When soap and water are not available, use alcohol-based disposable hand wipes or gel sanitizers
Keep hands away from eyes, nose, and mouth
Stay away from people who are sick; wear a surgical mask when caring for sick people
Stay home when you are sick so as not to expose others
7. What are the priority groups?
All children aged 6-23 months
Adults aged 65 years and older
Persons aged 2-64 years with underlying chronic medical conditions
All women who will be pregnant during the influenza season
Residents of nursing homes and long-term care facilities
Children aged 6 months-18 years on chronic aspirin therapy
Health-care workers involved in direct patient care
Out-of-home caregivers and household contacts of children aged <6 months.
8. What about vaccination of persons not in the priority groups?
They should be informed about the urgent vaccine supply situation, asked to forego or defer vaccination, and encouraged to practice URP.
9. What if I have vaccine leftover from last flu season?
Leftover influenza vaccine is required to be returned to the supplier by June 30 of each year. There are two reasons for this policy:
The vaccine has expired.
The formulation of the vaccine changes each year depending on the strains that are anticipated to be prevalent in the upcoming flu season.
10. Where can I get updated information, as the situation changes?
Position of the Medical Society of New Jersey Physicians Revolt In “ Trenton Tea Party” Arguments Against Ambulatory Care Facilities Tax:
Uncompensated (charity) care is a societal problem, and requires the whole of society to responsibly address the problem. New Jersey physicians are dedicated to providing quality medical care for patients, regardless of ability to pay. This dedication stems from the healing essence of the noble profession.
Physicians with hospital privileges are mandated by law and ethically obligated to provide uncompensated care when called upon. No requirement exists for physician compensation, despite assumption of significantly increased liability due to emergency/urgent situations with no available patient history.
In 2003, the state reimbursed hospitals $381 million for what they expended in charity care. Although hospitals routinely include physician fees in their submissions for charity care, they rarely pass along any compensation to physicians. The current state budget allocates nearly $600 million for hospital charity care, but nothing for physicians. New Jersey’s Ambulatory Care Facilities (ACF) tax was passed to generate revenue toward that $600 million for charity care.
Many physicians with hospital privileges also hold partial/full ownership in ACFs as extensions of their general practices and to offset lost revenue from charity care. The Medical Society of New Jersey opposes the ACF tax as an onerous and unfair burden on one profession to pay for a societal obligation.
Effects On Physicians
The imposition of a 3.5% tax on ACF gross revenues assumes that the physicians in the facilities do not deliver charity care services. In fact, dedicating ACF tax revenues to fund charity care would essentially extract money from physicians to pay for medical services they already delivered for free!
The New Jersey Hospital Association testified in favor of the bill before the Senate and Assembly Budget Committees. Physicians and medical staffs were quick to express their displeasure that initiation of the tax came from their partners in the delivery of health care. This wedge between physicians and hospitals comes at a time when physicians were attempting to rebuild relationships with legislators. As a result, on July 15 NJHA communicated to its members: “Although NJHA supports efforts to fairly share the charity care tax burden, we are concerned that the far-reaching implications of this tax may unfairly target physicians who already provide charity care in both the inpatient and outpatient environments.”
Trenton has not conducted a cost-benefit analysis to determine the impact of the ACF tax. Treasury has no appropriate data on ACF ownership and financial status.
Effects On Financial Stability
The imposition of a 3.5% tax on ACF gross receipts implies profitability of these facilities. Physician and medical fees are largely capped by insurance companies, meaning that any additional expenses/assessments cannot be passed along to patients. The ACF tax on gross revenues must be paid first, and disregards flat or declining managed care reimbursements, as well as rising costs for medical liability insurance, staff salaries, benefits, and other expenses.
Many of these facilities are heavily capitalized, partially due to the need to maintain latest technology for delivery of quality care. The 3.5% tax would wipe out the already thin profit margin at many ACFs, forcing them to close.
ACFs are already taxed as business entities. The physician owners are also taxed as private individuals. The ACF 3.5% tax represents a third tax on essentially the same services.
Effects On Patients
ACFs are more efficient than hospitals in delivering procedures. Most patients prefer ACFs because of the ability to obtain a timely appointment (including evening hours), convenience to home or work, and shorter time to perform procedures. ACFs can also be safer due to less exposure to bacteria and airborne contaminants.
Managed care plans reimburse hospitals at higher rates than those provided to ACFs for similar procedures. If ACFs close because they can no longer operate profitably, more procedures will have to be performed in hospitals, which drive up managed care expenses and insurance premiums for patients.
Governor McGreevey has already stated his desire to increase mammography rates in the fight against breast cancer. The vast majority of mammograms are performed and reviewed in ACF radiology centers. As fewer radiologists read mammograms due to liability risk factors and more ACF radiology centers close due to this tax, then women will find significantly reduced access to mammography services.
Plastic Surgery Tax — Position
Different insurance companies have varying coverage criteria for medical necessity/function. Physicians and insurers often disagree on medical necessity. The bill provides no guidance on whether the physician, patient, insurer, or even a state agency will ultimately determine medical necessity.
Some procedures are partially cosmetic and partially functional, which raises questions whether the tax will apply only to the portion that is cosmetic.
The tax on plastic surgery and cosmetic procedures has strong possibility of violating federal patient privacy (HIPAA) regulations if records have to be reviewed by state officials to determine medical necessity.
New Jersey has not conducted a cost-benefit analysis to determine the impact of the plastic surgery tax.
On occasions, insurance will cover all or part of something that all parties agreed was cosmetic. The law does not stipulate whether the insurer or patient would be liable for the tax.
The law is unclear on the definition of surgery, due to surgery-like modalities. Examples include endermologie for cellulite, injections, high-energy nonlaser light sources, radiofrequency, cryotherapy and ultrasound. Some procedures may be provided in salons, spas, and other nonmedical facilities. There are questions about LASIK or other refractive eye surgery (cosmetic/functional), tattooing (or removal), permanent eyeliner, and body piercing.
A patient may have a surgery performed by a NJ-licensed physician in his Philadelphia or NYC location, but get post-operative care in NJ. The situation could also be reversed. The law does not state whether tax would be owed.
Laboratories do not know whether their pre-op workup is performed for a cosmetic or medically necessary procedure. Some laboratories are out-of-state. The law does not state if any party would incur tax in these instances.
The law does not stipulate record-keeping obligations for physicians.
MORRIS COUNTY MEDICAL SOCIETY
ACTIONS OF THE 2004 HOUSE OF DELEGATES
REFERENCE COMMITTEE A
RES#
Ref Comm
Sponsor
Subject
2
A
Union
Authorship of Resolutions
NOT ADOPTED
RESOLVED that future resolutions submitted to the MSNJ House of Delegates for deliberation include the names of the authors as well as the county or specialty society that is sponsoring the resolution.
6
A
J. Taboada, MD
Protecting MSNJ’s Political Neutrality
NOT ADOPTED
RESOLVED that the Medical Society of New Jersey shall strive to avoid partisanship in developing and implementing its political strategy and will use its influence and resources to support/endorse only individual political candidates, whose ideas and proven record have been congruent with the goals of the Society.
7
A
Morris
Expert Witness Assessment and Disciplinary Program
ADOPTED
RESOLVED that the Medical Society of New Jersey work with the American Medical Association to encourage all specialty societies to implement an assessment and disciplinary system for physician testimony including possible expulsion from the specialty society for providing inappropriate or fraudulent testimony.
REFERENCE COMMITTEE B
1
B
Camden
CDS Licensing
ADOPTED
RESOLVED that the Medical Society of New Jersey petition the New Jersey Drug Control Unit and the other necessary agencies to abolish the current CDS licensing requirements that must be met in order to prescribe controlled substances in New Jersey .
3
B
Union
Third-Party Contracts Notification
AMENDED
RESOLVED that the Medical Society of New Jersey petition the Commissioner of the New Jersey Department of Banking and Insurance to require health insurance companies to notify physicians of additional third-party contracts when the physicians’ yearly contracts are renewed or within sixty days of signing these third-party administrative agreements, whichever comes first, and further require that physicians be given sixty days from the time of notification to opt out of the plan.
4
B
Union
Unilateral Changes in Insurer/Physician Contracts
REFERRED
Referred to the MSNJ Board of Trustees for appropriate action including, but not limited to, incorporation of a requirement, into ongoing managed care litigation, that all health care insurers, when contracting for physician services, refrain from making unilateral changes in the contract after it has been signed by the physician
RESOLVED that the Medical Society of New Jersey petition the legislature to require all health insurers, when contracting for physician services, to refrain from making unilateral changes in the contract after it has been signed by the physician; and be it further
RESOLVED that the legislature require, in the event that any contractual change is deemed essential, that the insurer be required to host a meeting of the entire physician network, in order to explain its reasoning, and that this meeting be held within thirty days of the time of notification to physicians in the network of the proposed change, and at least thirty days prior to any implementation of the proposed change.
9
B
Middlesex
Quality and Outcomes Initiative
SUBSTITUTE ADOPTION
RESOLVED that the Medical Society of New Jersey take the appropriate actions to encourage the adoption of patient-outcomes measures as the major criteria for evaluating the quality of health care; and be it further
RESOLVED that the Medical Society of New Jersey issue a position statement calling for quality and outcomes measures, not simply the number of procedures performed, to be the standard for evaluating the quality of health care rendered to patients in New Jersey .
REFERENCE COMMITTEE C
5
C
Union
Genetic Testing for Mucolipidosis IV
AMENDED
RESOLVED that the Medical Society of New Jersey petition its specialists in obstetrics and gynecology and the American College of Obstetrics and Gynecology to consider routine testing for mucolipidosis IV in the genetic testing panel for appropriate patients.
8
C
Middlesex
Scope of Practice
SUBSTITUTE
RESOLVED that the Medical Society of New Jersey continue to affirm its position of referring all scope of-practice issues to the Scope of Practice Subcommittee.
10
C
F. Primich, MD
Medical Education Options
ADOPTED
RESOLVED that the Medical Society of New Jersey Committee on Medical Education review the current MSNJ administration and organization policy compendium in respect to education (200.972 and 200.985); and be it further
RESOLVED that the Medical Society of New Jersey Committee on Medical Education submit to the Board of Trustees a list of options and recommendations as to how continuing medical education may be provided by MSNJ to its members now and in the future.
11
C
F. Primich, MD
Electronic Medical Education
ADOPTED
RESOLVED that the Medical Society of New Jersey Committee on Medical Education be directed to investigate the continuing medical education needs of MSNJ physicians, to investigate how these educational needs may be better met electronically, and to submit recommendations to the Board of Trustees.
12
C
F. Primich, MD
Medical Education
ADOPTED
RESOLVED that the Medical Society of New Jersey Committee on Medical Education investigate the feasibility of jointly sponsoring with the American Medical Association basic and advanced disaster life support courses for New Jersey physicians, and that it report their findings and recommendations to the Board of Trustees.
13
C
Essex
Investigate Access to Medical Justice Corporation
REFERRED to BOT
RESOLVED that the Medical Society of New Jersey investigate the possibility of an alliance with the Medical Justice Corporation to make it more well known and accessible to all MSNJ members.
14
C
Essex
Deregulation of the Sale of Hypodermic Needles
NOT ADOPTED
RESOLVED that the Medical Society of New Jersey seek to rescind the law requiring a prescription for the sale of hypodermic needles with the goal of decreasing the multi-person use of such needles and, thereby, reducing the incidence of HIV and hepatitis B and C transmission.
15
C
Union
Friend of the Court in Community Hospital Group, Inc v. More
TASK FORCE
RESOLVED that the Medical Society of New Jersey reverse the decision of the Executive Committee of the Board of Trustees and participate as “amicus curiae” in the case of The Community Hospital Group, Inc v. More, with the American Medical Association and the four component societies – Union, Essex, Somerset and Middlesex – as granted leave to do so by the Supreme Court of New Jersey. (Emergency resolution)*
* A special meeting of the Board of Trustees was held on Wednesday, April 21 in response to this resolution. The Board voted to participate, and the amicus brief was filed prior to the 3 rd session of the House.
Of note, the Bylaws will be amended so that the Committee on Political Action comes under standing committees of MSNJ, but the Chairman, Vice Chairman, Secretary and Treasurer shall be selected annually by the Committee (instead of being appointed by the President, as with other standing committees), subject to approval of the Board of Trustees.
The 2005 membership dues for the Medical Society of New Jersey will remain at $450 for active members.
2004-2005 Officers of MSNJ:
President -
President-Elect -
1 st Vice-President -
2 nd Vice-President -
Secretary -
Treasurer -
S. Manzoor Abidi, M.D.
Eileen Moynihan, M.D
Charles Moss, M.D.
Richard Scott, M.D.
Ruth Schultze, M.D.
Robert Rigolosi, M.D.
MSNJ’s Current Executive Director - Mr. Michael Kornett
Composition of Reference Committees
Reference Committee A – Michael Richardson, M.D., Chair; Leonard Corwin, M.D., Dean Dent, M.D., Louis Fares II, M.D., A. Ralph Kristeller, M.D., Bruce Monaghan, M.D. and Stephen Pilipshen, M.D.
Reference Committee B - Arnold Pallay, M.D., Chair; Harry Chaiken, M.D., Richard Ioffreda, M.D., Francis Lumia, M.D., Nancy Mueller, M.D. and Alan Pope, M.D. (Anthony Tarasenko, M.D. could not make the first meeting).
Reference Committee C – Eugene Lind, M.D., Chair; Leticia De Castro, M.D., Michael Graff, M.D., Roland Johnson, M.D., Joseph Pena, M.D., Frank Sparandero, M.D., and Anna Vander Schraaf, M.D.
If you have any questions about the Annual Meeting or what transpired there, please feel free to call the Society office at (973) 539-8888.
The MSNJ Annual Meeting is scheduled to be held again next year at the Borgata from Thursday, April 28 – Saturday, April 30, 2005 . The site for the first session (first Saturday in April) has yet to be determined.
MORRIS COUNTY MEDICAL SOCIETY GENERAL MEMBERSHIP MEETING
MARCH 31, 2004 WEDNESDAY
ASSET PROTECTION
“WHY MEDICAL LIABILITY INSURANCE IS NO LONGER ENOUGH”
Topics to be discussed:
State of the Insurance Market
Insolvencies, Start-Ups and the E&S Lines - Brian Kern
McLachlan Insurance Affiliates, Inc. Planning for a Safe Retirement:
Investing & Protecting Wealth - Jeanne Naglak The Healthcare Business Planning Group, LLC Estate & Wealth Planning: Transactional, Tax &
Business Law - Steve Holt Kern Augustine Conroy & Schoppmann, P.C.
CLARK MARTIN MARTIN•BONTEMPO•MATACERA•BARTLETT, INC.
MSNJ LOBBYIST
MARK T. OLESNICKY, M.D. PRESIDENT, MEDICAL SOCIETY OF NEW JERSEY
VINCENT A. MARESSA, ESQ. EXECUTIVE DIRECTOR, MEDICAL SOCIETY OF NEW JERSEY
ROCKAWAY RIVER COUNTRY CLUB
39 POCONO ROAD, DENVILLE
CASH BAR: 6:30 P.M.
DINNER: 7:15 P.M.
A portion of the cost of the dinner meeting is being underwritten by NJ Pure. Reservations are required. Cancellations must be received 72 hours prior to the dinner.
The Westwood Restaurant, North Avenue, Garwood GSP to exit 137 – Make right – 3 miles up on right across from Hess gas station
Thursday, October 2, 2003
Registration and Refreshments – 1:00 pm
Seminar – 1:30pm – 3:30pm
H.I.P.A.A. Privacy Rule enforced 4/15/03
– Are You Compliant?
H.I.P.A.A. Electronic Transactions & Code Sets begin 10/16/03
– Are You Ready?
H.I.P.A.A. Security Rule enforced 4/21/05
– What should you be doing now?
Program Goals:
Provide physicians with an update on the Privacy Rules
Guidelines for compliance with the Privacy Rule
Guidelines for obtaining information and working with vendors on the Transactions and Code Sets mandates
Provide physicians with an overview of the Security Rule.
Members/staff: $35.00
Non-Members/staff: $65.00
Please RSVP no later than Friday, September 26, 2003.
Forward RSVP and check (payable) to : Union County Medical Society 1164 Springfield Avenue, Mountainside, N.J. 07092 Questions? Call your county medical society :
The Medical Society of New Jersey has advised us that all New Jersey physicians will be receiving or have received legal notices for a class action suit against Independent Blue Cross. If you participate in the Independent Blue Cross settlement you cannot participate in any New Jersey settlements. You have until August 1, 2003 to file a letter to opt-out and/or file objections with the Pennsylvania court. If you do not exclude yourself from the Pennsylvania Class Actions Settlement (and if the settlement is approved by the Pennsylvania court) you may be automatically bound by that settlement, including the universal release of all claims.
The proposed Pennsylvania Class Actions Settlement includes:
Provides no relief from alleged wrongful practices relating to medical necessity, failure to pay claims in a timely manner, administrative burdens and contracting issues by AmeriHealth, but does seek to dismiss and release allclaims you may have against AmeriHealth or IBC.
Provides no significant relief for AmeriHealth’s claims payment processes, but does seek to dismiss and release all your payment claims, including claims based on alleged improper bundling, downcoding, failure to pay modifiers and other allegedly wrongful practices that affect all physicians.
Does notrequire AmeriHealth to make any cash payment to physicians in return for the universal release of all claims.
The relief comparison between the Aetna settlement and the proposed IBC/AmeriHealth settlement and the opt-out form can be downloaded from this site.
The Aetna settlement should serve as a benchmark for resolution of other lawsuits against managed care companies.
Should you have questions, please feel free to call the Society office.
AIP/atd
Request For Opt-Out of Gregg v. Independence Blue Cross, et al.;
Good v. Independence Blue Cross, et al.;
and/or Pennsylvania Orthopaedic v. Independence Blue Cross et al. Click here to download (PDF: 38K) Summary of the IBC/AmeriHealth/Keystone/QCC(“IBC”) Settlement Click here to download (PDF: 23K)
