February 2017 - Medical Association of the State of Alabama

Archive for February, 2017

Keep Calm & Carry On… Insight for Changes in Post-Election Uncertainty

Posted by admin on February 24, 2017

The year 2017 is going to be a year of change like we have not seen for a very long time. For some, it’s a welcomed change. For others, it’s not. The uncertainty of the details/extent of the changes makes planning difficult, if not impossible. As a business owner, you want to be prepared. So how do you get ready when faced with so much uncertainty? We think the best way is to stay the course — Keep Calm & Carry On. In other words, make decisions based on what you know and keep moving forward until you have more certainty.

President Trump promised a lot, especially in his first 100 days in office. The timeline below can help you stay calm and focused when the media begins reporting on the new President’s 100 Day Plan in the coming months.

January 3
Congress returns to Washington

January 20
Inauguration of President-elect Trump

January 23
IRS accepts e-filing of returns. This is the official start of 2017 Tax Season.

January 31
Due date for W-2s and 1099s; new deadline for this year for Forms 1094 and 1095s to employees

February 28
Due date for paper-filed Forms 1094-C and 1095-C to IRS

March 15
Due date for corporate business returns and new this year, partnership/LLC returns

March 31
Due date for e-filed Forms 1094-C and 1095-C to IRS

April 18
Due date for individual tax returns and first quarter estimated tax payment. Due date extended by Federal law through the weekend because of Washington, D.C. holiday on Friday, April 15.

April 30
End of President Trump’s first 100 days

Tax season officially started January 23. The first date e-filed returns will be accepted by the IRS marks the opening of tax season. However, get your tax information ready early and send to your tax preparer. This is going to be a very busy tax season with several new early due dates. As news comes from Washington during the first 100 days, your tax preparer will be bombarded with questions about how the changes impact taxes. President Trump’s tax reform changes will require additional planning by you and your tax preparer. The sooner you get your information to your tax preparer, the better.

Extension for tax return. Additional time may be needed to make decisions for accounting methods that defer income or accelerate deductions. An extension gives certain individuals additional time to make retirement plan contributions or recharacterize contributions to a Roth IRA.

New tax due dates for partnerships and LLCs. Historically, Partnerships and LLCs had a due date of April 15. Starting in 2017, this due date will be March 15. This shortened filing period means a compression of time for filing these returns on the same date as corporation returns. Schedule K-1s are required to be provided to the entity’s partners. LLPs and general partnerships must file their tax returns by March 15 or file extensions.

Affordable Care Act Repeal. As of the writing of this article, the Senate has voted to move ahead with the fiscal 2017 budget resolution that would include reconciliation instructions repealing Obamacare. Both the Senate and House hope to see the budget resolution adopted by January 20. Repeal could come quickly but changes, including ACA’s tax provisions, may not be in place until 2018 or later. Predictions from various members of Congress indicate no changes in 2017.

Mandated penalties. In 2016, ACA penalties increase to $695 per adult or 2.5 percent of income, with a family maximum of $2,085 per person. This is a significant increase from the 2015 penalty of $285 per adult or 2 percent of income above the filing limit. Even with repeal of Obamacare contemplated, this penalty will apply for 2016 tax returns.

Form 1094 and 1095 Reporting. These forms are prepared by employers to report the health insurance coverage offered by employers and accepted by employees. The sole purpose of the form is to assess penalties under the individual mandate penalty and the applicable large employer penalty. Until the law is repealed, employers should continue to follow the law regarding offering of qualified health insurance and file the returns required. Starting with the 2016 reporting year, employers with 50 or more full-time employees must file these forms. The due date of these forms changed in 2017 and are required to be furnished to employees by January 31. An automatic extension was provided by the IRS pushing this date to March 2, 2017. No other extension will be approved for furnishing these forms to employees. However, it’s important to remember the forms are required to be filed with the IRS by February 28 if filing on paper or March 31 if filing electronically. An extension of time can be obtained for filing with the IRS.

MACRA and MIPS. There is no indication that these requirements will be repealed along with the repeal of Obamacare. Opinion from leading experts is that these payment programs will stay in place. What you do in 2017 will determine your MIPS payment adjustment in 2019. It is very important that you not wait but get on board. Penalties start at 4 percent in 2019, 5 percent 2020, 7 percent 2021 and 9 percent in 2022 and forward. In the MACRA final rule, CMS added several ways for doctors to participate. They call the various options Pick Your Pace. With Pick Your Pace, hardly anyone will be penalized – but you must choose how much you will participate in MIPS in 2017 to benefit from the new options.

Delayed Refunds. The IRS expects to issue most refunds in less than 21 days. However, the PATH act of 2015 mandates the IRS hold refunds on tax returns claiming the Earned Income Tax Credit (EITC) or the Additional Child Tax Credit (ACTC) until February 15.

Article contributed by Patti G. Perdue, CPA.CITP, Jackson Thornton CPAs and Consultants. Jackson Thornton is a Bronze Partner with the Medical Association. The information in this article is not intended as tax or legal advice. Please consult your tax advisor for specific information regarding your individual situation.

Tags: manage, management, tax

Posted in: Management

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What is a Business Associate Agreement, and Why Should You Care?

Posted by admin on February 24, 2017

Health care providers are primarily concerned with the treatment and wellbeing of their patients. They gather and maintain tremendous amounts of protected health information^[1] (PHI) throughout the treatment process and commonly share that PHI with third parties who assist them with carrying out their work. This process of sharing PHI with a third party, non-workforce member, may create a business associate relationship. With the passage of the Health Information Technology for Economic and Clinical Health (“HITECH”) Act, medical practices are now required to identify business associate relationships and enter into Business Associate Agreements (BAAs). Failure to comply can led to heavy fines imposed by the Department of Health and Human Services.

A common challenge to compliance with this regulation is assessing whether an individual or entity falls within the definition of a Business Associate. To make this determination, medical practices are required to identify third parties who create, receive, maintain, or transmit PHI on behalf of the covered entity, including subcontractors. After documenting this process, an appropriate BAA must be executed to govern the relationship and to protect any PHI.

BAAs are contracts that dictate how a Business Associate must use, disclose and safeguard PHI, as well as the covered entity’s responsibilities to the Business Associate. At a minimum, the BAA must include the following provisions:

Establish the permitted and required uses and disclosures of PHI by the Business Associate;
Provide that the Business Associate will not use or further disclose the information other than as permitted or required by the contract or as required by law;
Require the Business Associate to implement appropriate safeguards to prevent unauthorized use or disclosure of the information, including implementing requirements of the HIPAA Security Rule with regard to electronic PHI;
Require the Business Associate to report to the covered entity any use or disclosure of the information not provided for by its contract, including incidents that constitute breaches of unsecured PHI;
Require the Business Associate to disclose PHI as specified in its contract to satisfy a covered entity’s obligation with respect to individuals’ requests for copies of their PHI, as well as make available PHI for amendments (and incorporate any amendments, if required) and accountings;
To the extent the Business Associate is to carry out a covered entity’s obligation under the Privacy Rule, require the Business Associate to comply with the requirements applicable to the obligation;
Require the Business Associate to make available to HHS its internal practices, books, and records relating to the use and disclosure of PHI received from, created, or received by the Business Associate on behalf of the covered entity for purposes of HHS determining the covered entity’s compliance with the HIPAA Privacy Rule;
At termination of the contract, if feasible, require the Business Associate to return or destroy all PHI received from, or created or received by the Business Associate on behalf of, the covered entity;
Require the Business Associate to ensure that any subcontractors it may engage on its behalf that will have access to PHI agree to the same restrictions and conditions that apply to the Business Associate with respect to such information; and
Authorize termination of the contract by the covered entity if the Business Associate violates a material term of the contract. Contracts between Business Associates and their subcontractors are subject to these same requirements.^[2] (DHHS, 2013)

Don’t Think This Applies to You? Think Again!

Business Associate relationships are voluminous in medical practices. More often than not, the modern medical practice will have multiple relationships that require a BAA. A few examples may include:

Tech support for an Electronic Health Record (EHR)
Data storage services
Repair services for copiers with hard drives
Data destruction
Cloud hosting
CPA firms that provide accounting services
Independent medical transcription services
Claims processing

Business Associates May Face Penalties as Well

In June of 2016, Catholic Health Services of the Archdiocese of Philadelphia settled with HHS for $650,000 when it was discovered that they may have violated the HIPAA Security Rule. CHCS provided management and information technology services to the nursing home company creating a Business Associate relationship. HHS alleged that the theft of a CHCS iPhone without password protection compromised the PHI of numerous nursing home residents.

“Business associates must implement the protections of the HIPAA Security Rule for the electronic protected health information they create, receive, maintain, or transmit from covered entities,” said U.S. Department of Health and Human Services Office for Civil Rights (OCR) Director Jocelyn Samuels. “This includes an enterprise-wide risk analysis and corresponding risk management plan, which are the cornerstones of the HIPAA Security Rule.”

Medical practices should be eager to institute BAAs where appropriate as they shift liability to the Business Associate for the inappropriate conduct of the Business Associate. Medical practices should not allow any relationship with contractors to exist without first analyzing the need for a Business Associate Agreement. If not, the medical practice could be required to perform breach notification or pay litigation costs for the actions of the Business Associate. It is paramount that your medical practice attain BAAs when necessary and have a system in place to track them. A proper tracking system will notify you when BAAs expire. Additionally, a proper tracking system will ensure that nothing slips through the cracks. Understand that if during an audit it is determined that your medical practice lacks the necessary BAAs, has expired BAAs or that they don’t have the required provisions, your entity could be fined for non-compliance with the HITECH Act.

It is important to note that there are a number of exceptions to the Business Associate Agreement requirement that may apply. Some exceptions include conduits, workforce members and janitors. To protect your practice, you should have a qualified professional perform a risk analysis to determine if a BAA is necessary and to fashion a BAA to the specific relationship.

Samarria Dunson, J.D., CHC, CHPC is attorney/principal of Dunson Group, LLC, a health care compliance consulting and law firm in Montgomery, Alabama. www.dunsongroup.com

^[1] PHI includes many common identifiers, like a patient’s name, date of birth, address, social security number, full-face photo or any other personal identifiers.

^[2] Department of Health and Human Services. (2013) Business Associate Agreement Contracts. Retrieved from https://www.hhs.gov/hipaa/for-professionals/covered-entities/sample-business-associate-agreement-provisions/index.html

Tags: agreement, associate, BAA, compliance, health, HITECH, PHI, privacy, protect

Posted in: Liability

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U.S. House Leaders Outline Plan to Repeal/Replace Obamacare

Posted by admin on February 17, 2017

Earlier this week, House Republican leaders presented outlines of a plan to replace the Affordable Care Act, leaning heavily on tax credits to finance individual insurance purchases and sharply reducing federal payments to the 31 states that have expanded Medicaid eligibility.

While GOP leaders opined that the plan would not “pull the rug out from anyone who received care under states’ Medicaid expansions,” the plan does appear to fundamentally remake Medicaid, which provides health care to more than 70 million Americans. Under the plan, Medicaid, an open-ended entitlement program designed to cover all health care needs, would be put on a budget.

The Affordable Care Act’s subsidies, which expand as incomes decline, giving poorer Americans more help, would be replaced by fixed tax credits to help people purchase insurance policies. The tax credits would increase with a person’s age, but would not vary with a person’s income. New incentives for consumers to establish savings accounts to pay medical expenses still assume that workers would have money at the end of a pay period to sock away.

The House Republican plan would also make it easier for consumers to buy health insurance from companies licensed in other states. Click here to read the plan.

The Medical Association has been vocal with concerns about changes to the health care system that could cause patients to lose access to their care and/or their insurance plans. Executive Director Mark Jackson and President-Elect Jerry Harrison, M.D., recently traveled to Washington, D.C., for a series of meetings with Alabama’s Congressional Delegation to voice the concerns of Alabama’s physicians in person.

“Dr. Harrison and I felt it was necessary to go to Washington and meet with our Congressional Delegation so they could hear our concerns about a repeal-and-replace of the current health care system,” Jackson said. “Anything that could possibly endanger our residents’ access to care needs to be given serious consideration before any action is taken. It was important for us to remind them that what they may see as dollars in a budget equate to patients in our treatment rooms here in Alabama.”

The Medical Association has released its 2017 State and Federal Legislative Agendas, developed with guidance from the House of Delegates and input from individual physician members. Click here to learn more about what issues the Medical Association supports and opposes.

Tags: ACA, obamacare, repeal, replace

Posted in: Advocacy

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Florida’s Physician “Gun Gag” Overturned on Appeal

Posted by admin on February 17, 2017

The full panel of the U.S. Court of Appeals for the 11th Circuit struck down the Florida law restricting physicians from speaking to patients and families about the risks of guns in the home. The case, Wollschlaeger v. Scott, was filed on June 6, 2011, challenged the Florida law, which could censor, fine and revoke the licenses of physicians if the Florida Board of Medicine determined whether the physician violated the law.

The American Medical Association along with several other major medical societies opposed the gun-gag law arguing it infringed on the First Amendment right of physicians to discuss gun safety, especially when patients have children who may happen across a loaded, unsecured firearm in the home. The law banned asking gun ownership questions except when deemed clinically necessary and forbade physicians from recording whether a patient owned a weapon in the medical chart claiming that the question was discriminating and harassing of gun owners.

“There was no evidence whatsoever before the Florida legislature that any doctors or medical professionals have taken away patients’ firearms or otherwise infringed on patients’ Second Amendment rights,” the court said, noting that lawmakers based their measure on six anecdotes about medical gun questions in a state with more than 18 million residents. “There is no actual conflict between the First Amendment rights of doctors and medical professionals and the Second Amendment rights of patients that justifies FOPA’s…restrictions on speech.”

Read the U.S. Court of Appeals for the 11th Circuit’s full decision here.

The continuation of the law would have prohibited a simple conversation in the physician’s office that can save lives. Research has shown that when physicians offer guidance on gun locks and safe storage, appropriate to a child’s specific age and development, it is more likely that families will take those necessary steps.

“Pediatricians routinely counsel families about safety issues, including firearm safety, as part of anticipatory guidance, in order to reduce risk of injury to children,” said Cathy Wood, M.D., FAAP, president of the Alabama Chapter of the American Academy of Pediatrics. “Florida’s ‘gun’ law was an assault on physicians’ right to counsel their patients. We are thankful for this court decision and the hard work of the pediatricians and other physicians in Florida that worked to protect this right, not just in Florida but hopefully for all states.”

Tags: advocacy, appeal, florida, gag, gun, law

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Be Heart Healthy in February!

Posted by admin on February 14, 2017

According to the Centers for Disease Control and Prevention (CDC), one out of every four female deaths in 2013 was due to cardiovascular disease, yet only 54 percent of women recognize that heart disease is the leading cause of death among them.

“Having uncontrolled blood pressure, which has no symptoms, can result in cardiovascular disease, also known as heart disease, and lead to catastrophic health incidents such as a heart attack or stroke,” said State Health Officer Dr. Thomas Miller, who added that almost two-thirds
of women who die suddenly of heart disease had no previous symptoms.

Cardiovascular disease is the leading cause of death both in Alabama and the country at large. In 2014, more than 12,400 Alabamians died because of heart disease. According to data from 2015, more than 40 percent of Alabamians suffer from hypertension, or high blood pressure.

Heart disease is not only a growing health concern, it also greatly impacts the economy. According to a study conducted by Cornell University, the combined direct and indirect cost of cardiovascular disease in the United States was estimated to be $444 billion in 2010. The CDC stated that cardiovascular disease accounted for $1 out of every $6 spent on healthcare during that year.

“We aren’t just looking to prevent premature deaths, we want to help Alabamians live healthier, more prosperous lives,” said Dr. Miller.

For information regarding cardiovascular health, go to adph.org/CVH, facebook.com/ALCardioHealth, or twitter.com/ALCardioHealth.

Tags: adph, cardio, disease, heart

Posted in: Health

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Physicians Call for Prior Authorization Reform

Posted by admin on February 10, 2017

The Medical Association has joined a coalition of physicians’ groups, hospitals, medical groups, pharmacists and other health care organizations to urge health plans, benefit managers and other groups to reform prior authorization requirements imposed on medical tests, procedures, devices and medications. The coalition is responding to what has been deemed unreasonable hurdles for patients seeking care and argue that requiring pre-approval by insurers before certain treatments can delay or interrupt medical services, divert significant resources from patient care and complicate medical decisions.

Given the potential barriers prior authorizations can pose to patient-centered care, the coalition is urging an industry-wide reassessment of these programs to align with a newly created set of 21 principles. Prior authorization programs could be improved by applying the principles’ common-sense concepts grouped in five broad categories:

Clinical validity,
Continuity of care,
Transparency and fairness,
Timely access and administrative efficiency, and
Alternatives and exemptions.

“Strict or bureaucratic oversight programs for drug or medical treatments have delayed access to necessary care, wasted limited health care resources and antagonized patients and physicians alike,” said AMA President Andrew W. Gurman, M.D. “The AMA joins the other coalition organizations in urging health insurers and others to apply the reform principles and streamline requirements, lengthy assessments and inconsistent rules in current prior authorization programs.”

The data entry and administrative tasks associated with prior authorization reduce time available for patients. According to a new AMA survey, every week a medical practice completes an average of 37 prior authorization requirements per physician, which takes a physician and their staff an average of 16 hours, or the equivalent of two business days, to process.

The AMA survey illustrates that physician concerns with the undue burdens of preauthorizing medical care have reached a critical level. Highlights from the AMA survey include:

Seventy-five percent of surveyed physicians described prior authorization burdens as high or extremely high.
More than a third of surveyed physicians reported having staff who work exclusively on prior authorization.
Nearly 60 percent of surveyed physicians reported that their practices wait, on average, at least one business day for prior authorization decisions—and more than 25 percent of physicians said they wait 3 business days or longer.
Nearly 90 percent of surveyed physicians reported that prior authorization sometimes, often, or always delays access to care.

For specialists like Montgomery oncologist Stephen Davidson, M.D., at the Montgomery Cancer Center, issues with PAs can begin when the patient checks in for the first appointment.

“There are days when I have patients who are scheduled to see me as new patients. They are at the front door. They have something that brought them here that has also emotionally disturbed them greatly. If their PA is not in place, they can’t so much as walk down the hall to see me,” Dr. Davidson said. “This happens…constantly.”

Dr. Davidson and his team see an average of 60 patients each day. During that time, he and his treatment team are also securing PAs for patients for imaging and medicine. Rarely are cancer medications generic, making them very expensive, so PAs must be secured for monthly refills, taking even more time away from patient care.

“It has become a tremendous burden,” Dr. Davidson said. “Somewhere along the way the burden of proof shifted from the insurance company to the physician. Traditionally there has been a respect for a physician’s judgment and decision making on behalf of the patient. That’s a very special and sacred relationship. Now, because of a number of factors, primarily economic, we have insurance companies that don’t respect the physician’s authority in the decision-making process.”

Read more about what Dr. Davidson and Lee Carter, M.D., of Autaugaville had to say about PAs in our article from Alabama Medicine magazine, Between Doctors & Physicians: Prior Authorizations.

Tags: author, authorization, prior

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IRS: Watch Out for Dangerous W-2 Phishing Scam

Posted by admin on February 10, 2017

WASHINGTON — The Internal Revenue Service, state tax agencies and the tax industry issued an urgent alert today to all employers that the Form W-2 email phishing scam has evolved beyond the corporate world and is spreading to other sectors, including school districts, tribal organizations and nonprofits.

In a related development, the W-2 scammers are coupling their efforts to steal employee W-2 information with an older scheme on wire transfers that is victimizing some organizations twice.

“This is one of the most dangerous email phishing scams we’ve seen in a long time. It can result in the large-scale theft of sensitive data that criminals can use to commit various crimes, including filing fraudulent tax returns. We need everyone’s help to turn the tide against this scheme,’’ said IRS Commissioner John Koskinen.

When employers report W-2 thefts immediately to the IRS, the agency can take steps to help protect employees from tax-related identity theft. The IRS, state tax agencies and the tax industry, working together as the Security Summit, have enacted numerous safeguards in 2016 and 2017 to identify fraudulent returns filed through scams like this. As the Summit partners make progress, cybercriminals need more data to mimic real tax returns.

Here’s how the scam works: Cybercriminals use various spoofing techniques to disguise an email to make it appear as if it is from an organization executive. The email is sent to an employee in the payroll or human resources departments, requesting a list of all employees and their Forms W-2. This scam is sometimes referred to as business email compromise (BEC) or business email spoofing (BES).

The Security Summit partners urge all employers to be vigilant. The W-2 scam, which first appeared last year, is circulating earlier in the tax season and to a broader cross-section of organizations, including school districts, tribal casinos, chain restaurants, temporary staffing agencies, healthcare and shipping and freight. Those businesses that received the scam email last year also are reportedly receiving it again this year.

Security Summit partners warned of this scam’s reappearance last week but have seen an upswing in reports in recent days.

New Twist to W-2 Scam: Companies Also Being Asked to Wire Money

In the latest twist, the cybercriminal follows up with an “executive” email to the payroll or comptroller and asks that a wire transfer also be made to a certain account. Although not tax related, the wire transfer scam is being coupled with the W-2 scam email, and some companies have lost both employees’ W-2s and thousands of dollars due to wire transfers.

The IRS, states and tax industry urge all employers to share information with their payroll, finance and human resources employees about this W-2 and wire transfer scam. Employers should consider creating an internal policy, if one is lacking, on the distribution of employee W-2 information and conducting wire transfers.

Steps Employers Can Take If They See the W-2 Scam

Organizations receiving a W-2 scam email should forward it to phishing@irs.gov and place “W2 Scam” in the subject line. Organizations that receive the scams or fall victim to them should file a complaint with the Internet Crime Complaint Center (IC3) operated by the Federal Bureau of Investigation. Employees whose Forms W-2 have been stolen should review the recommended actions by the Federal Trade Commission at www.identitytheft.gov or the IRS at www.irs.gov/identitytheft. Employees should file a Form 14039, Identity Theft Affidavit, if the employee’s own tax return rejects because of a duplicate Social Security number or if instructed to do so by the IRS.

The W-2 scam is just one of several new variations that have appeared in the past year that focus on the large-scale thefts of sensitive tax information from tax preparers, businesses and payroll companies. Individual taxpayers also can be targets of phishing scams, but cybercriminals seem to have evolved their tactics to focus on mass data thefts.

Be Safe Online

In addition to avoiding email scams during the tax season, taxpayers and tax preparers should be leery of using search engines to find technical help with taxes or tax software. Selecting the wrong “tech support” link could lead to a loss of data or an infected computer. Also, software “tech support” will not call users randomly. This is a scam.

Taxpayers searching for a paid tax professional for tax help can use the IRS Choosing a Tax Professional lookup tool or if taxpayers need free help can review the Free Tax Return Preparation Programs. Taxpayers searching for tax software can use Free File, which offers 12 brand-name products for free, at www.irs.gov/freefile. Taxpayer or tax preparers looking for tech support for their software products should go directly to the provider’s web page.

Tax professionals also should beware of ongoing scams related to IRS e-Services. Thieves are trying to use IRS efforts to make e-Services more secure to send emails asking e-Services users to update their accounts. Their objective is to steal e-Services users’ credentials to access these important services.

Tags: IRS, phishing, scam

Posted in: Legal Watch

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Celebrating Black History Month: Meet Alabama’s First African-American Physician

Posted by admin on February 10, 2017

Dr. Cornelius Nathanial Dorsett was born a slave sometime between 1852 and 1859 in Davidson County, NC. He was separated from his mother, when she was sold, when he was just 2 months old. He was also the first African-American to pass the Alabama State Medical Examination.

Once slavery ended, Dr. Dorsett attended Hampton Institute in Virginia and graduated in 1878. He went to the Medical College in Syracuse, NY, but failed to graduate because of poor health and lack of funds. After his health improved, he attempted to enter the Medical College of New York City but was denied admission because of his race. Subsequently, the University of Buffalo in New York accepted him, and he was able to graduate from there in 1882. This was accomplished only after one of his former employers agreed to pay his tuition.

After completing medical school, he worked in an insane asylum in Detroit, MI. There he was able to raise enough money to allow him to move to Montgomery, Ala. in 1884.

Dr. Dorsett was the first African-American to pass the Alabama state medical examination. In the 1800s that test was a six-day written and oral test. Learning that a black person had accomplished this feat, many white physicians said they were astonished he “had enough brains to write a better examination than many whites.” Booker T. Washington wrote of Dr. Dorsett in his memoirs and stated: “Many white physicians welcomed him as a colleague in arms.” Some also offered their services to help him start his private practice in Montgomery.

Dr. Dorsett helped organize the National Medical Association, which continues today as the largest organization for African-American physicians. In addition to his successful medical practice, he owned an office building, operated a drug store, and established the first hospital for African-Americans in Alabama. Dr. Dorsett died in Montgomery in 1897.

Contributed by Jefferson Underwood III, M.D., F.A.C.P., President of the Medical Association’s Board of Censors

Tags: African-American, black, february, history

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Between Doctors & Patients: Prior Authorizations

Posted by admin on February 9, 2017

Physicians face various regulatory and administrative hurdles in a day, but few are as frustrating, or as expensive, as prior authorizations, or PAs. Commercial insurance companies, Medicaid, Medicare and other third-party interests use PAs to reduce costs. This leaves physicians and their staff wondering when the practice of medicine became more about the dollars and cents than what makes sense for patients?

“The system is there for a reason, and we understand that,” Lee Carter, M.D., said. Dr. Carter practices family medicine in Autaugaville, a rural community in Autauga County with a population of less than 1,000. “But, it can be very frustrating, not only to the physicians and our staff, but to the patients who have to wait for their medications.

According to a 2012 Kaiser Family Foundation estimate of about 835,000 practicing physicians, 868.4 million hours are spent annually on PAs. A 2011 study by Health Affairs estimated physicians spend an average of $83,000 annually interacting with insurance plans to secure prescribed treatments, procedures or therapies for patients needing prior approvals.

In Dr. Carter’s practice, he and his partner treat a variety of issues in their patients ranging from colds and flu to more chronic conditions like diabetes and ADHD as well as procedures involving MRIs and X-rays. Each physician has a staff member devoted to prescription renewals and obtaining PAs. Still, keeping up with the demands of charting and following the rules for the payers for PAs can be daunting.

“When a patient comes in that you’ve been treating for months or even years, and you know there’s something new out there that will work better for that situation, you want to find what works best for your patient. Most of the time, that medication is going to be a generic, which is covered by most insurance plans because it’s cheaper for them and it’s cheaper for your patient. But, what if that med doesn’t work for your patient? What if your patient is allergic to that med or another med? You have to find a balance. That’s the key,” Dr. Carter said.

For specialists like oncologist Stephen Davidson, M.D., at the Montgomery Cancer Center, issues with PAs can begin when the patient checks in for the first appointment.

According to Dr. Davidson, the burden of proof isn’t specific to oncology. Physicians fighting to get the best treatment regimens for their patients have all experienced the same process with payers in trying to secure prior authorizations, and perhaps the most time consuming and frustrating part of the system is the peer-to-peer conversations in which physicians advocate on behalf of their patients with the payers.

“The problem is that in oncology specifically, and with medicine in general, it’s not black and white,” Dr. Davidson said. “There is a lot of leeway. There is a lot of individualism for treatment plans for patients, so problems start to happen when major insurance companies hire third-party companies to come in and do nothing but screen all your imaging and either green-light or red-light your treatment plans.”

For both of these physicians, the delay caused by the waiting game can put the patient’s health in the balance. Dr. Carter often encourages his patients to engage in the appeals process with their health insurance plan by calling the numbers listed on their insurance cards. Dr. Davidson has enlisted the assistance of his patients as well.

“When the patient calls the insurance company and gets into the conversation, it shows just how much the patient is concerned about the situation,” Dr. Carter said. “It absolutely helps for the patient to get involved and review with their insurance company what treatments have already been tried, and why they didn’t work. The patient is looking for a solution just as much as the physician.”

Fortunately, in Dr. Carter’s experience, a reply for a PA request usually takes 24 to 48 hours. Things get more complicated, however, for specialists like Dr. Davidson.

“There is more bureaucratic pressure placed on the medical practice and more delay and anxiety on the part of the patient (when dealing with PAs),” Dr. Davidson said. “We are a larger facility, and we have five full-time employees that deal with nothing but authorizations. It’s still a burden for us. I don’t know how smaller practices deal with it. Essentially your first swipe at the PA is a website, so someone is taking a patient’s medical record and actually typing it into an online form to see if it will fit exactly cookie-cutter into this form. The patient is not cookie cutter. There is no way to cookie cutter every patient, no matter what the specialty or situation.”

Some states have pursued legislative solutions to PA problems, but with little success, as insurance companies and their lobbyists come out in droves in opposition. As non-physicians increasingly attempt to dictate health care delivery, the Medical Association is committed to finding solutions to PAs and other related issues so that we keep health care decisions between doctors and patients.

Tags: author, authorization, Insurance, PA, prior

Posted in: Advocacy

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Federal Regulations Stipulate Physicians Need a Translator…

Posted by admin on February 9, 2017

And, we have a solution. The Medical Association has partnered with CTS Language Link to deliver multilingual interpretation and translation communication services to meet the growing needs of your practice. As of Oct. 16, 2016, physicians receiving financial assistance from HHS, except solely Medicare Part B, must provide language assistance for persons with limited English proficiency (Section 1557 of the Affordable Care Act – Nondiscrimination Provisions).

Medical Association members will receive a 20% discount from CTS LanguageLink from standard rates. With over-the-phone interpretation services, physicians have access to more than 240+ languages, and the call center is available 24/7/365 with no monthly minimums, no monthly fees, and no volume requirements. The rate per minute is $1.40 for all 240 languages and dialects for Medical Association members. (Standard rates are $1.75 per min and $100 set-up fee.)

CTS LanguageLink provides document translation for 110+ languages. Document translation quotes are provided at no charge. Physicians can email documents to be translated and receive a quote within 24 hours.

Once physician members sign up for CTS LanguageLink, it takes about 1-2 business days to start utilizing services. CTS LanguageLink has established and extensive language resources, utilizing only native-speaking, professional translators and interpreters, uniquely qualified for your project needs. CTS LanguageLink is a recognized leader in providing the most trusted multilingual communication services to a wide range of corporate and government clients since 1991.