Guest guest Posted December 31, 2003 Report Share Posted December 31, 2003 The following story provides an excellent example of what can be accomplished when a group of professionals organize and formalize their efforts. This one of the major benefits of membership in professional associations. Are you a member of yours? Ken Mailly, PT Mailly & Inglett Consulting, LLC 68 Seneca Trail Wayne, NJ, 07470-4427 Tel. 973 692-0033 Fax 973 633-9557 www.NJPTAid.biz Bridging the Gap! You have been sent this message from khmailly@... as a courtesy of washingtonpost.com Docs Feel Hassled, Too In the constant war between insurers and doctors over payments for health care, physicians often complain that it's unnecessarily difficult to get reimbursed. Minimizing these snags is the goal of the " hassle factor log " program that has been operating in Virginia and other states for several years. In a recent 18-month period, said Mike Jurgensen, director of health policy for the Medical Society of Virginia, doctors across the state sent " well over 800 or 900 " hassle reports to his group. (Others are handled by the Medical Society of Northern Virginia.) The " hassle factor log " is a form that allows doctors to circle some problems with getting paid or getting care to patients: denied referrals, denied preauthorizations, patterns of late payment, lost claims -- even such seemingly mundane gripes as " telephone always busy " and " excessive telephone hold time. " Jurgensen said most complaints involve coding -- the system that helps determine whether the care was covered by the patient's policy and how much the doctor should receive for it. " The paperwork is astonishing, " Jurgensen said, and doctors often have to add to their expenses and subtract time from patient care to ensure that claims are not rejected due to improper coding. " There's an incredible amount of value to this [hassle factor] program, " said Syer, director of physician network management for Anthem, the Blue Cross Blue Shield affiliate for most of Virginia. He said he meets at least monthly with staffers at the medical society to address the 10 to 15 complaints received about Anthem in a typical month. " Things get dealt with and discussed in real time, " he said. " It's wonderful for patients because it provides a seamless delivery of health care. " " You can't fix things if you don't know they're broke, " said pediatrician Libby, who endorses the program as a way " to identify where the more disreputable . . . practices " of insurers are hampering payments to physicians. Libby said information like that collected on the Virginia logs helped expose " less than honorable patterns of paying claims " that recently led insurance giants Aetna and Cigna to settle federal class action suits filed by doctors. " I can't say that we've been logging many " hassle-factor complaints in his practice, said Libby, president of the Virginia Pediatric Group, which has offices in Fairfax and Herndon. " You can only deal with so many disputed payments at one time. " Some insurers' rules seem designed to " deter, demoralize or deny payment or service, " he said. " They do the same thing to us as [to] consumers. " Still, he said, with the logs and other methods of tracking abuses, " we are evolving a more effective way of correcting the problem " of unfair business practices. -- Tom Graham The System welcomes comments from patients, providers, insurers and others about the delivery of health care. While we cannot advocate on behalf of individuals, we are looking for examples of problems and solutions that may direct our reporting. Contact us by U.S. Mail at the address that appears on Page F2 or by e-mail at thesystem@.... Do not send original documents. Would you like to send this article to a friend? Go to http://www.washingtonpost.com/ac2/wp-dyn/admin/emailfriend?contentId=A23098- 2003Dec22 & sent=no & referrer=emailarticle Visit washingtonpost.com today for the latest in: News - http://www.washingtonpost.com/?referrer=emailarticle Politics - http://www.washingtonpost.com/wp-dyn/politics/?referrer=emailarticle Sports - http://www.washingtonpost.com/wp-dyn/sports/?referrer=emailarticle Entertainment - http://www.washingtonpost.com/wp-srv/eg/section/main/index.html?referrer=ema ilarticle Travel - http://www.washingtonpost.com/wp-dyn/travel/?referrer=emailarticle Technology - http://www.washingtonpost.com/wp-dyn/technology/?referrer=emailarticle Want the latest news in your inbox? Check out washingtonpost.com's e-mail newsletters: http://www.washingtonpost.com/ac2/wp-dyn?node=admin/email & referrer=emailarti cle © 2003 The Washington Post Company Quote Link to comment Share on other sites More sharing options...
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