Relationship Termination Checklist, MGMA 2/6/2019

Firing a patient is never a task we like to undertake. Unfortunately, sometimes it cannot be avoided. MGMA has provided a checklist for just such instances. POET Ink is building a file called “Provider-Patient Relationship. You can locate that file in “The Business End”.

Humana has the “POET red line” of the agreement. They received it in October 2019. Unfortunately, Humana’s new review system for contracts appears to have issues causing a delay. POET ‘s contact at Humana has been working to obtain the current status.

Stay tuned in….

Texas Insurance Commissioner Kent Sullivan is reminding insurers of their obligations under the state’s new baseball-style arbitration law to resolve disputes on many out-of-network medical bills.

In a letter Tuesday addressed to “the health plans of Texas,” Mr. Sullivan said the Texas Department of Insurance (TDI) will monitor how health plans implement Senate Bill 1264, passed during last year’s session of the Texas Legislature and now in effect.

“We expect you to be proactive to meet both the letter and spirit of SB 1264,” Mr. Sullivan said. “Review your policies and procedures and address potential issues quickly.”

The letter highlighted several of the plans’ responsibilities in relation to the law. The commissioner’s letter noted that:

• State law requires plans to cover medical screenings necessary to rule out the presence of an emergency condition;
• For emergency care, claim denials based on failure to meet the prudent-layperson standard must be based on the patient’s presenting symptoms, not on the later diagnosis code;
• Plans must meet required deadlines to promptly adjudicate clean claims; and
• Plans must be ready to provide accurate information about the new law, including required notices about mediation and arbitration, on explanations of benefits. The plans must be able to quickly respond to questions from policyholders and practitioners.

Mr. Sullivan’s letter noted that TDI has set up an SB 1264 page on its website, which includes a link to the state’s new portal for mediation and arbitration requests.

The Texas Medical Association has published a brief overview of the new law for physicians.

Last Updated On

January 09, 2020

Joey Berlin

Are you looking for a tool for conducting performance conversations with your employees?

Click “Differentiating Staff Worksheet” to review this sample worksheet from “Results that Last”.

Or look in the sub File “Human Resource” located in the “The Business End”.

Click link to get the latest version: https://community.poetllc.org/download/health-plan-representatives-updated-11-27-2019/

Click on the title to find great advice in the article, “7 Financial Reports Your Practice Needs to Run”.

As “POET Ink” grows, you will find more articles like this one under FILES in the folder called “The Business End”.

Special Edition of CMS MLN Connects November 12,2019

HICN Claims Reject

We are 50 days out from the end of the Medicare Beneficiary Identifier (MBI) transition period. Use the MBI on Medicare claims and other transactions now. Starting January 1, regardless of the date of service:

• We will reject claims submitted with Health Insurance Claim Numbers (HICNs) with a few exceptions
• We will reject all eligibility transactions submitted with HICNs

See the MLN Matters Article to learn how to get and use MBIs.