In a year that began with talk about how national healthcare reform would impact the medical industry, state healthcare associations unveiled lobbying plans for the Mississippi Legislature with one goal in mind: protecting providers.

 

“In 2010, the Mississippi Hospital Association (MHA) will continue to promote hospital advocacy and will have a strong legislative presence at the state capitol,” said MHA CEO Sam W. Cameron. “This year’s major legislative focus will be to protect hospital reimbursements. We’ll continue to honor the 2009 Medicaid agreement made between MHA and the state executive branch. MHA will strongly oppose any attempt to breach this compromise, which provides important hospital protections in exchange for a provider assessment agreement over the next three years.”

 

Additional legislative priorities include shielding healthcare providers and their insurers from frivolous lawsuits, protecting the state’s trauma program, and strengthening the hospital workforce, said Cameron. 

 

“Collectively, these issues all impact hospital bottom lines and ultimately access to care,” he said. “With the promise of state budget reductions, our goal is to protect hospitals from harmful cuts, so they can continue to provide quality healthcare to patients. We understand our state will have a difficult year ahead, but hospitals cannot shoulder the burden.”

 

Insurance reform tops the legislative agenda for the Mississippi State Medical Association (MSMA), said Randy Easterling, MD, president of MSMA.

 

“For too long, Mississippi insurance companies have had the benefit of a narrow window in which physicians and their patients must file claims while enjoying an unlimited amount of time in which to ‘look back’ at paid claims to deny coverage for services,” Easterling explained. “This is why the MSMA is making the ‘Fair and Equitable Claims Process Act of 2010’ top priority for the upcoming legislative session.”

 

Easterling said it’s not uncommon for an insurance company to deny a claim years after the physician performs a procedure—and after the patient received the benefit of insurance coverage. In practice, the insurance company collects amounts it feels were overpaid to the doctor for a covered claim by making an adjustment to future payments. 

 

“This insurance practice is unfair and is bad news for more than doctors,” said Easterling. “It’s bad news for Mississippians. When the physician disagrees with the findings, the insurer is allowed to deduct the claim from the balance owed the physician. The appeals process can be convoluted and interferes with patient care. This practice could result in patients being held responsible for the repayment to the physician.”

 

Easterling said there’s no limitation on retrospective claim denials for health insurance claims paid to physicians for services rendered, adding that situations have arisen in recent years where physicians have been asked to repay a claim paid in error, sometimes years after the date of the claim.

 

“Once the insurance company ‘looks back’ and denies a previously covered claim, then both the patient and the doctor are left ‘holding the bag,’” he said. “The doctor must find the patient for payment if the adjustment was valid, while at the same time consider his or her rights to appeal an erroneous adjustment of the insurance company. Outdated or erroneous ‘look back’ adjustments can destroy relationships between physicians and insurers such that a physician will no longer accept certain insurance coverage. In that instance, patients are left without adequate access to physician care.”

 

Not all insurance companies operate in this manner, Easterling emphasized. 

 

“In fact, Blue Cross Blue Shield, the largest health insurer in Mississippi has endorsed this change in statute as a method to ensure good working relationships between physicians and health insurance providers,” he said. “Mississippians deserve a fair claims process.”

 

Alabama, Arizona, Colorado, Georgia, Maine, Missouri, Virginia and West Virginia all have 12-month limitations on retrospective health insurance claim denials. District of Columbia, Maryland and Texas have 6-month limitations on retrospective claim denials. Nearly half of the states in the United States have some form of limitation on this practice, said Easterling.