Recent settlement pays physicians

CAL/AAEM News Service calaaem_news at yahoo.com
Tue Dec 5 14:42:07 PST 2006


Recent settlement pays physicians 

Source: AMA eVoice (http://www.ama-assn.org/ama/pub/category/1827.html) 
Date: November 30, 2006 


Thanks to the tireless efforts of 20 state and county medical societies—and help from the
AMA—physicians nationwide were recently reimbursed more than $134 million as part of the
recent settlement of Multi-District Litigation (MDL) lawsuit involving WellPoint
(Anthem).

The MDL lawsuit also included Aetna, Cigna, Health Net and Humana, which have reached
separate settlements with the nation's physicians. Each settlement provides for greater
transparency in claims processing and payment practices by these health plans, including
prompt payment, retrospective refund request limits and the disclosure of fee schedules,
claim coding, and payment policies. The settling health plans also have agreed to comply
with most AMA CPT® codes, guidelines and conventions.

In addition, a compliance dispute in the settlement with Aetna has resulted in
retroactive payments of more than $12.5 million to physicians who resubmitted previously
denied claims to Aetna by a Nov. 11, 2006, deadline. These claims were connection to EKG
lead-service procedures that were billed with an emergency room evaluation and management
service.

Physicians are urged to stay vigilant in reviewing claim payments from these health plans
to ensure they are adhering to the settlement terms. In doing so, physicians and their
practice staffs should audit and track all payments from these health plans to make sure
they process and pay claims according to the settlement agreements. Physicians are
encouraged to file a claim appeal with a health plan that does not adhere to its
settlement provisions and record a compliance dispute if necessary.

Visit the Web site (http://www.ama-assn.org/ama/pub/category/12120.html) for detailed
information about the settlements and how they may affect your practice.



Cyrus Shahpar & Brian Potts 
Managing Editors, CAL/AAEM News Service
University of California, Irvine

The CAL/AAEM Archives are available at: http://maillists.uci.edu/mailman/public/calaaem/



 
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